In order to receive a full proposal for the expected cost for your Work Comp coverage, we need the following information:
The Face Page (or Declaration page) from your existing Workers' Compensation policy, showing the payroll broken out by class code, employer liability limits, and experience modification factor.
Any additional endorsements or any discounts that are currently part of your policy.
Coverage may be elected on renewal of your current Workers' Compensation policy or at any time the company decides. The application for coverage form must be received one week prior to effective date of insurance coverage. Our policies run calendar year for the ease of audit.
You may send the information to our office via email firstname.lastname@example.org or fax (704) 594-6290.