What does the ACORD 130 workers compensation application ask for?
The ACORD 130 is the workers compensation application. It asks who the employer is (legal entity, FEIN, NCCI risk ID, years in business), where employees work (every location, by state), and then the rating information: for each state and location, the class codes that describe the work, the number of employees in each, and the estimated annual payroll per code, plus whether officers and owners are included or excluded. It asks about prior coverage and five years of claims, and a page of underwriting questions covers the hazards a comp carrier cares about, from work at heights to group transportation to employees who travel out of state.
Workers compensation, explained.
What it covers, who must carry it, and what your payroll makes it cost.
Workers compensation, explainedSend us what you have. We’ll tell you if it’s right.
Your current policy paperwork, a renewal notice, or nothing at all. A licensed agent reads it and replies the same business day.
The detail
The ACORD 130 opens with applicant information including legal business name, mailing address, legal entity type, years in business, federal employer ID number and NCCI risk ID number, and the rating information must be entered by state and location, with multiple named insureds shown by entity.
Workers compensation is priced on payroll and risk classification: each job duty is assigned a class code with its own rate, and the rating section of the ACORD 130 carries the class codes, employee counts and estimated annual payroll that the premium is calculated from.
First Connect, "How to Complete the ACORD 130: Step-by-Step Guide for Agents"
The ACORD 130 field map includes an individuals section for owners, partners and officers with their titles, ownership percentage and whether each is included in or excluded from coverage, and an unemployment number and prior coverage details.
Vertafore Help, "Form Field Map: Workers Compensation Application (ACORD 130)"
The loss history section of the 130 documents prior workers compensation claims with injury dates, descriptions and financial outcomes, which insurers use to predict the likelihood of future injuries.
Total CSR, "ACORD 130 Workers Compensation Application: Key Steps & Tips"
In this agency's question bank, annual payroll is the single fact underwriters chased most often after a comp submission went out, and on the health-care sector every account it was chased on was lost.
Boring Insurance question bank, 237 applications read, measured 2026-09-25
What this means for you
- Payroll by class, not total payroll.An office manager and a roofer at the same company are two codes with rates that differ tenfold. Split the payroll by what people actually do and the premium is right; lump it and the audit does the splitting for you, at the carrier's pace.
- Decide about the owners before the form.Most states let owners and officers exclude themselves, which lowers the premium and removes their coverage. Some general contractors and states will not accept an excluded owner on site. Know which you need.
- Out-of-state work needs saying.Comp is state by state. An employee who works a job across the state line, or who lives in another state, changes which policy responds and whether it responds at all.
Go deeper on any of these
Related questions
- What is the NCCI risk ID on the ACORD 130?
A number the National Council on Compensation Insurance assigns to an employer with a claims history, used to track experience across carriers and to calculate the experience modifier. A new business does not have one yet, and the box stays blank without harm. An established employer can find it on a prior policy or experience rating worksheet.
- Do I need an ACORD 130 for a state fund policy?
State funds accept the 130, and several publish their own instructions for it. The information is the same wherever the coverage is placed: payroll by class by state, the owners' status, and the claims history.
- How accurate does the payroll estimate need to be?
Honest rather than exact. Workers compensation is audited at the end of every term, and the premium is trued up to actual payroll. An estimate from your payroll service for the coming year is the right answer; a number chosen to lower the deposit is a bill later.
Need this handled?
Reading about it and having it handled are different jobs, and the second one is ours. We place the accounts other brokers decline — claims history, a cancellation, an unusual operation, a business nobody wants to underwrite twice — and we will tell you when the policy you already have is the right one. Tell us the situation and a licensed human replies the same business day.
Written by the licensed brokers at Boring Insurance. Last updated 2026-09-25. See all guides.