ACORD 130 — Workers Compensation Application

Edition 2026/01 · PDF format

Standard application for workers compensation and employers liability coverage. Collects employee classification codes, payroll information, loss history, and workplace safety details.

What is ACORD 130?

ACORD 130 (Workers Compensation Application) is the application form for workers compensation and employers liability coverage. It captures employee classifications by NCCI (or state bureau) class code, payroll for each class, the experience modification factor, and prior loss history.

WC pricing is highly formulaic: payroll × class code rate × experience mod = manual premium. The accuracy of the data on ACORD 130 directly drives the premium and the carrier's underwriting decision.

Who needs this form

Every business with employees in any of the 49 states (and D.C.) where workers compensation is mandatory. Texas allows non-subscription, but most employers still buy WC coverage.

When to use it

Submit at every new submission, renewal, and material change. Mid-term changes (adding employees, changing operations, opening new locations) typically require an updated ACORD 130 or endorsement.

Key Fields on ACORD 130

The information the form captures, in the order it typically appears:

Applicant name, FEIN, mailing address
Locations covered with state
Class codes and payroll for each class
Number of employees by class
Experience modification factor (e-mod) and effective date
Officer information (included or excluded)
5-year loss history by accident year
Workplace safety program details, OSHA recordables
Prior carrier and reason for shopping
Estimated annual premium

Common Mistakes

Recurring errors that delay processing or expose brokers to E&O claims:

Wrong class code

Class codes drive rates. Using an incorrect code (lower-rated than actual operations) leads to audit chargebacks and possible coverage disputes.

Underreporting payroll

Carriers audit payroll annually. Underreporting at submission triggers large premium adjustments at audit. Use accurate, projected payroll.

Forgetting to update e-mod

E-mods change annually. Use the current e-mod from NCCI or the relevant state bureau, not last year's.

Excluding owners/officers without proper paperwork

Owner exclusions vary by state. Some require a separate exclusion form. Check state requirements before excluding.

Frequently Asked Questions

What is the experience modification factor (e-mod)?

The e-mod is a multiplier (typically 0.85–1.50) that adjusts manual premium based on a business's three-year loss history. An e-mod above 1.0 means premium is higher than manual; below 1.0 means a credit.

Are owners required to be on workers comp?

Depends on entity type and state. Sole proprietors and partners are generally exempt. LLC members and corporate officers can usually be included or excluded by election. Each state has specific rules.

What's the difference between Part A and Part B coverage?

Part A (Workers Compensation) pays statutory benefits to injured workers. Part B (Employers Liability) defends against lawsuits by injured workers seeking damages beyond statutory benefits. Both are bundled in standard WC policies.

Related ACORD Forms

ACORD 125