ACORD 130: Workers’ Compensation Application
ACORD 130 is used to apply for or renew a workers’ compensation insurance policy, covering employee wage and classification details.
How to fill out ACORD 130
What your insurance producer enters in each section, and why it matters.
Applicant Information
Enter the legal business name, FEIN, and entity type.
Rating Information
Lists each state of operation and the governing classification codes.
Class Code Information
States employee job classifications, estimated annual payroll, and number of employees per class.
Prior Carrier Information
Documents the previous workers’ comp carrier and loss history, if applicable.
The mistake that actually matters
Misclassifying employees under the wrong class code is a frequent, costly error that can affect premium calculations and audits.
Where to submit this form
Submitted to the underwriter as part of a new or renewal workers’ compensation application.
Frequently asked questions
Who needs to file ACORD 130?
Any employer applying for or renewing workers’ compensation coverage.
How is payroll estimated?
Based on projected annual payroll for the coming policy period, later reconciled in an audit.
Daniel Whitfield
Daniel researches and writes about ACORD insurance forms and commercial insurance documentation, helping agents, brokers, and business owners understand what each form requires and how to complete it correctly.
This site is not affiliated with, endorsed by, or sponsored by ACORD LLC. ACORD® is a registered trademark of ACORD Corporation. This guide is for informational purposes only and is not legal or insurance advice.