Understanding ACORD Forms 130 and 4 for Workers' Comp Insurance

3 min. readlast update: 10.18.2023

Hello, business owners! Are you trying to navigate the world of workers' compensation insurance and looking for some guidance on ACORD forms? You've come to the right place! In this article, we'll provide an overview of ACORD Forms 130 and 4, so you know exactly when and how to use them.

ACORD Forms 101

ACORD (Association for Cooperative Operations Research and Development) is a nonprofit organization that develops standardized forms for the insurance industry. These forms help streamline communication and transactions between policyholders, agents, and insurers. When it comes to workers' compensation insurance, two of the most commonly used forms are ACORD 130 and ACORD 4.

ACORD Form 130: Workers' Compensation Application

ACORD Form 130 is the standard application form for workers' compensation insurance. This form is used when businesses apply for coverage or request changes to their existing policies. It gathers essential information about your business, such as:

  1. General details about your company (name, address, FEIN, etc.)
  2. Description of your operations and locations
  3. Employee classifications and estimated annual payroll
  4. Details about your existing workers' compensation insurance (if any)
  5. Loss history and information on any pending claims

To complete ACORD Form 130, work closely with your insurance agent, who can help you accurately fill out the form and submit it to the appropriate insurance carrier. 

You can download a copy of ACORD Form 130 here.

ACORD Form 4: Workers' Compensation – First Report of Injury or Illness

ACORD Form 4 is used to report work-related injuries or illnesses to your workers' compensation insurance carrier. Timely and accurate reporting is crucial for processing claims and ensuring that your employees receive the necessary medical care and benefits. When an employee suffers a work-related injury or illness, you should complete and submit ACORD Form 4 as soon as possible.

This form collects information such as:

  1. Employee details (name, address, Social Security number, etc.)
  2. Employer information (name, address, policy number, etc.)
  3. Details of the injury or illness (type, cause, date, and location)
  4. Description of the incident and any witnesses
  5. Treatment received and medical provider information

As an employer, it's essential to maintain open communication with your injured employee and your insurance carrier throughout the claims process. Your insurance agent can also provide valuable guidance and support in managing workers' compensation claims. 

You can download a copy of ACORD Form 4 here.

Final Thoughts

Understanding and properly utilizing ACORD Forms 130 and 4 can make the workers' compensation insurance process smoother for you and your employees. Collaborate with your insurance agent to ensure that you're completing and submitting these forms accurately and in a timely manner. This will help you protect your business and provide essential support to your employees when they need it most.

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