Educational Series

Assigned Risk Application Processing
approx. duration: 2 hours
Instructor(s): Lauri Burns, Robin Eleson, Brenda McCurdy
Frequency: semi-annually

I. Applications

A. Acord 130
B. Acord 133
C. www.acord.com or 845-620-1700 or 800-444-3341

II. Thresholds

A. Applicant’s name & address
B. General information (legal status, federal ID# & locations)
C. Effective date
D. States
E. Rating information (classification codes, rates and # of employees)
F. Owners/officers (signatures)
G. Description of operations
H. Three insurance company refusals

III. Rules & Guidelines

A. All fields on applications must be completed in full.
B. Coverage bound 24 hrs. after the US postmark date. No meter date.
C. Applicant’s signature.

IV. Premium Payment

A. Check made payable to ICRB
B. Experience modifications, 25% surcharge, limits of liability, LSRP, expense constant & terrorism surcharge.
C. Deposit
D. Mail to: NCCI
E. Producers fee %
V. Cancellations
A. Rules

VI. RMAP’s - Online Applications

A. www.ncci.com or 1-800-NCCI-123
B. Residual market
C. No charge, free service
D. Payment by electronic check or credit cardVII. Additional Forms
A. Farms or domestic labor (Form 46)
B. Sole proprietors, partners, members & LLC (State Form 36097)
C. Temporary Labor Contractor
D. Employee leasing & PEO’s
E. Labor contractor
F. Client information
G. Workers Compensation State Directory

Notes:
Instructors are the individuals who process all Assigned Risk applications for the State of Indiana. Lecture will be presented in a Power Point format and supplemented by real world examples and case study exercise. “Helpful hints” to accelerate the acceptance of applications will be shared throughout.