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Workers Comp Application

Workers Comp application (ACORD 130) to Excel — class codes, payroll, prior losses

Drop an ACORD 130 Workers Comp Application and get experience modifier, state coverage, class codes with payroll and rate, and the prior loss history.

5 free extractions on every account. No credit card required.

Class codes and payrolls per state — ready to paste into NCCI rating sheets.
Prior losses extracted with date, description, and incurred amount.
Captures officer/owner inclusion/exclusion election and waiver of subrogation.

Frequently asked

Does it support state-specific WC supplements?
We capture the base ACORD 130. State-specific WC supplements (NY, FL, TX) are on the roadmap.

Pricing starts at $49/month

100 documents/month on Starter, 500 on Pro, 2,000 on Agency. Self-serve, cancel anytime.

See pricing
Workers Comp application (ACORD 130) to Excel — class codes, payroll, prior losses — InsurancePDFtoExcel