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WORKERS' COMPENSATION INSURANCE APPLICATION SUBMISSION REQUIREMENTS

AMERISAFE provides workers' compensation insurance in high hazard industries many other providers avoid

AMERISAFE works in high hazard industries many other providers avoid. Our firsthand experience in these industries allows us to make informed decisions, assessing each submission individually and considering all risks regardless of e-modifiers. The more information you include in a submission, the better we can serve our policyholders. Please include the following:

  • ACORD 130
  • Loss Runs – all at current value with detailed loss summary
    • A minimum coverage of eight (8) months, plus loss data for first renewal
    • Prior 3 years and Expiring (current term)
  • Experience Mod Worksheet (when they exist)
  • For Florida Roofers: Contact your Underwriter or Territory Sales Manager prior to submission

AMERISAFE accepts submissions 120 days in advance of the current expiration date allowing our Field Safety Professionals ample time to survey accounts prior to Underwriting making a final decision. Our minimum rated premium is $5,000. However, there are several exceptions due to the nature of those classes. 

For a complete guide to submitting business, download our Ready Reference Guide.

Additionally, the following is useful during the submission process:

Contact your AMERISAFE Underwriter for information.

800.256.9052
underwritingservices@amerisafe.com

AMERISAFE AGENTS