Submission Requirements

• Excess Workers Compensation Application with Fraud Warning Supplement 
• 10 years of payroll and loss detail
• Concentration of Risk Supplement
• Employer Profile Questionnaire
• Contact Information Form
• Most recent audited financials for: healthcare, construction, trucking, and auto parts manufacturing
   

Submission requirements may vary by state and exposure, including the need for additional supplements not listed.

• Excess Workers Compensation Application with Fraud Warning Supplement 
• 10 years of payroll and loss detail 
• Concentration of Risk Supplement 
• Member listing
• Fund classification rates
• Weighted average modification factors
• Underwriting guidelines
• Most recent audited financials
• Actuarial report

Submission requirements may vary by state and exposure, including the need for additional supplements not listed.

• 10 years of payroll and loss detail 
• Large claim detail for losses greater than $50,000 
• Concentration of Risk Supplement 
• Audited Financial Statements for the last 2 years 
• Captive Feasibility Study 
• Profile of current or prospective members, including description of operations

• Complete ACORD application 
• 10 years paid and incurred losses, broken down by policy period 
• 10 years large losses (greater than $50,000), by the policy period 
• 10 years historical payroll, by class code 
• 3 years audited financials for healthcare, construction, and trucking 
• Concentration of risk, by location 
• Employer Profile Questionnaire 
• Healthcare Supplemental Application 
• Vehicle Supplemental Application
• Aircraft Supplemental Application 
• MEC Approved TPA 
• Collateral will be required by an approved financial institution