Templates

ACORD 130

ACORD 130

All
Insurance
Use this template
Datapoint
Description
This is some text inside of a div block.
This is some text inside of a div block.
Employer Details
Name, address, and contact information of the business applying for coverage.
Federal Employer Identification Number (FEIN)
Unique tax ID for the employer.
Classification Codes
Industry-specific codes that classify employee job duties for risk assessment.
Number of Employees
Total count of employees covered under the policy.
Estimated Payroll
Projected payroll amounts by classification to calculate premiums.
Experience Modification Factor (Mod Factor)
Numerical factor reflecting the employer’s claims history and risk.
Claims History
Record of past workers’ compensation claims and losses.
State(s) of Coverage
Jurisdictions where employees are covered by workers’ compensation insurance.
Use of Subcontractors
Details about subcontracted labor and how they’re covered.
Coverage Limits Requested
Specific limits or endorsements requested by the employer.

The ACORD 130 form is the primary application used to establish workers’ compensation coverage for businesses. Feathery’s AI extracts structured employer details such as business name, contact information, FEIN, and employee headcount. It also pulls classification codes, payroll estimates, and coverage limits requested, which are critical inputs for underwriting and premium rating. The system further captures risk-related factors including use of subcontractors, claims history, and the employer’s experience modification factor, offering a complete view of exposure.

This template is particularly useful for agents, brokers, and carriers evaluating employer liability and calculating workers’ compensation premiums. Automating the extraction of ACORD 130 data reduces manual processing, ensures payroll and classification accuracy, and supports faster risk evaluation. By making claims and coverage history instantly accessible, insurers can streamline underwriting workflows, improve pricing precision, and help businesses maintain compliance with workers’ compensation requirements across multiple jurisdictions.

Related templates

ACORD 25

Learn more

ACORD 26

Learn more

ACORD 27

Learn more
No items found.