Worker's Comp Application

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Insurance

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Datapoint

Description

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Entity Type

Identifies the insured company’s legal structure, such as Corporation, LLC, Sole Proprietor, or Partnership.

FEIN / SSN

Captures the Federal Employer Identification Number or Social Security Number of the applying business entity.

Business Name and Address

Returns the legal name and complete mailing address of the business as listed on the Workers Compensation application.

Contact Information

Extracts the name, phone number, and email address of the primary business contact submitting the application.

Requested Effective Date

Captures the date Workers Compensation coverage is requested to begin.

Requested Expiration Date

Returns the proposed end date for the requested Workers Compensation policy term.

Business Description

Provides a summary of the applicant’s primary operations or services performed.

Classification Code Numbers

Returns the 4- or 5-digit NCCI or state-specific classification codes associated with each business activity.

Estimated Annual Payroll by Class Code

Captures the projected annual payroll submitted for each class code listed on the application.

Number of Employees

Returns the total number of employees reported for coverage, typically by classification or location.

Owner / Officer Inclusion or Exclusion

Indicates whether business owners or officers are elected to be included or excluded from Workers Compensation coverage.

Prior Workers Compensation Carrier

Returns the name of the most recent insurer providing Workers Compensation coverage to the applicant.

Prior Policy Term Dates

Lists the effective and expiration dates of the applicant’s prior Workers Compensation policy.

Loss Runs / Claims History

Indicates whether a history of prior claims or loss runs has been provided, including total claims reported over the past 3 to 5 years.

TRIA Terrorism Election

Indicates whether the applicant elects to include or exclude terrorism coverage under the Terrorism Risk Insurance Act (TRIA).

A workers compensation application gathers essential details about a business, its operations, and employee classifications to assess risk and set policy terms. It includes core business identity data such as entity type, FEIN or SSN, business name and address, and contact information for the submitting party. Coverage term details such as effective and expiration dates are also captured.

Feathery’s AI extracts operational data including business descriptions, classification codes, estimated payroll by class code, number of employees, and owner/officer inclusion or exclusion elections. The system also identifies prior workers compensation carriers, policy term history, and loss run or claims history. Additional declarations like the applicant’s TRIA terrorism coverage election are also parsed. Automating this intake accelerates underwriting, improves data accuracy, and streamlines workers compensation policy setup.

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