Worker's Comp (California) Policy

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Description

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Named Insured

Legal name of the business or individual covered under the Workers Compensation policy.

Named Insured Address

Mailing address of the insured, including street, city, state, and ZIP code.

Policy Effective Date

Start date of the Workers Compensation policy coverage period.

Policy Expiration Date

End date of the Workers Compensation policy coverage period.

Policy Number

Unique identifier assigned to the Workers Compensation policy.

Insurer Name

Name of the insurance company providing the Workers Compensation policy.

A.M. Best Rating

Financial strength rating assigned to the insurer at time of policy issuance.

Insurer Status

Indicates whether the insurer is admitted, surplus lines, or other within California.

Classification Code(s)

Standard WCIRB (or NCCI if applicable) job classification codes for insured employees.

Payroll or Exposure Basis

Declared payroll or other exposure base used for rating each classification.

Experience Modification Factor (EMOD)

Adjustment factor applied to the premium based on the insured’s claims history.

Bodily Injury by Accident Limit

Maximum payout per covered accident under the policy.

Bodily Injury by Disease - Per Employee

Limit of liability for disease-related claims per employee.

Bodily Injury by Disease - Aggregate Limit

Total policy limit for all disease-related claims during the policy term.

Estimated Annual Premium

Projected annual premium for the Workers Compensation policy, before taxes and fees.

Taxes, Fees, and Surcharges

Breakdown of mandatory state surcharges, assessments, or other charges.

Installment Plan

Indicates whether the insured selected a monthly, quarterly, or annual payment plan.

Executive Officer Coverage Status

Indicates whether executive officers are included or excluded from coverage under the policy.

Reporting Form Usage

Specifies if the policy uses a reporting form to declare payroll or exposure during the policy period.

Audit Provision

Indicates whether the final premium is subject to audit at the end of the policy term, based on actual payroll.

Medical Provider Network (MPN) Participation

Specifies whether the insured participates in a designated Medical Provider Network for managing workers compensation claims.

Drug-Free Workplace Credit Applied

States whether a certified drug-free workplace program has been implemented and whether a credit was applied to the premium.

Safety Program Credit

Indicates whether a formal workplace safety program is in place and whether the insurer has applied a premium credit as a result.

Per Occurrence Deductible

Deductible amount applied to each individual WC claim, if applicable.

Drug-Free Workplace Credit

Indicates if a certified drug-free program discount is applied.

Safety Program Credit

Shows whether a formal safety program is in place and recognized with a premium credit.

California workers’ compensation policies outline key insured details, coverage terms, and rating information essential for policy administration and compliance. Feathery’s AI extraction engine automates the capture of the named insured, mailing address, effective and expiration dates, policy number, insurer name, A.M. Best rating, and insurer status. It pulls classification codes, payroll or exposure bases, and the insured’s experience modification factor to support accurate rating. Limits for bodily injury by accident, disease per employee, and aggregate disease claims are extracted along with estimated annual premium, applicable taxes and fees, and selected installment plan.

The engine also identifies coverage modifiers such as executive officer coverage status, reporting form usage, and audit provisions, as well as MPN participation, drug-free workplace credits, and safety program credits. Per-occurrence deductibles and other applied discounts are returned for complete premium transparency. This template is ideal for carriers, MGAs, and brokers managing workers’ compensation risks, enabling faster policy setup, accurate rating, and seamless integration into policy administration systems.

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