General Submission Requirements

Submission Requirements:

• Completed ACORD 130 Application: (including the following information): 

                 - Federal Employer ID Number
                 - Detailed Description of Operations
                 - Completed General Information section – including explanations for 
                   all ‘Yes’ Answers
                 - Insured Contact Information 

• Loss Runs (4 years + current year valued within 60 days) 
  
• Claim Detail (individual claims > $25k) 
  
• Current Experience Modification Worksheet 
  
• Payroll History (4 years + current) 
  
• Supplemental Application (industry specific)
• Company Financials (Accounts > $500,000) 
  
• Loss Control Pre-Inspection (Accounts > $250,000)

submissions@mu-programs.com
 

Resources

• Supplemental Applications
• WC State Websites

RISKMD®

Patented Visualization Software for the Acquisition, Valuation, and Management of Insurance Transactions