· Eligible to Social Service providers, including Home Healthcare and Medical Staffing programs.

· Not available in the monopolistic states of Ohio, Washington, Wyoming, and North Dakota.

· Limited Wisconsin availability, please contact Chad Rowan to discuss

· Nursing Homes and Assisted Living Facilities with premiums below $75,000 are excluded.

· Nursing Home and Assisted Living operations with premiums in excess of $75,000 may be eligible under our Standard Voluntary Workers’ Compensation plan and will be underwritten on an account-by-account basis.

Small to Medium Sized Businesses (premium $2,500 to $250,000)

· Minimum premium of $2,500 (California minimum premium $3,500)
· Experienced Mod minimum of .65 and maximum of 1.49
· Guaranteed Cost
· Brokers will receive 5% commission on premiums up to $250,000
· Single or Multi-state employers
· State and Federal Act coverages available

Large Businesses (premium $250,000+)

· Customized solutions for corporations with annual revenue up to $700 million
· Guaranteed Cost Programs
· Large Deductible Programs
· Incurred-Loss and Paid-Loss and Paid-Loss Retention Plans
· Self-Insured Retention programs structures
· Aggregate Stops

Before downloading and signing any insurance applications, make sure that you know your state's fraud warnings.

Required Application:

Workers Comp Application Small - Medium Size Business

Workers Comp Application Large Size Business

Please also provide the following required documents along with the above application:

· WC Acords
· 5 years Currently Valued Loss Runs
· Current Experience Mod worksheets
· 5 years Verifiable Payrolls & Premiums

Workers Compensation Losses:
Workers Compensation Reporting procedures vary by state. Please consult the insured organization’s WC policy for appropriate claim reporting procedures.

Chartis Fax: (866) 420-1404
Download Claims Reporting Instructions

If you need further assistance, please contact our Claims Department at (800) 622-8272.