Available Forms

Excess Workers’ Compensation Application

  • Complete this form for all new business and renewal submissions.

  • Includes applicant, contact, and insured information fields.

Aircraft Supplemental Application

  • Required only if your client operates aircraft or has aviation-related exposures.

Employee Concentration Form

  • Used to report employee counts and worksite concentration details.
  • Helps assess exposure and coverage requirements.

Submission Requirements

Ready to submit a case? View the full checklist and instructions to get started.

  • Completed Excess Workers’ Compensation Application

  • 10 Years of loss data with corresponding historical payroll totals

  • Estimated Payroll by class code & description

  • Large Loss Injury Descriptions (> $25,000 total incurred)

  • Risk control & employee safety training details

  • Financial Statements

  • Employee Concentration Data

  • Supplemental Applications (e.g., aircraft, watercraft)