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This form is used for obtaining a premium indication for Workers’ Compensation insurance from the State Bar of California.

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How to fill out workers compensation premium indication

How to fill out Workers’ Compensation Premium Indication Form

01

Obtain the Workers’ Compensation Premium Indication Form from your state’s workers’ compensation board or your insurance provider.

02

Fill in your business information, including the name, address, and contact details.

03

List all employees, specifying their job titles and the number of hours they work.

04

Provide the total annual payroll amount for each class of employee.

05

Include any previous workers’ compensation claims history if applicable.

06

Summarize any information about subcontractors or additional coverage you may have.

07

Review the completed form for accuracy and completeness.

08

Submit the form to the appropriate insurance company or state agency.

Who needs Workers’ Compensation Premium Indication Form?

01

Employers who are required by law to carry workers’ compensation insurance.

02

Businesses looking to calculate their premium for workers' compensation coverage.

03

Employers who want to assess the risks associated with their workforce.

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What is Workers’ Compensation Premium Indication Form?

The Workers’ Compensation Premium Indication Form is a document used to calculate the expected premium for a workers' compensation insurance policy, reflecting the company's payroll, classifications of employees, and historical claim information.

Who is required to file Workers’ Compensation Premium Indication Form?

Employers who are seeking workers' compensation insurance coverage or who need to adjust their current coverage based on changes in payroll or employee classifications are required to file the Workers’ Compensation Premium Indication Form.

How to fill out Workers’ Compensation Premium Indication Form?

To fill out the form, employers should gather relevant payroll data, identify worker classifications, report any previous claims history, and accurately complete each section as instructed in the form's guidelines.

What is the purpose of Workers’ Compensation Premium Indication Form?

The purpose of the Workers’ Compensation Premium Indication Form is to provide insurers with necessary information to determine the appropriate premium amount for workers’ compensation coverage based on the specific risks associated with the employer's business operations.

What information must be reported on Workers’ Compensation Premium Indication Form?

The form requires reporting of total payroll amounts by employee classification, details of any prior claims or losses, information about business operations, and any changes that may affect the risk profile of the employer.

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