Insurance Documentation

Forms and Documents Requests:

Corporate Structure

ERM-14 is a “Confidential Request for Information” Form used by the National Council of Compensation Insurance (NCCI) to link insureds for Experience Modification rating purposes. The ERM-14 advises NCCI of any material/non-material changes such as changes in the insured’s name, any ownership changes, mergers, combining of entities and more.

* Name change (show the before and after.)
* Combination of separate entities
* Sale, transfer or conveyance of ownership interest
* Merger or consolidation
* Forming of a new entity/business
* Sale, transfer or conveyance of an entity’s physical assets to another entity which takes over operations
* Voluntary or court mandated establishment of a trustee or receiver

The ERM-14 must be completed and signed.

Risk ID

Whether from NCCI or your State Bureau, each corporate entity is assigned a tracking number for workers compensation experience. It is typically attributed after a company has employed workers for 3 or more years. You or insurance broker can access this number typically online through NCCI or state bureau by searching with your FEIN or corporate name. This ID number is requested by all underwriter for researching your loss history and matching to your provided loss information. It also serves as the source to obtain your “Experience Modifier”.

Experience Modifier

Also know as Experience Mod, this is the calculating factor that sets your company rate deviation as compared to companies similar to yours (by industry classification). NCCI and State bureau’s monitor loss history information and categorize through their respective business classifications to determine benchmark performance of each respective industry class. Through this process you are monitored and assigned your factor know as your “Mod”. In rating of your workers compensation policies your Mod is used to either increase, decrease, or use the rates as is.

If your company has employed personnel for 3 or more years you will be assigned a “Risk ID” for Unit Stat filings by your insurance carrier. In certain cases you may not be assigned a Experience Mod because your company premiums are to small or insufficient loss data. In these cases you are rated at a 1.0 factor (unity) to the manual rates on your insurance rates. The Unit Stat filings are used to track experience as calculated based with payroll, premium and losses for experience benchmarking. In summary, your losses are attributed to payroll by classification and compared to the similar industry classes by comparative benchmarking. If you have better than industry performance you receive a credit mod, similarly, if your losses are worse than industry averages you receive a debit mod.

  • - Credit Mod: A credit multiplier (or reduction) used in rating your firms manual rates on a policy.
  • - Debit Mod: A debit multiplier (or increase) used in rating your firms manual rates on a policy.

Maintaining a good experience modifier is essential to containing costs related to purchasing workers compensation. If your loss experience is negative against industry averages you end up paying more for insurance by the proportion compared to others in the same industry sector. It is in your best interest to understand and manage your company risks to keep this modifier in the credit bracket as it is one of the key cost drivers affecting your premium and insure-ability. The two most used documents for underwriters are:

Experience Mod Sheet
Experience Mod Calculation Worksheet

The difference between the two is the Experience Mod sheet is just the calculated factor for you to know. The Experience Mod Calculation Worksheet is the details of the calculations made to arrive at the factor you are assigned.