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WORKERS' COMPENSATION PROGRAM
- You must be a member of MAIA or your state's IIABA affiliate.
- You must have a broker’s agreement with Number One Insurance Agency, Inc.
- You must have a valid producer's license for the state you are submitting business for.
- Submit Application to Colleen Lahna via email to email@example.com or fax it to her at (508) 634-2930
- Acord 130 - be sure it is complete (We've included application requirements!)
- Loss runs:
- The Hartford and Norfolk & Dedham require 3 years - if any claims within past 3 years.
- Alternative Market requires 4 years loss history with every submission. (If coverage did not exist for any of the 4 years - simply note application and reasons why, for example: Sole Proprietor.)
- Don't forget Letter of Inclusion for (Sole Proprietors/Partners/LLC Members) if applicable or DIA Form 153 if excluding officers.
- If in a hurry? - For N&D and The Hartford - Just ask us to BIND Coverage and we won't bother forwarding a quote. If not directed, we will forward a quote and wait for your acceptance.
- If we need additional information or must decline the risk, we will notify you. If it is an acceptable risk, you will receive a quote via fax or email – based on what you provide us.
- Please email or fax back your acceptance - as instructed (Different carriers have different contact information).
- Please note that our Alternative Market requires a copy of the deposit premium check in order to bind coverage.
- You will then receive a binder from us via fax or email...and you're done!
- Norfolk & Dedham and The Hartford will bill your client directly.
- Our Alternative Market - Have the insured put the "Quote Number" on the deposit check and mail it directly to:
| AmTrust North America
P.O. Box 318004
Cleveland, OH 44131-9973
(AmTrust Renewals will be billed directly to your client.)
- To insure accuracy for your client, it is very important to review all names, addresses, tax id, coverage limits, class codes payrolls, endorsements, etc. when the new policy is received.
Please see “Our Markets” section for billing options.