About this form

This Workers Comp Liability Quote intake collects the essential information needed to produce an accurate workers’ compensation and employer liability quote. It gathers key details about the applicant’s employee headcount, job duties, locations, payroll, and ownership structure—core factors underwriters rely on to evaluate work comp exposure. The intake also captures information about prior coverage, high-hazard operations, out-of-state work, subcontracting, and other risk indicators that influence pricing and eligibility. All responses automatically populate the appropriate ACORD forms and workers’ compensation supplemental applications, helping agents generate complete, ready-to-submit submissions without duplicating data.