Submission Requirements

The following information is needed in order to provide a proposal:

• Completed Work Comp ACORD application.

• Current year and prior year NCCI experience mod worksheet.

• Premium history for current year.

• Loss runs for 5 years, valued within 6 months of the proposed effective date.

• Details on losses valued $25,000 or more in the last five years.

• Narrative describing Operations/Locations and current safety program.

• Description of how raw products are received and finished products are delivered.



Benefits of WCTI Membership:

  1. Ownership
  2. Loss Prevention
  3. Aggressive Claims Management
  4. Managed Care Program
  5. Prescription Drug Program
  6. Prompt Reporting

Need more information?

If you would like additional information on this successful program, please contact Angie Blakeney at 800.252.5059, ext. 1117 or e-mail Angie at ablakeney@ccmsi.com.