Submit an Application for Workers’ Comp

Please send the following information (if applicable) to our quote inbox:

Please send the following information (if applicable) to our quote inbox or submit online:

  1. Completed Acord 130 Application
  2. Currently Valued Loss Runs and Premium Information for the last 3 years
  3. Current NCCI Experience Rating Worksheet
  4. Detailed narrative explaining the operations of the insured
  5. Detailed description of losses in excess of $25,000
  6. Current Financial Statement for risks generating $250,000 or more in premium
  7. Any other information which might help in the underwriting/pricing of the risk

If you need a fast indication, try out our quick indication app (subject to underwriting guidelines, review, and approval).

Note: AIA requires all agencies that bind business with AIA to have completed an Agency Appointment Packet. AIA will send an Agency Appointment Packet once the first policy is bound by an agency not currently appointed. All appointment information received will be considered strictly confidential. If you have any questions, please call us at 1-800-981-4242.