Form Field Map: Workers Compensation Application (ACORD 130)

 

This is one of several forms comprising the Workers Compensation policy. See Form Field Map: Workers Compensation for information about additional forms.

Workers Compensation information from specific fields in AMS360 appears in corresponding ACORD 130 form fields. You can refer to the following sample of the ACORD 130  Workers Compensation Application form to determine the corresponding AMS360 fields.

ClosedACORD 130 with Images of the Policy Data Entry Sections

Click in the area of the ACORD 130 Workers Compensation Application form to view the AMS360 fields from which the information flows.

When you click on a section in the ACORD form, a pop-up image of the corresponding AMS360 field(s) appears. To close this image, click outside the ACORD form.

ClosedACORD 130, Page 1

ClosedACORD 130, Page 2

Or you may refer to a selection of images from the AMS360 user interface to determine which fields on the ACORD 130 form correspond to the depicted fields from AMS360.

ClosedPolicy Data Entry Sections with Images of the ACORD 130

The following images represent policy information fields in AMS360. Data flows from the AMS360 fields to a corresponding section on the ACORD 130 Workers Compensation Application form. Click the images to view where data appears on the ACORD 130 form.

ClosedPolicy: First Named Insured

To access these fields in AMS360, go to Policy > First Named Insured.

This policy applicant information originates in Customer Setup, Name and Address section. If you click Update from Customer, information automatically flows from Customer Setup into these fields.

You can also edit the information directly inside the First Named Insured fields. Because these are AMS360 fields that flow into the ACORD 130 form, editing here will modify the information that appears on the ACORD 130.

ClosedPolicy: Basic Policy Information

To access these fields in AMS360, go to Policy > Basic Policy Information.

ClosedAdditional Policy Information: Master Code and Sub Code

To access these fields in AMS360, go to Policy > Basic Policy Information > Additional Policy Information.

ClosedPolicy Contacts

To access these fields in AMS360, go to Policy > Policy Contacts.

Closed125, 130 Applicant Information / Locations

Unlike other ACORD forms for commercial lines of business, the ACORD 130 Workers Compensation form does not require completion of the ACORD 125 Applicant Information Section. The ACORD 130 includes sections for Applicant Information and Commercial Locations.

To access these fields in AMS360, go to Policy > 125, 130 Applicant Information / Locations. Information from the topmost fields flow to the first page of the ACORD form.

If you enter data in the Nature of Business field in this section, it appears on Page 2 of the ACORD 130 form.

Commercial Location information is listed on Page 1 of the form. To access these fields in AMS360, go to Policy > 125, 130 Applicant Information / Locations > Commercial Locations.

ClosedLine of Business Fields
ClosedPart 1 Workers Compensation States

To access these fields in AMS360, go to Policy > Line of Business > Workers Compensation > Part 1 Workers Compensation States.

ClosedPart 2 Employers Liability
Initial Limits Only

To access these fields in AMS360, go to Policy > Line of Business > Workers Compensation > Part 2 Employers Liability. The first groups in this section include the basis of coverage, the type of liability, and limit data.

The following example from AMS360 includes information regarding initial policy limits, but does not include Increased Limits. Limit and deductible data flow to the ACORD 130 form.

Information from these fields flows to the ACORD 130 only if the Deductible and Limit fields are blank under Increased Limits. If present, Limit and Deductible amounts in the Increased Limits data fields appear on ACORD 130 instead.

Increased Limits

To access these fields in AMS360, go to Policy > Line of Business > Workers Compensation >Part 2 Employers Liability. The first groups in this section include the basis of coverage, the type of liability, and limit data.

The following example from AMS360 includes information regarding both initial policy limits as well as Increased Limits.

If present, Limit and Deductible amounts in the Increased Limits data fields appear in the corresponding fields on ACORD 130. Amounts in these fields override other limit and deductible amounts that you may have entered elsewhere in Part 2 Employers Liability.

Other Coverages

Data in the Other Coverages group fields flow to specific areas of the ACORD 130 form.

Some of the Coverage types here are represented by labeled check boxes on the ACORD 130. If a policy includes a matching coverage, then an X appears in the appropriate box.

If a policy includes a coverage that does not correspond to a labeled check box, then a blank box is selected and a label is added.

Additional Coverage Information

Any text in the last field of the Part 2 Employers Liability section also appears on the ACORD 130 form. Click the image to see where the text appears.

ClosedPart 3 Other States Insurance

To access these fields in AMS360, go to Policy > Line of Business > Workers Compensation > Part 3 Other States Insurance.

ClosedClassification/Rating Information

To access these fields in AMS360, go to Policy > Line of Business > Workers Compensation > Classification/Rating Information.

The ACORD 130 form accommodates up to four entries, in order based on the Location number of each Classification group. Additional entries appear on the overflow form called Workers Compensation Rating Information.

If there is information in the Additional Rates/Premium Information section, then that data appears on a risk-level Additional Coverages and Endorsements overflow form.

ClosedIndividuals Included/Excluded

To access these fields in AMS360, go to Policy > Line of Business > Workers Compensation > Individuals Included/Excluded.

ClosedGeneral Information

To access these fields in AMS360, go to Policy > Line of Business > Workers Compensation > General Information.

ClosedAdditional Coverages

Additional Coverages do not appear on the ACORD 130 form. They overflow to a form called Additional Coverages and Endorsements.

ClosedAdditional Interests

Additional Interests do not appear on the ACORD 130 form. They overflow to the ACORD 45 Additional Interests form.

ClosedRemarks

To access these fields in AMS360, go to Policy > Line of Business > Workers Compensation > Remarks.

ClosedLoss History

Loss History and Prior Carrier data for the policy applicant appear together in the same section of the ACORD 130 form. Loss History information appears first in the section rows, followed by Prior Carrier information. To access these fields in AMS360, go to Policy > Loss History.

ClosedPrior Carrier

Prior Carrier and Loss History data for the policy applicant appear together in the same section of the ACORD 130 form. Loss History information appears first in the section rows, followed by Prior Carrier information. To access these fields in AMS360, go to Policy > Prior Carrier.

 

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