Important Information Regarding Mississippi Workers Compensation Assigned Risk Applications
Effective May 7, 2007, NCCI began processing workers compensation assigned risk applications for Mississippi. Click here for details
Frequently asked Questions
Where should I mail the application?
v Mississippi applications should be mailed to:
Attn: Treasury Department
P.O. Box 3045
Boca Raton, FL 33431
What do I do if I need to send the application overnight?
v For overnight delivery, the address should be:
Attn: Treasury Department
901 Peninsula Corporate Circle
Boca Raton, FL 33487-1362
Can I send the application and premium electronically?
v Producers may submit applications via the Internet using NCCI's free RMAPS Online Application Service. Producers should contact NCCI (1-800-NCCI-123 and select the products and services option from the phone menu) to obtain a user id and password.
What is required to apply for coverage under the
v A valid application consists of:
§ a completed ACORD 130 form
§ a completed ACORD 133 form
§ and a check from the employer/applicant or the producer made payable to NCCI
(Don't use an ACORD 125)
An application cannot be processed if any of these are missing. Both ACORD forms must be signed by the producer and applicant.
Do I have to provide a Federal Employer ID number
to submit the application?
v Processing of an application comes to an immediate halt if there is no Federal Employer ID Number (or social security number) on the application.
What is critical about the legal status?
It is always important to include an applicant’s legal status.
Furthermore, the applicant’s legal status should be consistent with the
applicant's name. Here are some
§ If the name ends in Inc., legal status must be Corporation or “S” Corp.
§ If an individual uses a “dba” name, list the individual’s name first then the dba name. Legal status will be individual.
§ Only one name can be used if legal status is individual. Listing two individuals, even a husband and wife, connotes a partnership or other entity type.
Can I list states other than Mississippi on the Application?
v Mississippi applications are for Mississippi coverage only. The ACORD 130 LOCATIONS section cannot be blank and all locations listed must be within Mississippi. Part 1 (States) may include MS only and Part 3 - OTHER STATES INS must be left blank. States other than MS will be removed from the application. (Note: MS employees are covered while temporarily working in other states.)
Will you fill in the class if I don't know it?
v The class and payroll at each location must be supplied in the rating section. Be sure to include the payroll of any persons listed as included from the back of the ACORD 130 form. Contact NCCI at 1-800-622-4123 if you are unsure of the class to use.
How much premium must I send in? Do you have a pay plan available?
v If the total premium is under $5,000 or if any portion is financed by a premium finance company, the entire amount is due with the application. For amounts:
$5,000 and $10,000, send at least 75% of the total premium
(balance due in 6 months);
$10,000 and $25,000, send at least 50% of the total premium
(balance due in 3 quarterly payments);
§ $25,000 and over, send at least 25% of the total premium (balance due in 9 monthly payments).
Do I have to list any individuals?
v Be sure to complete the section on the back of the ACORD 130 form entitled INDIVIDUALS INCLUDED/EXCLUDED. For each person listed provide all information requested and note whether they are to be included in or excluded from coverage. Note, if the employer is:
individual, list the name again here;
partnership, list all partners;
§ a corporation, list all officers.
What are the eligibility requirements?
v To be eligible for coverage through the MS Workers’ Compensation Assigned Risk Plan there must have been no offers of voluntary coverage and the applicant must have been turned down by at least TWO insurance companies. Also, there cannot be any unpaid workers comp premium due on prior policies.
What commissions are paid?
v A producer fee is paid based on the policy premium as shown in the table below. This will be paid by the assigned carrier after the policy is issued. Do not deduct the producer fee from the deposit premium.
v For best results, always use the most current ACORD forms available. Forms may be obtained from ACORD by calling 800-444-3341.
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Compensation Insurance Services LLC