Workers’ Compensation Insurance

Workers’ compensation is a form of insurance that provides wage replacement and medical benefits for employees who are injured in the course of employment, in exchange for mandatory relinquishment of the employee’s right to sue his or her employer for the tort of negligence.

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Request A Quote

Please take a moment to fill out the form below and one of our local insurance agents will contact you with a free, no-obligation quote. This information will be kept confidential and will be used for quote purposes only.

Workers' Compensation Insurance Quote Request

Your Full Name (required)

Company Name:

Address:

City:

Select a State:

Zip Code:

Business Phone Number: (required)

Business FAX Number:

Your Email: (required)

Current Workers' Comp Insurance Information

Insurance Company Name (Carrier, not agency):

Policy Expiration Date:

Premium Amt.: $

NCCI Experience Modification: If not sure, use "NA".

Years Insured:

About Your Business

Number of Employees:

Years in Business:

Number of Locations:

Annual Sales: $

Detailed Description of your Business:

Payroll Information (if known)

Estimated Annual Payroll (Gross):$

Class Codes Employee Duties Annual Payroll $ Hourly Wage $

Additional Comments or Questions:

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Please click the “Submit Quote Request” button to send your quote request. No coverage is in effect until bound by an insurance carrier. This is a request for quotation only.