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Available Programs:

 Carrier Risk Tolerance:

Pay As You Go Workers' Compensation

All risks acceptable:  low, medium, and high.

Includes risks such as contractors, trucking, roofing, and temporary staffing.

Direct Bill Work Comp

All risks acceptable:  low, medium, and high.

Pay As You Go General Liability

Contractor and service risks acceptable:  low, medium, and high.

Commercial Packages- 12 Equal Installs

Non-construction risks only.

Workers Compensation Information:

 Owners Wages for Workers' Compensation

Individuals and Partners

Sole Proprietors and Partners are not covered by the PA Work Comp Act.

LLC Members

Statutorily excluded.  Can't elect coverage to be subject to the law.

Members are treated the same as partners and sole proprietors.

Corporate Officers: Corporations

$20,800.00- Min Annual Payroll (effective 04.01.08).

Executives may be excluded by endorsement.

 General Liability Information:

 Owners Wages for General Liability:

Individuals and Partners

$5,200- flat annual.

Corporate Officers & LLC Members

$5,200- flat annual.

PA Resources & Links:

 PA Workers Compensation Forms:

State of Pennsylvania

http://www.pa.gov/portal/server.pt

Department of Labor and Industry

http://www.dli.state.pa.us/

Labor & Industry Building
Room 1700
7th and Forster Streets
Harrisburg, Pennsylvania 17120
(717) 787-5279
 

Bureau of Workers’ Compensation

http://www.dli.state.pa.us/landi/cwp/view.asp?a=138&q=220671

 
1171 South Cameron Street, Room 324
Harrisburg, Pennsylvania 17104-2501
(800) 482-2383 (inside Pennsylvania)

(717) 772-4447 (local/out of state)

TTY: (800) 362-4228 (for hearing and speech impaired only)
E-mail:  ra-li-bwc-helpline@state.pa.us

Click here to download free fillable PDF (Portable Document Format) versions of Pennsylvania workers’ compensation forms courtesy Interface Technologies—http://www.interfacetec.com/

State Workers’ Insurance Fund

http://www.dli.state.pa.us/landi/cwp/view.asp?a=151&q=209835

Street Address
100 Lackawanna Avenue
Scranton, Pennsylvania 18503
 

Mailing Address
Post Office Box 5100
Scranton, Pennsylvania 18505-5100
(570) 963-4635
E-mail: ra-li-e-mail-swif@state.pa.us

Workers’ Compensation Appeal Board

http://www.dli.state.pa.us/landi/cwp/view.asp?a=296&q=202912

1171 South Cameron Street, Room 305
Harrisburg, Pennsylvania 17104-2511
(717) 783-7838, Fax: (717) 772-0343

Acord 130 Form

Certificate Request Form

ERM-14 Form

Order Loss Runs (Example)

NCCI Mod Authorization

* Information contained herein is based on the most accurate data as of the time of posting.  Please check with you states Division of Workers' Compensation Insurance for the most up to date information and to verify accuracy.