Workers' Compensation

Number One Insurance Agency provides MAIA members with WC options for the voluntary market. Experience a high level of personal service and assistance with no volume commitments. This program is available for insureds whose main location is in Massachusetts. 

 

New Business Information

Forward new business submissions to Michelle St. Angelo or contact her for questions.

Direct Bill Only.  Installment options are available. Outside financing is not permitted.

Class Codes & Eligibility
Ineligible Risks
WCRIB of MA Class Code Lookup
Applications and Forms
Acord 130
Form 153
ERM 14
Restaurant & Contractor Supplements
Electrical Wiring – Commercial & Residential
Landscaping
Plumbing – Residential
Restaurant
Waiver of Subrogation
The Hartford Application for Waiver of Subrogation
Alternative Market Application for Waiver of Subrogation
Norfolk & Dedham - No application. Please provide written request and include the details of the job, work tasks performed and estimated time frame.  

 

Underwriting Tips

Owners/Officers

Individuals & Partnerships & LLCs: Automatically Excluded

  • To Include:  Provide signed “Letter of Inclusion” on insured’s letterhead.

  • Minimum/Maximum payroll is $48,700 effective October 1, 2017.

Corporations:  “Active” Officer:  Automatically Included

  • Min/Max Payroll: $10,920 - $55,120
  • To Exclude: Owners/officers with a minimum of 25% ownership investment can exempt themselves of coverage. The individual must complete and submit a DIA Form 153 to the DIA for stamped approval prior to writing the policy. Without a submitted Form 153, the owner/officer must be included with at least the minimum payroll. Approval forms may be submitted mid-term for endorsement.
  • Inactive Officer:  If an officer has no duties or ceases to perform any duties and does not come on the premises, except perhaps to attend directors’ meetings – they should be listed in this section and under duties enter “Not Active” and no payroll is required for this individual.

Non-Profit Information

  • In Massachusetts, the word “employer” shall not include nonprofit entities that are exclusively staffed by volunteers. No coverage is required.
STOP WORK ORDERS

If a client walks in your door with a STOP WORK ORDER, we recommend the following:

 

  1. Retain a copy of the STOP WORK ORDER.
  2. Include the Stop Work Order with your submission to the carrier.
  3. Once Coverage is bound, ask the carrier to send notice to the contact on the STOP WORK ORDER. The DIA will not accept notice from an insurance agent. Be sure the carrier, policy number, limits provided & effective date are listed.
  4. The insured should contact the DIA to pay their fees. Daily fees and the STOP WORK ORDER remain in effect until BOTH Proof of Coverage AND fees are paid.

 

Program Commission Rates 

CONTACT MAIA

*Denotes required field.