Workers' Compensation Insurance

Florida Workers’ Compensation Insurance

Author Information

Martin Summers

Insurance Agent


General Contact Information

Business Name:
Your Name:
Your Title/Position:
Contact Phone Numbers:
Your Email:
Mailing Address:
Mailing Address Line 2:
City, State, Zip:

Business Details

Please describe the nature of your business:
What type of legal entity is your business? IndividualPartnershipCorporationLLC
What is your business Tax ID Number (FEIN)?
What year was your business established?
How many years of experience do you have in this industry?
Do your employees travel outside the state of Florida? YesNo
How did you hear about FloridaWC? Search EngineAdvertisementReferralMailerOther

Payroll Breakdown by Employee Classifications

  Classification Code
or Job Decription
Number of EmployeesEstimated Annual Payroll
Job 1:
Job 2:
Job 3:
Job 4:
Job 5:

Workers Comp Insurance Background

Do you currently have workers comp coverage in force? YesNo
Are you currently under cancellation for any reason? YesNo
Current insurance company (not agency):
Current expiration date:
Policy #:
Have you had any workers comp claims in the last 3 years? YesNo
If yes, please describe here:

Florida Workers Comp Insurance
Information about individual aspects of the insurance coverage. If you are new to purchasing the insurance, read the Workers Comp Introduction. Other pages are available with more detailed information about specific aspects of workers comp:

Workers Comp Claims
Understanding Work Comp Rates
Exempting Officers From Coverage

Experience Modification Factors
Often called Experience Mods or X-Mods, these rating factors are computed using a formula based on previous workers comp claims. This factor is multiplied by the manual premium and directly influences the final premium paid by your business.

Learn More about Experience Mods

Florida Workers Comp Division
Black Bear Insurance Agency
270 Waymont Ct Suite 100
Lake Mary, FL 32746

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