Employer Name
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Effective Date
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27 |
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1 |
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1 |
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Today: 5/1/2025
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Expiration Date
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Sun |
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Tue |
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Thu |
Fri |
Sat |
27 |
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29 |
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1 |
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25 |
26 |
27 |
28 |
29 |
30 |
31 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
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Today: 5/1/2025
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Cancellation Date
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Sun |
Mon |
Tue |
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Thu |
Fri |
Sat |
27 |
28 |
29 |
30 |
1 |
2 |
3 |
4 |
5 |
6 |
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8 |
9 |
10 |
11 |
12 |
13 |
14 |
15 |
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17 |
18 |
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20 |
21 |
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25 |
26 |
27 |
28 |
29 |
30 |
31 |
1 |
2 |
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Today: 5/1/2025
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Cancellation Type
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Was policy issue short term to replace a binder or to establish
concurrency with other policies?
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Schedule Rating(xx.xx)
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Waiver of Subrogation(xx.xx)
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Employers Liability
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Small Deductible Programs applicable to Workers' Compensation only
and not Employers Liability
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MA Benefits Deductible Program:
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MA Benefits Claim & Aggregate Deductible Program:
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Experience Modification(x.xx):
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Merit Rating:
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MA Construction Credit(xx):
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ARAP Surcharge(x.xx):
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Large Deductible Program applicable to both Workers' Compensation
and Employer's Liability - not subject to experience rating(xx.xx):
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Premium Discount Carrier Type:
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QLMP Credit(xx.xx):
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Admiralty/FELA Employers Liability Limits:
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Audit Noncompliance Charge (ANC)(xx.xx):
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DIA Assessment:
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