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Certificates of Insurance

Producers may either request certificates of insurance from the WCRIBMA using the Certificate of Insurance tool on our website or may continue to submit requests to the assigned carrier. Since the producer is not a contract agent or agency of the Massachusetts Workers' Compensation Assigned Risk Pool, the producer has no authority to issue certificates of insurance on assigned risk business. For policies with no agent listed, employers must request certificates of insurance from the assigned carrier.

WCRIBMA Certificate of Insurance Web Tool

As of September 2015, the WCRIBMA is providing to producers who have OAR (Online Assigned Risk) accounts a tool on our website through which the producer can request certificates of insurance from the WCRIBMA that provide evidence of Massachusetts workers’ compensation and employers’ liability insurance coverage. To request a certificate through this tool all of the following conditions must be met; otherwise the producer must request the certificate from the assigned carrier.

  • The policy is a Massachusetts Assigned Risk Pool policy.

  • The policy has been issued by the assigned carrier, reported to the WCRIBMA, and successfully loaded into the WCRIBMA’s coverage database. The status of the policy can be verified by accessing the Proof of Coverage - Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/.

  • The producer reported on the policy as the broker of record is the same as the producer logged into OAR and requesting the certificate of insurance.

  • The policy is not more than three (3) years old.

  • The policy was not reported to the WCRIBMA as an employee leasing policy.

  • The certificate does not require multiple employers, multiple addresses, or special coverage wording to be shown on the certificate as no wording can be added to or removed from the our certificate of insurance form.

Copies of all certificates of insurance issued through the WCRIBMA’s Certificate of Insurance tool are provided to the assigned carriers through our web product Manage Policy.

For detailed information on using the Certificate of Insurance web tool, refer to the Certificates of Insurance section of the OAR User's Guide.

Certificate of Insurance Requests to the Assigned Carrier

All requests for certificates of insurance must be submitted to the servicing carrier or voluntary direct assignment carrier (“assigned carriers”) on the MASSACHUSETTS ASSIGNED RISK POOL REQUEST FOR CERTIFICATE OF INSURANCE FORM or on a document that is formatted to contain information identical to that on the form and enables the carrier to quickly ascertain if all of the required information is provided.

The assigned carrier will issue and distribute the certificate of insurance by email or facsimile to each contact provided within two (2) business days of the carrier's receipt of a fully and accurately completed form. For new business where the policy has not yet been issued, the carrier is allowed ten (10) days from the date the assigned carrier is in receipt of both 1) the assignment package and deposit premium from the WCRIBMA and 2) a fully and accurately completed Massachusetts Assigned Risk Pool Request for Certificate of Insurance Form to issue and distribute the certificate of insurance.

If no email address or fax number is provided for a person or persons to whom the certificate of insurance should be issued, the carrier will mail the certificate of insurance.

If the assigned carrier receives an incomplete request form, the carrier will email or fax the form back within two (2) business days of receipt, to the producer or to the insured if no producer is identified, indicating the form’s deficiency. The carrier will not track returned forms. It is the requestor’s responsibility to re-submit the corrected form to the carrier. The certificate of insurance will then be issued by email or facsimile within two (2) business days of the carrier’s receipt of the resubmitted form.

The Massachusetts Assigned Risk Pool Request for Certificate of Insurance form is available in PDF format for printing or in Word format which can be saved to your own PC and completed in Word. The form may be emailed, mailed or faxed to the designated representative(s) for each assigned carrier. Each assigned carrier has designated staff to issue certificates of insurance as follows.

References:

Circular Letter #2263 dated September 11, 2015 - Online Certificate of Insurance Tool - Assigned Risk Pool Policies.
Circular Letter #2258 dated May 21, 2015 - the Division of Insurance issued Bulletin 2015-02 to provide guidance with respect to implementation of M.G.L. c.175L concerning the issuance of Certificates of Insurance in the Commonwealth.
Circular Letter #2254 dated February 19, 2015 - An Act relative to certificates of insurance was signed into law on January, 7, 2015.
Circular Letter #2199 dated July 3, 2012 - which provides a new format that is easier to follow, incorporates the instructions for issuing Certificates of Insurance that were originally announced in Circular Letter #2045, and contains some clarifying language.
Circular Letter #2176 dated April 8, 2011 - which provides a copy of the Division of Insurance Bulletin regarding certificates of insurance, evidence of coverage forms and binders.
Circular Letter #2071 dated October 24, 2007 - which provides Audit Guidelines for Sole Proprietor and Partnership Certificates of Insurance. These guidelines, which are effective immediately, are mandatory for all Residual Market policies.
Circular Letter #2057 dated June 22, 2007 - which addresses some of the questions that have been asked as a result of the Procedures effective May 1, 2007.
Circular Letter #2045 dated February 14, 2007 - which announces additional Procedures for Issuing Certificates of Insurance for Sole Proprietors and Partnerships. These procedures have a mandatory effective date of May 1, 2007.
Special Bulletin #09-03 dated September 8, 2003 - which announces new procedures for obtaining Certificates of Insurance on assigned risk policies effective October 1, 2003.
Notice to Pool Carriers #02-1 dated December 16, 2002 - which announces no change in the procedure requiring that certificates of insurance for Pool policies only be issued by servicing carriers or voluntary direct assignment carriers (VDACs).

Servicing Carriers

Acadia Insurance Company

C/O Berkley Risk Administrators Company
P.O. Box 59143
Minneapolis  MN  55459
Hours of Operation: Monday - Friday 7:30 a.m. to 4:30 p.m. CST

Tel: 888-548-7431
Fax: 866-215-8118
policyservices@berkleyrisk.com

For 24/7 online services: berkleyassignedrisk.com

AmGuard Insurance Company

Policy Services
16 South River Street
P.O. Box AH
Wilkes-Barre PA 18703
Hours of Operation: Monday - Friday 8:00 a.m. to 4:30 p.m.

Gina Kapral
Tel: 800-673-2465
Fax: 570-820-7968
underwriting3@guard.com

Associated Industries of MA Mutual Insurance Company (A.I.M.)

54 Third Avenue
P.O. Box 4070
Burlington  MA  01803-0970
Hours of Operation: Monday - Friday, 8:00 a.m. to 4:00 p.m.

Debbie Cox
Tel: 781-270-8740
Fax: 781-270-5690
dcox@aimmutual.com

Debra Gargano
Tel: 781-270-8975
Fax: 781-270-5690
dgargano@aimmutual.com

LM Insurance Corp.

Commercial Service Operations
P.O. Box 8090
Wausau  WI  54402-8090
Hours of Operation: Monday - Friday, 8:00 a.m. to 5:00 p.m. CST

Cindy Thiel
Tel: 715-261-5341
Fax: 603-427-1885
macerts@libertymutual.com

Travelers Indemnity Company of America

Travelers - RMD
P O Box 5600
Hartford  CT  06102-5600
Hours of Operation: Monday - Friday, 8:00 a.m. to 5:00 p.m.

Tel: 800-443-4404
Fax: 877-336-6036

Voluntary Direct Assignment Carriers (VDAC)

ACE American Insurance Company

Travelers - RMD
P O Box 5600
Hartford  CT  06102-5600
Hours of Operation: Monday - Friday, 8:00 a.m. to 5:00 p.m.

Tel: 800-443-4404
Fax: 877-336-6036

American Zurich Insurance Company

Travelers - RMD
P O Box 5600
Hartford  CT  06102-5600
Hours of Operation: Monday - Friday, 8:00 a.m. to 5:00 p.m.

Tel: 800-443-4404
Fax: 877-336-6036

Associated Industries of MA Mutual Insurance Company (A.I.M.)

54 Third Avenue
P.O. Box 4070
Burlington  MA  01803-0970
Hours of Operation: Monday - Friday, 8:00 a.m. to 4:00 p.m.

Debbie Cox
Tel: 781-270-8740
Fax: 781-270-5690
dcox@aimmutual.com

Debra Gargano
Tel: 781-270-8975
Fax: 781-270-5690
dgargano@aimmutual.com

Rebecca Beninati
Tel: 781-270-8935
Fax: 781-270-5690
rbeninati@aimmutual.com

Atlantic Charter Insurance Company

25 New Chardon Street
Boston  MA  02114
Hours of Operation: Monday - Friday, 9:00 a.m. to 5:00 p.m.

Damali Peters
Tel: 617-488-6542
Fax: 617-488-6501

Amanda Velez
Tel: 617-488-6511
Fax: 617-488-6501

Requests for Certificates of Insurance may be emailed to:
CertificateRequest@atlanticcharter.com

Continental Casualty Company

Travelers - RMD
P O Box 5600
Hartford  CT  06102-5600
Hours of Operation: Monday - Friday, 8:00 a.m. to 5:00 p.m.

Tel: 800-443-4404
Fax: 877-336-6036

Hartford Underwriters Insurance Company

Travelers - RMD
P O Box 5600
Hartford  CT  06102-5600
Hours of Operation: Monday - Friday, 8:00 a.m. to 5:00 p.m.

Tel: 800-443-4404
Fax: 877-336-6036

Liberty Mutual Fire Insurance Company

Commercial Service Operations
P.O. Box 8090
Wausau  WI  54402-8090
Hours of Operation: Monday - Friday, 8:00 a.m. to 5:00 p.m. CST

Cindy Thiel
Tel: 715-261-5341
Fax: 603-427-1885
macerts@libertymutual.com

Travelers Property Casualty Company of America

Travelers - RMD
P O Box 5600
Hartford  CT  06102-5600
Hours of Operation: Monday - Friday, 8:00 a.m. to 5:00 p.m.

Tel: 800-443-4404
Fax: 877-336-6036

Problems and Emergencies:

Each assigned carrier has designated a management level person(s) who the WCRIBMA can contact to address any issues or special circumstances regarding the issuance of certificates of insurance.

If a producer or insured employer has any problems with an assigned carrier issuing certificates of insurance, they should contact the WCRIBMA’s Vice President of Customer Services, Daniel Crowley, CPCU, Tel: 617-646-7594, Fax: 617-646-7569. Mr. Crowley will work with the producer or insured employer and the assigned carrier to resolve the problem.

Certificates of insurance will be issued by facsimile within two (2) business days of the assigned carrier’s receipt of an accurately and fully completed MASSACHUSETTS ASSIGNED RISK POOL REQUEST FOR CERTIFICATE OF INSURANCE FORM or on a document that is formatted to contain information identical to that on the form and enables the carrier to quickly ascertain if all of the required information is provided. If circumstances exist that require a producer or an insured employer to obtain a certificate of insurance on an expedited basis (same day or within one business day of request), the producer or the insured employer should contact the designated WCRIBMA representative. The WCRIBMA representative, in conjunction with the assigned carrier, will make every effort to obtain the certificate of insurance on an expedited basis.

The WCRIBMA Representative is:

Daniel Crowley, CPCU
Vice President of Customer Services
Tel: 617-646-7594
Fax: 617-646-7569

Important: Producers and insured employers, who request expedited issuance of certificates of insurance, must describe to the WCRIBMA representative the emergency circumstance that necessitates the expedited service. The WCRIBMA will keep a log of requests for expedited issuance of certificates of insurance for the purpose of monitoring the effectiveness of these new procedures.

 

 

Resources

Applications and Forms

Assigned Risk Application Calculator

Certificates of Insurance

Depopulation Reports

FAQs

Links

Frequently Used Links:

MWCARP Application Status Search

OAR User's Guide

Pool Carriers

Pool Procedures:

 

The Workers' Compensation Rating and Inspection Bureau of Massachusetts
101 Arch Street, 5th Floor
Boston, MA 02110