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DIA Promulgates New Form for Verification of Out-of-State Workers’ Compensation Coverage

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Workers' Compensation Programs

This program is available to Massachusetts Insureds ONLY.
Welcome...
to the Number One Insurance Agency’s Workers’ Compensation Program!  We have redesigned this webpage to try and make it more user friendly. Please read through the table of contents below to see what information you need and “click” on the appropriate link.  Feel free to print out the pages and make your own booklet on WC for quick easy desk access.  Just remember, things constantly change.  We will do our best to keep this site up to date with rates, notices, underwriting changes, etc.  Thank you for your interest and we look forward to working with you!
Table of Contents
  1. How to Submit Business
  2. Class Codes
  3. Acord 130 – Workers Compensation Application & Completion Instructions
  4. Form 153 – to Exclude Coverage
  5. ERM 14 – to Change Ownership/Entity
  6. General Information:
  7. Attorney General Advisory on Independent Contractor Law
  8. Our Markets [Contact Information (audits, claims, service, etc.), Billing, Certificates of Insurance & Workflow]
  9. Underwriting Criteria:
  10. Restrictions to Class Code Criteria
  11. Additional Questionnaires:
  12. Waiver of Subrogation options available by carrier:


    Norfolk & Dedham – reviews on an individual request basis.  Please submit details of request to include the details of the job, work tasks being performed and estimated time frame.  Once reviewed by underwriting, we will inform you if available or not.

    The Hartford requires an application and a premium is charged if offered: 
    The Hartford’s Application for Waiver of Subrogation

    AIU Holdings, Inc. offers a “Blanket Waiver of Subrogation”.
    • The waiver covers the insured on all jobs for the period of the policy.
    • The carrier just needs a request to add it – no pre-underwriting required!
    • It cannot be backdated – just added after request is made.
    • The charge is 2% of the unmodified premium.
    Please check with your insured’s and then simply email us to add to a policy and we will forward the information to the carrier and the policy will be endorsed.
  13. Declination Procedures
  14. Prior Carrier Information