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Policyholder Experience Rating Worksheet Request

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A policyholder may use the request form on the link below to request a free copy of its experience rating worksheet. Only policyholders may use this form. All other parties should refer to the Policyholder Information section for information.

An experience rating worksheet summarizes a policyholder's payroll and loss experience by classification and policy year. This data is reported to the WCIRB by a policyholder's insurance company and is used by the WCIRB to administer the California experience rating systems.

The regulations governing the experience rating system can be found in the California Workers' Compensation Experience Rating Plan - 1995  (Experience Rating Plan). Additional information about experience rating is available in the Learning Center.

The WCIRB is permitted to release confidential experience rating information only to the policyholder, the policyholder's insurer of record or a third party who has been specifically authorized by the policyholder.
 

Complete the Policyholder Experience Rating Worksheet Request Form>

 

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