Experience Rating Worksheets ($17 per worksheet)
An Experience Rating Worksheet (catalog #OP1009X) contains a summary of loss and payroll data for a policyholder and includes a policyholder's experience modification calculation. When issued by the WCIRB, copies are sent to a policyholder's insurer. Additional copies are available from the WCIRB upon request. A policyholder is entitled to receive one copy of its current experience rating worksheet each year at no cost.
Inspection Reports ($10 per report, per location)
An Inspection Report (catalog #OP2002X) is a description of an employer's business processes prepared by the WCIRB after an inspection. The report assigns classifications to business operations for statistical reporting purposes. The WCIRB sends one copy of an Inspection Report to the policyholder once the report is complete. Additional copies are available from the WCIRB upon request.
Unit Statistical Reports ($8 per report)
A Unit Statistical Report (catalog #OP1006X) is used by a policyholder's insurer to report detailed premium, payroll and loss information for a policy to the WCIRB. Copies are available from the WCIRB upon request.
A policyholder is entitled to receive one copy of its current experience rating worksheet each year at no cost. See the Policyholder Experience Rating Worksheet Request Form for details. Additional copies may be ordered using the Policyholder Product Order Form (Form 801). The policyholder's insurer of record may also use Form 801 to obtain this information. A policyholder may authorize other individuals or entities to receive information on its behalf as follows:
Insurers, Agents and Brokers
Insurers, agents and brokers licensed to transact workers' compensation insurance in California must submit a Policyholder Product Order Form (Form 801) accompanied by a Letter of Authorization and Instructions to Access Policyholder Data (Form 810) in order to receive policyholder information:
Beginning in August 2018, the entire letter of authorization process will be online and fully integrated with WCIRB Connect. No longer will users have to print and fill out a letter of authorization to access policyholder data (Form 810), get the policyholder’s wet signature, and scan and upload the document. Get More Details>
Third Parties Other Than Insurers, Agents and Brokers
Individuals and organizations other than insurers, agents and brokers licensed to transact workers' compensation insurance in California must submit a Policyholder Product Order Form (Form 801) accompanied by a Special Power of Attorney Form (Form 809) in order to receive policyholder information.
All prices are subject to change. Please include 9.5% sales tax for orders placed from or shipped to California addresses. All orders from WCIRB insurer members will be billed in accordance with established billing procedures. Orders from non-WCIRB members must be accompanied by full payment, including any applicable sales tax or by completing required VISA or MASTERCARD information on the order form.