Policyholder Experience Rating Worksheet Request

If you are an employer or policyholder, you may request a free copy of your Experience Rating Worksheet (ratesheet) which includes payroll, claims and experience modification information by classification.


An experience rating worksheet, or ratesheet, provides a merit rating percentage known as an experience modification, or X-Mod, to qualified policyholders. The rating percentage is calculated based upon the policyholder's audited payroll and losses for three consecutive policy periods, as reported to the WCIRB by the policyholder's insurance company.

A policyholder may use the request form at the following link to request a free copy of its ratesheet be delivered via email or postal mail. Only policyholders who qualify for experience rating may use this form. If you do not qualify for experience rating and require verification of this, please email the Contact Center for assistance.

The WCIRB is only permitted to release confidential experience rating information to the policyholder's insurer, agent or broker of record or a third party who has been specifically authorized by the policyholder. Insurers, agents and brokers may obtain ratesheets in the following ways:

The regulations governing the experience rating system are in the California Workers' Compensation Experience Rating Plan—1995. Additional information about experience rating is available on the California's Experience Rating System page.