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Policyholder Experience Rating Worksheet Request

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 the policyholder's insurance company and is used by the WCIRB to administer the California experience rating systems. A policyholder may use the request form at the link below to request a free copy of its Experience Rating Worksheet (ratesheet). 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 or agent/broker of record or a third party who has been specifically authorized by the policyholder. Only policyholders may use this form.

Insurers, agents and brokers: Sign up or log in to WCIRB Connect to access ratesheets and inspection reports online. Refer to the Policyholder Data Products page for more information about ordering hard copies of ratesheets.