The Intelligent Insurance Solution

How to Obtain a Quote

The Trust accepts Acord applications for new business submissions. All new business submissions should contain the following:

  • Completed Acord Commercial Insurance Application
  • Completed Acord Workers Compensation Applications (Note that the Trust caps each individual's payroll at a maximum of $75,000 per year so please adjust payrolls accordingly, including executive officers, owners and members of an LLC)
  • Completed Supplemental Workers' Compensation & Fleet Application
  • Home Care Companies, please complete the Home Care Supplemental Questionnaire
  • Ambulance Companies, please complete the Ambulance Fleet Questionnaire.
  • Schools, please complete the Supplemental School Questionnaire
  • Museums, please complete the Supplemental Museum Questionnaire.
  • Clerical payroll (8810) must be broken out separately regardless of governing code(s) used
  • Current valued Loss Runs (5 years + current)
  • Current Experience Modification Worksheet, if applicable
  • If quote is to include commission or to be quoted on a net basis
  • Indicate if account is to be direct bill or “Pay As You Go”

Quotes can be provided very quickly once the above information is received. Send all information to the marketing department via email to or, by fax to 203-294-4816 or by mail to the following address: Workers’ Compensation Trust, P.O. Box 5042, Wallingford, CT 06492. Attention, Nathan Shippee, Executive Director, Marketing