​​​ 321-735-0381

Florida Workers' Compensation Application ACORD Form 130-FL (2015/02)
Your agent will help you complete this standard application to apply for workers' compensation coverage.

NCCI Safety Premium Credit Application
Policyholders ­use this form to apply for a 2% premium credit for having a formal safety program.­­

NCCI Drug Free Premium Credit Application
Policyholders use this form to apply for a 5% premium credit for having a formal drug-free workplace program.

Florida Contracting Classification Premium Adjustment Program Application 2010 (FCCPAP)
Policyholders use this form to apply for a premium adjustment based on their contracting classification and average hourly wage.­

Construction Class Codes List
The Florida Division of Workers’ Compensation’s official list of NCCI class codes the State of Florida considers to be in the construction industry.

Construction Industry Questionnaire
Supplemental application for contractors or construction industry.

2016 Workers' Compensation Rates

2015 Workers' Compensation Rates

Exemption Application - DWC 250 - Online Application
This online application is used to apply and pay for an exemption from workers' compensation insurance or benefits.  Please do not apply for an exemption without discussing the consequences of making this decision that waives your rights to important workers' compensation benefits.

Revocation of Election to be Exempt - DWC 250 R
This form is used to revoke a currently held exemption from workers' compensation insurance.

First Report of Injury Form - DWC 1
This form is ­used to report ­all workplace accidents.

Monthly Change Sheet ACORD Form
This form is used to inform or request changes to policies. Please contact your  agent for assistance in completing this form.

Workers Compensation Guide

Detailed overview and summary of the workers compensation system provided by the Florida Division of Workers Compensation.

Key Coverage Requirements

Brochure covering key insurance coverage requirements from the Florida Department of Financial Services.

Florida Division of Workers’ Compensation Website
This website explains ­general information about employers’ responsibilities under the Florida workers’ compensation law.

Sunbiz.org - Florida Division of Corporations Website

Florida Division of Corporations´ Sunbiz™ web site.   This website allows you to search and access filed information for corporations, limited liability companies, limited partnerships, general partnerships, trademarks, fictitious name registration.

Proof of Coverage Database
This state database is used to verify coverage or the exempt status of employers.­ Contractors can use this database to verify subcontractors’ exemptions or workers’ comp policies are valid.