Erm 14 Forms
You hereby certify that you are either 1 the employer subject to this ownership form or 2 the current carrier of record or producer of record for the employer organization employer.
Erm 14 forms. All items must be answered completely or the form may be returned. We will be adding more online training modules throughout the coming months and we will announce these on our linkedin page as well as in our newsletters. A comprehensive list of wcrb forms are provided below. We are glad you stopped by.
Updated in july 2018 the minnesota statistical plan manual contains instructions for submitting unit statistical reports usrs which must be filed for every workers compensation and employers liability policy written in minnesota. Louisiana office standard lines brokerage of la 3321 hessmer ave. This form 2 pages is used to detail the ownership of an entity or entities. Effective 01 dec 2003.
This is a special service our company provides. If you need a form or document its here. Workers compensation experience modification rate and erm 14 review service. Welcome to mwcias online training section.
Fort lauderdale office 5900 hiatus road tamarac fl 33321 ph 954 724 7014. Ma erm form confidential request for information updated form as of april 1 2017. To see forms for a specific organization type select the show me links below show me agent forms. Erm 14 form is to be submitted for reporting changes in ownership mergers consolidations or a combination of entities.
Its designed for employers policyholders insurance agents and brokers who have concerns and questions about accuracy of their workers compensation experience modification rate the erm 14 and the emr calculation process. Minnesota statistical plan manual.