Carlson Insurance Group • Workers Comp Quotes

Getting Started
Provide the following details requested below.
Business/Account Name*
The full legal name of the business.
Rating State
Select the primary state where the business operates.
Rating State*
Select the primary state where the business operates.

State
Instant Rating Not Available for this state.

States currently available for instant rating are AL, AR, GA, NC, SC, TN, & VA.
For other states, you will still receive SAME DAY QUOTES VIA EMAIL, but we think honesty is the best policy so you know what to expect.

Choose an Industry

Choosing the right class description is important for accurate pricing. Let's narrow the list by selecting an industry. If you don't find yours, choose "other" to see more class descriptions in the next section.
Industry Type*

Class Descriptions
Each person and their payroll should only be counted once. Only include those who DO NOT have their own insurance or state applicable exclusion.
Class 1
Click to expand the section.
Start typing a word in the field below to see possible class description matches.
Class 1 Description*
Employees and Payroll
Each person and their payroll should only be counted once. Only include those who DO NOT have their own insurance or state applicable exclusion.
Class 1 Payroll*
Class 1 Full Time*
# of employees
Class 1 Part Time*
# of employees
Add another class code?
Class 2
Class 2 Description*
Class 2 Payroll*
Class 2 Full Time*
# of employees
Class 2 Part Time*
# of employees
Add another class code?
Class 3
Class 3 Description*
Class 3 Payroll*
Class 3 Full Time*
# of employees
Class 3 Part Time*
Section Break
Adword/Keyword
Class 1 Description (For Admin View)
Class 2 Description (For Admin View)
Class 3 Description (For Admin View)
Total Payroll

Do you expect to pay any money to subcontractors that have their own workers comp?*
Only include amounts paid to subs with their own insurance or a valid state exemption. This amount will not affect premium, but must be disclosed.
- Yes
- No
Insured Subs
Total Annual Amount Paid to Insured Subcontractors*
Subcontractor %
Subcontractor Labor?
Subcontractor Labor?

Business History
Experience in your field and any prior coverage may help lower your premium - even if there is a lapse.
Number of Years in Business*
Number of Years with Prior Coverage*
Number of Years Experience*
Describe the Owners Experience*
Required if less than 3yrs in businss or less than 3yrs prior coverage.
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Prior Coverage
Is there an experience mod?*
- Yes
- No
Experience Mod*
Please enter a number from .6 to 2.0.
Is coverage currently lapsed?*
Total Amount of Claims in 3 Years*
Paid and Reserve Dollars- NOT # of claims
Total Amount of Claims in 5 Years*
Paid and Reserve Dollars- NOT # of claims
ARAP
1.0 is Default. If you're unsure, do not change it.
Please enter a number from .6 to 2.0.
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What other quotes are you interested in?
Multi-policy pricing may apply
- General Liability
- Commercial Auto
- Other Commercial Policies
- Personal Home Insurance
- Personal Auto Insurance
- None
Estimates
GET RATE
You will select a pay plan during the application process
There are not any voluntary market options that will accept less than $15k payroll. A minimum of $25k payroll may generate even more carrier interest.
There are not any voluntary market options that will accept less than $15k payroll. A minimum of $25k payroll may generate even more carrier interest.
5606 is typically not acceptable as the primary class. Please make sure the primary trade or operation being supervised is also selected- even if there is 0 payroll in that class.
For optimal pricing, you should have at least $15,000 payroll in a trade class OTHER than 5606, 8810, 8742, etc.
Policy Selections
Employers Liability- Each Injury per Person
Employers Liability- Each Disease
Employers Liability- Each Disease per Person
Lead State
This field is for zapier notifications only.
Lowest Est Premium
Lowest Est Down Pymt
Lowest Est Carrier
Selected Quote Name
Selected Premium
Selected Down Payment
Selected Fee
Lead Grade

Let's Complete Your Profile
Summary
Business Name*
The full legal name of the business.
Doing Business As (DBA)
Entity Type
Choose the type of business you have
Does the business have a Tax ID Number (FEIN)?*
- Yes
- No
FEIN
Describe the business operations*
What is your relationship to the business?*
- Owner, proprietor, officer, member
- Employee
- Other (spouse, friend, etc)
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Address
Click the arrow to the right to enter the address.
Business Mailing Address
Address Line 1 Address Line 2 City State ZIP Code
Physical Address
Same as Mailing

Address Line 1 Address Line 2 City State ZIP Code
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Contact Info
Click the arrow to the right to enter contact information.
Name*
First Last
Email*
Contact Phone*
Title*
Agent Info
Name of Agency*
Agent Name*
First Last
Agent Email*

This email is where underwriting correspondence will be sent.
Requested Effective Date*
Date Format: MM slash DD slash YYYY

This Date must be at least one business day into the future.
Premium Indications are not offers to bind. Coverage is not bound until confirmed in writing by an authorized representative of the insurer.*
- I understand.
Unique ID
Source URL
Comments
This field is for validation purposes and should be left unchanged.

Exterior Work over 2 Stories	Chimney Cleaning
Work performed on Airports or Aircraft	Roofing
USL&H or Jones Act	Work Performed on Airports or Aircraft
Welding	Work on Public Roadways
Siding Installation	Work Above 20 Feet
Pressure Washing	Gutter Installation

Getting Started