Broker of Record Form

The following form assists in creating a letter that may help you transfer your existing workers compensation insurance policy to one of our affiliates. Please call 1-888-678-1888 to determine if you qualify and to be assisted through the process. If qualified, you will be able to input your current policy number and be assigned to the appropriate broker below.

Often employers transfer their policies due to a variety of factors including the need for better service or lower negotiated rates.