Workers' Compensation Quick Quote Form - Law Offices

8820: Attorney/Law Office (attorneys, paralegals and other employees involved in investigative work):

(do not include corporate officers in the 8820 employee count or payroll)

Annual payroll for category 8820 employees:

7720: Detectives (private detectives and messengers who serve subpoenas):

Annual payroll for category 7720 employees:

8742: Messengers (legal firm messengers, excluding those who serve subpoenas):

Annual payroll for category 8742 employees:

8810: Clerical (court reporters, receptionists, bookkeepers):

Annual payroll for category 8810 employees:

9015: Custodial (janitors, maintenance personnel):

Annual payroll for category 9015 employees:

Corporate Officers/ Partners (sole proprietors not eligible):

Gross annual payroll for corporate officers/partners (list each individually):

* Required

This is not an offer to sell insurance. Insurance coverage cannot be bound or changed via submission of this online form. Note that any proposal of insurance we may present to you will be based upon the values developed and exposures to loss disclosed to us on this online form and/or in communications with us. All coverage is subject to the terms, conditions and exclusions of the actual policy issued.