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NCCI WCIP STATE INSTRUCTIONS Use the state chart below along with the ACORDTM Forms Instruction Guide for completing the ACORDTM 133 Workers Compensation Insurance Plan Assigned Risk section and ACORDTM 130 Workers Compe
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Document Date: 2011-06-23 12:50:30

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City

Indianapolis / Chicago / /

Company

NCCI Inc. / Northern Trust Co. / Compensation Insurance Inc. / /

Country

United States / /

Currency

USD / /

/

IndustryTerm

assigned servicing carrier / bank / assigned carrier / applicable state law / /

Organization

Indiana Compensation Rating Bureau / National Council on Compensation Insurance / Labor / Workers Compensation Board of Indiana / US Federal Reserve / U.S. Postal Service / /

Person

Coverage Form / Leasing / /

/

Position

labor contractor / Plan Administrator / Contractor / corporate officer / Administrator / /

ProvinceOrState

Illinois / Indiana / /

PublishedMedium

the ACORDTM Forms Instruction Guide / /

URL

www.in.gov/workcomp / ncci.com / /

SocialTag