Workers' Compensation Insurance Application - Alliance for Contractors

Workers' Compensation Insurance Application

Phone: 1-800-ALLIANCE | Email: [email protected]
Website: www.allianceforcontractors.com

Alliance Integration Benefits

Automated Systems Integration: This application integrates seamlessly with your Alliance iCOS platform, automated payroll systems, and safety management programs for streamlined processing and optimized premium calculations through our advanced experience modification factor optimization.

Section I: Business Information *

Section II: Construction Industry Classification Codes

Code Description Rate per $100 Select Est. Annual Payroll
5403 Carpentry - Residential $8.44
5437 Carpentry - Commercial $11.26
5474 Electrical Work - Inside $4.32
5478 Electrical Work - Outside Lines $15.67
5538 Plumbing $6.78
5606 Roofing $18.43
5645 Masonry $12.89
8810 Clerical Office Employees $0.56
Alliance Integration: Classification codes automatically sync with your iCOS platform for accurate job costing and payroll allocation.

Section III: Payroll Information & Employee Data

Alliance Payroll Integration

Automated Payroll Sync: Connect your existing payroll system with Alliance automation for real-time premium calculations, accurate classification tracking, and seamless quarterly reporting.

Section IV: Experience Modification Factors

Three-Year Loss History

Policy Year Total Payroll Number of Claims Total Incurred Claims Status
2023
2022
2021

EMR Optimization Through Alliance Safety Programs

Proactive EMR Management: Alliance safety program integration helps reduce your experience modification rate through comprehensive safety training, incident tracking, and proactive risk management.

Section V: Safety Program Integration

Current Safety Programs

Alliance Safety Management System

Comprehensive Safety Integration: Access Alliance's enterprise-level safety management tools including digital safety meetings, incident reporting, training tracking, and regulatory compliance monitoring.

Section VI: Claims Management Information

Previous Claims Detail

Alliance Claims Management Integration

Advanced Claims Processing: Streamlined claims management through Alliance's integrated platform with real-time reporting, medical provider networks, and proactive return-to-work coordination.

Section VII: State Regulatory Compliance

Additional State Requirements

Section VIII: Alliance Integration Benefits & Use Cases

Employee Protection

Comprehensive coverage integrated with Alliance safety protocols ensures maximum protection for your workforce while maintaining competitive premiums through our risk management programs.

Regulatory Compliance

Automated compliance monitoring across all operating states with real-time updates on regulatory changes and requirements through the Alliance platform.

Injury Claims Management

Streamlined claims processing with Alliance's preferred medical networks, return-to-work programs, and proactive case management to minimize claim costs.

Safety Program Integration

Enterprise-level safety management tools including training tracking, incident reporting, and safety meeting management integrated with your workers' comp coverage.

Payroll Management

Automated payroll integration ensures accurate premium calculations, proper classification management, and seamless audit processes through Alliance systems.

Classification Optimization

Advanced analytics and classification management to ensure optimal rating and premium calculations based on actual work performed and risk exposure.

Alliance iCOS Integration

Complete Business Management: Your workers' compensation coverage integrates seamlessly with Alliance's iCOS platform for comprehensive project management, cost tracking, and business intelligence reporting.

Section IX: Coverage Options & Premium Calculation

Coverage Option Description Premium Impact Select
Basic Coverage State minimum requirements Base Rate
Enhanced Coverage Additional medical benefits, extended wage replacement +15% Premium
Premium Coverage Maximum benefits, vocational rehabilitation, Alliance management +25% Premium

Section X: Declarations & Authorizations

Applicant Certification: I certify that the information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that any misrepresentation may void coverage or result in claim denial.

Applicant Signature

Print Name: _________________________

Title: _______________________________

Date: _______________________________

Alliance Representative

Print Name: _________________________

Title: _______________________________

Date: _______________________________

Office Use Only

Next Steps with Alliance

Application Processing: Upon submission, your application will be processed through Alliance's integrated underwriting system. You'll receive access to your iCOS dashboard, safety management tools, and claims reporting portal within 24-48 hours of policy approval.

Contact Information: Questions about your application or Alliance integration? Contact your dedicated Alliance representative at 1-800-ALLIANCE or through your iCOS platform messaging system.