How do I know which payroll to include?

Include wages that the insurer will use for premium calculation: taxable payroll for the proposed policy year and any payroll related to leased employees. Clarify subcontractor payments separately to avoid double counting.

Can the proposal be signed electronically?

Yes. Electronic signatures are generally enforceable under the ESIGN Act (15 U.S.C. §7001) and state UETA statutes; confirm any carrier-specific authentication or consumer disclosure requirements in regulated contexts.

What happens if payroll is understated?

Understatement discovered at audit leads to premium adjustments and possible penalties; accurate initial estimates and clear audit methodology reduce post-bind disputes.

Are loss runs mandatory with a proposal?

Most underwriters require loss runs for three to five prior years to calculate experience modification; omitting them will typically delay pricing or prompt provisional rates.

Do I need a notary for the signature?

Not typically required for standard proposals, but state or carrier rules may require notarization for certain attestations; check state-specific requirements before execution.

How should I correct an error after submission?

Issue a corrected proposal or written amendment, include revised attachments, and obtain an updated signature. Maintain version history to preserve auditability and avoid confusion during binding.

Electronic Signature
Templates
Insurance
Insurance Workers Comp Proposal

Insurance Workers Comp Proposal

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

Insurance Workers Comp Proposal

Applicant / Insured Information

Applicant Name Doing Business As (DBA) Mailing Address Location Address (if different)

Contact Person:

Title:

Phone:

Email:

Federal EIN / SSN:

Date of Birth:

Policy Proposal Summary

Proposed Policy Type: Workers' Compensation (Statutory Benefits) Employers Liability

Policy Period From:

To:

Employers Liability Limit:

Deductible (if any):

Proposed Annual Premium:

Payroll and Classification

Provide the estimated annual payroll by classification code. Premiums will be subject to audit and final premium adjustment.

Class 1 — Code: Description: Estimated Payroll: Rate: Est. Premium:

Class 2 — Code: Description: Estimated Payroll: Rate: Est. Premium:

Class 3 — Code: Description: Estimated Payroll: Rate: Est. Premium:

Class 4 — Code: Description: Estimated Payroll: Rate: Est. Premium:

Experience Modification & Loss History

Experience Modification Rate (EMR):

Recent Losses (most recent 3 years). Include date of loss, nature, amount paid, and status.

Loss 1 — Date: Description: Amount Paid: Outstanding:

Loss 2 — Date: Description: Amount Paid: Outstanding:

Loss 3 — Date: Description: Amount Paid: Outstanding:

Coverage Options & Endorsements

Select applicable optional coverages and endorsements:

Stop-Gap/Foreign Voluntary Compensation

Waiver of Subrogation

Employers' Non-Owned Auto (if related)

Hired Auto Liability Endorsement

Exclusions & Limitations

The proposed coverage is subject to standard policy exclusions, including but not limited to willful noncompliance with safety laws, punitive damages where excluded by law, and employment practices liability unless specifically endorsed. This proposal does not bind coverage; coverage is effective only upon issuance of a policy or binder by the insurer and receipt of any required premium.

Underwriting Requirements & Documentation Checklist

The following materials are required to complete underwriting and confirm final pricing. Check those already provided.

Loss runs for the prior 36 months

Most recent payroll tax returns / 941s

State workers' compensation filings (if applicable)

Current employee roster with job duties

Written safety program or loss-control plan

Additional Underwriting Notes

Premium Calculation & Payment Terms

Total Estimated Payroll:

Estimated Pure Premium: Loss Constant / Debits & Credits:

Expense Constant / Tax & Surcharges: Total Estimated Annual Premium:

Deposit / Minimum Premium Due at Binding: Audit Provisions: Premium subject to adjustment upon post-policy audit of payroll and classification.

Declarations, Authorizations & Conditions

The Applicant represents that all statements and answers contained in this proposal are true and complete to the best of the Applicant's knowledge and are offered as an inducement to the insurer to provide the proposed coverage.

The Applicant authorizes the insurer and its representatives to obtain and verify loss history, claims information, audits, and other underwriting-related information from prior insurers, claim administrators, and other sources. The Applicant acknowledges that final policy terms, premium and coverage are subject to underwriting review, receipt and acceptance by the insurer of required documentation, and a post-issuance audit.

The Applicant understands that the submission of this proposal and any payment of premium does not constitute binding coverage unless and until a policy or binder is issued by the insurer and any required premium is received. The insurer reserves the right to amend or withdraw this proposal based on further information obtained during underwriting.

Acknowledgement

I acknowledge that the statements in this proposal are accurate and that I have the authority to bind the Applicant to this certification.

Broker / Producer (if applicable)

Broker Name

Broker Contact:

Broker Phone:

Broker Comments / Notes

Signature and Certification

I certify that the information in this proposal is true, that I have read and understand the conditions and representations herein, and that I am authorized to sign on behalf of the Applicant. I understand that any intentional misstatement or omission of material fact may void coverage.

Applicant Name:

By (Signature):

Title:

Date:

What an Insurance Workers Comp Proposal Is and When It’s Used

An Insurance Workers Comp Proposal is a formal written offer from an insurer or broker that estimates premium, classification codes, payroll basis, experience modification application, coverage limits, and exclusions for workers' compensation coverage. It organizes payroll and classification inputs, proposed policy terms, and any underwriting conditions that affect pricing and eligibility. Employers use this document to compare offers, verify classification assignments, and provide supporting payroll data to underwriters. Accurate completion speeds underwriting, reduces audit exposure, and creates a clear record of the insurer’s proposed terms before a policy binder is issued.

Why a Clear Proposal Matters for Employers and Brokers

A complete, consistent proposal reduces underwriting delays, limits premium surprises at audit, and documents the insurer’s assumptions about payroll and classifications under ESIGN/UETA standards where electronic records are used.

Who Typically Prepares and Reviews These Proposals

These proposals are prepared and reviewed by insured organizations, brokers, payroll administrators, and underwriters to confirm wage bases, class codes, and coverage limits.

Employers and HR teams verifying payroll bases and classifications before submission to underwriters.
Insurance brokers assembling proposals, comparing carrier terms, and managing revisions across multiple insurers.
Underwriting departments confirming exposures, requesting clarifications, and issuing binders based on finalized proposals.

Clear roles and timely review reduce audit exposure and help match the right coverage and limits to the employer’s risk profile.

Core Sections to Include in a Professional Proposal

A well-structured proposal groups underwriting inputs, pricing, and policy terms so reviewers can confirm assumptions quickly and compare offers side-by-side.

Policy Summary

One-page overview of limits, policy period, deductibles, and premium type (annual/estimated) for quick comparison.

Payroll Basis

Detailed payroll by division or class, including pay period basis and whether subcontractors are included or excluded.

Classification Codes

List of NCCI or state class codes applied to each employee group with explanation for any nonstandard assignments.

Experience Mod

Current EMR/X-Mod calculation, prior loss runs referenced, and the effective dates used in the computation.

Exclusions & Endorsements

Any coverage exclusions, required endorsements, or special underwriting conditions that alter the base policy.

Audit & Payment Terms

Estimated audit methodology, reporting frequency, premium payment schedules, and audit adjustments procedure.

Step-by-Step: How to Prepare and Submit a Workers Comp Proposal

Complete the proposal in a logical sequence to avoid missing data and to make underwriting review efficient.

01

Assemble payroll: Gather current payroll and subcontractor records by class.
02

Attach loss runs: Include loss runs for the recommended prior three to five years.
03

Draft proposal: Populate proposal fields and summarize key terms on the first page.
04

Submit to insurer: Send proposal and attachments to the underwriter for review and bind request.

How to Configure an Efficient Digital Review Workflow

Standardize field requirements and authentication to streamline underwriting and broker review cycles.

Field	Configuration
Authentication	Email or SMS code; stronger KBA for sensitive submissions.
Conditional Fields	Show payroll detail fields only if employer selects 'multiple classifications'.
Template Name	Use consistent naming convention: Carrier_Proposal_YYYYMM.
Bulk Send	Enable for multi-location clients to distribute identical proposals.

Typical Electronic Proposal Workflow from Draft to Binder

This high-level flow shows typical steps for e-submission, review, signature, and archiving.

Prepare Proposal: Populate fields and attach payroll and loss runs.
Send to Underwriter: Deliver via secure e-mail or eSignature platform with audit trail.
Underwrite & Revise: Underwriter reviews, requests clarifications, and updates terms.
Sign & Archive: Authorized signer signs electronically and signed copy is retained.

Comparing Electronic Proposal vs Paper Proposal

Key functional differences affect speed, auditability, and ease of sharing between electronic and paper proposals.

Criteria	Electronic Proposal	Paper Proposal
Delivery	instant	in-person or mail
Audit Trail	automated	manual
Revision	version-controlled	prone to multiple copies
Storage	searchable digital	physical filing required

eSignature Vendor Pricing Overview for Proposal Workflows

Compare common vendor price points and key capabilities for eSignature and document workflows used to complete Workers Comp proposals.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day trial	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Security and Compliance Controls to Look For

Encryption: TLS 1.2/1.3 in transit; AES-256 at rest

Audit Trail: Comprehensive timestamp and IP logs

HIPAA Support: BAA available for PHI workflows

Certifications: SOC 2 Type II, ISO 27001

Legal Compliance: ESIGN and UETA adherence

Access Controls: Role-based permissions and SSO

Penalties and Material Risks from Inaccurate Proposals

Misclassification: Premium audit adjustments

Late Submission: Underwriting delays or surcharge

Missing Signatures: Proposal treated as non-binding

Incorrect Payroll: Audit liabilities and back charges

No Notarization: State-specific invalidation risk

Data Breach: HIPAA or state privacy fines

Common Preparation Pitfalls to Avoid

Submitting estimated payroll that includes future hires can inflate premium estimates and lead to audit disputes at renewal.
Using inconsistent classification codes across forms causes underwriters to request clarifications and delays binding decisions.
Failing to attach complete loss runs forces the underwriter to estimate loss ratios, which can raise initial pricing.
Relying on scanned handwritten totals increases data-entry errors and lengthens the review cycle during underwriting.

Who Has Authority to Sign a Proposal

Authorized Officer — CFO

A chief financial officer or comparable officer may sign on behalf of a corporate employer when corporate bylaws delegate contracting authority; include job title and capacity to bind the company in the signature block.

Authorized Manager — HR Director

Human resources or payroll directors can sign employer attestations if the company’s documented delegation allows it; attach a written authorization if not customary.

Frequently Asked Questions About Completing an Insurance Workers Comp Proposal

Practical answers to common questions encountered when preparing or submitting workers' compensation proposals.

Need help? Contact support

How do I know which payroll to include?
Include wages that the insurer will use for premium calculation: taxable payroll for the proposed policy year and any payroll related to leased employees. Clarify subcontractor payments separately to avoid double counting.
Can the proposal be signed electronically?
Yes. Electronic signatures are generally enforceable under the ESIGN Act (15 U.S.C. §7001) and state UETA statutes; confirm any carrier-specific authentication or consumer disclosure requirements in regulated contexts.
What happens if payroll is understated?
Understatement discovered at audit leads to premium adjustments and possible penalties; accurate initial estimates and clear audit methodology reduce post-bind disputes.
Are loss runs mandatory with a proposal?
Most underwriters require loss runs for three to five prior years to calculate experience modification; omitting them will typically delay pricing or prompt provisional rates.
Do I need a notary for the signature?
Not typically required for standard proposals, but state or carrier rules may require notarization for certain attestations; check state-specific requirements before execution.
How should I correct an error after submission?
Issue a corrected proposal or written amendment, include revised attachments, and obtain an updated signature. Maintain version history to preserve auditability and avoid confusion during binding.

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