Guide to the ERM-6 Form— Workers Compensation Experience Rating for Self-Insureds
ERM-6 Form Key Definitions:
Risk Identification No.: A 9-digit number that NCCI assigns to each rated insured.
State of Coverage: The state for which the policy was written; this is not necessarily the state in which the insured is located.
Effective Date of Rating: This is the first day of the rating period for an experience rating modification. This date is based on the effective date of the most current policy that ran a full year. For example, if last year’s policy effective date was 4/4/03, then the effective date of the experience rating would be 4/4/04.
What Fits on a Rating
A total of three years of experience can be included on a rating. Do not include the year immediately prior to the effective date of the rating.
For example, payroll and losses that would fit on a 4/4/04 rating would be:
The 4/4/03–4/4/04 experience will not fit on an experience rating effective 4/4/04.
Please Keep the Following in Mind When Preparing an ERM-6 Form: It is extremely important that everything be completely filled out and accurate. If handwritten, please print clearly.
Payroll It is not possible to have losses without payroll. All payroll amounts must be submitted in whole dollars only (e.g., correct $1; incorrect $1.25). Each payroll amount must have the appropriate class code assigned to it.