Submission Information

The structure of a captive program is based largely on the historical information of the employer. The availability and quality of data is critical. The more accurate and detailed the submission, the more successful the captive formation process.

At the minimum, any submission should include:

  • Company Profile
  • Description of Products and Operations
  • Accord Application
  • Five Years of the Following Data:
    • incurred losses
    • paid losses
    • details on all losses over $25,000
    • exposure by class and state
    • claim count broken out by indemnity and medical only
  • Financial Statements

Submissions can be mailed, faxed or uploaded in our secure client login area.

Download a summary form to expedite the submission process.