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Workers Compensation :

Workers that are injured on the job are entitled to benefits as prescribed by state laws. These benefits may involve income, medical, rehabilitation, death and survivor payments. Workers Compensation Insurance covers payment of all workers compensation and other benefits that the employer must legally provide to covered employees who are occupationally disabled.

If you are a new or start up business, or are expanding your current business operation to include employees, it is important to know that by state law you will be required to have workers' compensation insurance coverage. Generally, workers' compensation insurance coverage is mandatory for all employers who have one or more employees, whether they're part-time or full-time, including family members. Coverage ensures medical and wage-loss benefits to employees who are injured during the course of their job. Employers who so provide coverage are protected against lawsuits filed by injured workers.

Maintaining a safe working environment will go a long way toward controlling the cost of this type of coverage, but a careless or accident-prone employee can raise your insurance rates out of the realm of affordability very quickly. Proper selection and training must be practiced to minimize this risk.

Protect your business. Obtain coverage. Please ensure you complete the quotation form below as accurately as possible to obtain workers compensation insurance that provides dependable insurance protection at an affordable cost for your businesses. If you would rather speak to one of our representatives, please Call (973) 836-0310 or e-mail: : business@horizoncoast.com to setup a confidential consultation.

Completion of this form is for informational purposes only, and is just an estimate and is not a statement of contract. Coverage may not apply in all states. This WILL NOT result in a new policy, or change to an existing policy. For complete details of coverage, conditions, limits and losses not covered, be sure to read the policy, including all endorsements
   General Information
Name of Business:
Contact Name:
Address:
City:
  State:   Zip:
Business Status:
   
Business Phone:
       Fax:
Contact Email Address:
   Current Insurance Information
Company Name (not agency) :
Policy Expiration Date:
Premium Amount: $
NCCI Number:
 
NCCI Experience Modification #:
 
 What type of coverages do you currently have:
Bond Commercial Umbrella Group Life
Commercial Auto Directors & Officers
      Liability
Professional Liability
Commercial Liability Disability Commercial Property
Group Health Other 
   About Your Business
# of full-time
employees
# of part-time
employees
How long
in business
How many
locations
Annual
sales
years $
Please give a brief description of your business (below):
   Employee Information.
Employee# Classification code Estimate Yearly Payroll
1
2
3
4
Please list additional employees in the "Additional Comments" section below
  Business Information
Please select all that apply to Business:
Operate or Lease aircrafts/watercrafts
Store, treat, dispose or transport
      hazardous waste
Work Underground
Work above 15ft.
Work on vessels, docks or bridges
      over water
Require out of State travel

Use Subcontractors
Delivery Service
Pre-employment Physicals
Offer Safety and Incentive
      programs
Other  

Please give any additional comments you feel appropriate for this quotation
 
 
     
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