ACORD 133 is the Workers Compensation Insurance Plan Assigned Risk Section. It supplies plan-specific information when an eligible employer seeks workers compensation through an assigned-risk market. NCCI's current state instructions direct users to complete ACORD 133 with the ACORD 130 Workers Compensation Application.[1] It does not provide coverage by itself.
When is ACORD 133 used?
Assigned-risk plans provide a route for eligible employers that cannot obtain required workers compensation coverage in the voluntary market. ACORD 133 records information the plan administrator needs in addition to the standard ACORD 130 application. The ACORD Forms Index identifies the countrywide form as the Workers Compensation Insurance Plan Assigned Risk Section.[3]
What information needs special attention?
A publicly archived earlier specimen illustrates fields for the applicant and requested effective date, ownership or related entities, voluntary-market offers or refusals, and additional trucking questions when applicable.[2] Use the current edition and state instructions, and reconcile the legal name, payroll, class, location, and ownership information with ACORD 130 and supporting records.
Why do state instructions matter?
Workers compensation plans operate under state rules. A state may use the countrywide section, a state-specific ACORD 133, or a different application. The plan administrator can require special evidence, signatures, premium handling, or effective-date steps. An old copy from another state is not a safe substitute.
Does submitting ACORD 133 bind coverage?
No. The application must be complete, eligible, and accepted under the applicable plan. The assigned carrier or plan administrator confirms the effective date. Employers should maintain existing coverage until replacement coverage is confirmed so a paperwork delay does not create an uninsured gap.
Frequently asked questions
Can ACORD 133 be submitted without ACORD 130?
The countrywide assigned-risk section is designed to accompany the completed ACORD 130. State-specific instructions may require additional documents as well.
Is ACORD 133 the same in every state?
No. State-specific versions and separate plan applications exist. Verify the state suffix, edition, and plan instructions before completing the package.
The Bottom Line
ACORD 133 is the assigned-risk supplement to a workers compensation application. Use the correct state process, reconcile it with ACORD 130, and rely on the carrier's confirmation for coverage.
This guide is educational and describes ACORD 133 in original language. Menlo Insurance Services is not affiliated with ACORD Corporation or NCCI. The applicable plan and insurer documents control.
References
- 1.National Council on Compensation Insurance. “Workers Compensation Insurance Plan State Instructions.” Accessed September 5, 2026. https://www.ncci.com/Articles/Documents/RM_State_Instructions_AK.pdf ↩
- 2.ACORD form archive. “Earlier ACORD 133 Workers Compensation Insurance Plan Assigned Risk Section specimen.” Accessed September 5, 2026. https://www2.imms.com/members/3rdParty/ACORDpdf/133.pdf ↩
- 3.ACORD. “ACORD Forms Index, revision 5/08/2024.” Accessed September 5, 2026. https://acords.com/pdf/ACORD_Forms_Index.pdf ↩