Societies Insurance

Assigned Risk / State Pool Quote Request

Applicant Information:

Business Structure (Optional - choose one)

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Coverage details

What Assigned Risk / State Pool coverage includes

When no carrier will write your workers comp voluntarily, the state assigned risk pool is the coverage of last resort.

Good to know: pools usually require proof that one or more carriers declined you – and many businesses qualify for a voluntary carrier sooner than they think, so we check both.

Not covered: the pool will not cover uncollected premium from prior policies; most pools require all past premium paid before binding.

Insurance Application:

Assigned Risk / State Pool

Required forms

Assigned Risk / State Pool Supplemental Application (PDF)

Download, complete and email to info@societiesinsurance.com, or attach it with your quote request.

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