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Experience Rating Form

A Workers Compensation Term Defined, Described and Explained

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Experience Rating Form

A form produced annually that will indicate an employers premium, loss experience and experience modification factor.


These forms are typically known as Experience Modification Rate Worksheets. These forms will show all data used to develop the resulting Experience Mod Rate for an individual employer for a specific effective date. EMR worksheets are produced about 3 months prior to the employers anniversary rating date and provided to the employer by the rating bureau or advisory organization responsible for producing the EMR or Experience Modification Rate. They are a wealth of information.

Upon examination of the worksheet you will see audited classification codes and audited payroll for each code. You will see calculated expected primary and excess losses along with actual incurred, actual primary and excess losses. And you will see the actual calculation used in development of the resulting Experience Rate for that specific employer.

Worksheets are typically supplied directly to the employer in question by the rating bureau. If an employer has not received their worksheet they should make a request to their rating bureau and keep a copy of each form for each year.

These worksheets are complicated and when an employer finds a mistake or believes there is a mistake or error in the calculation of their EMR they should seek out the help of an independent work comp consultant!





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