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Policyholder Experience Rating Worksheet Request

An experience rating worksheet, also known as a ratesheet, provides a merit rating (which is known as an experience modification, or X-Mod) to qualified policyholders utilizing a policyholder's payroll and loss experience by classification and policy year during a set period. This data is reported to the WCIRB by the policyholder's insurance company and is used by the WCIRB to administer the California experience rating system. A policyholder may use the request form at the following link to request a free copy of its ratesheet. Only policyholders may use this form.

The WCIRB is permitted to release confidential experience rating information only to the policyholder, the policyholder's insurer, agent or broker of record or a third party who has been specifically authorized by the policyholder. 

Insurers, agents and brokers may obtain ratesheets in the following ways: 

The regulations governing the experience rating system are in the California Workers' Compensation Experience Rating Plan—1995. Additional information about experience rating is available in the Learning Center.