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Policyholder Experience Rating Worksheet Request

An experience rating worksheet, or ratesheet, provides a merit rating percentage known as an experience modification, or X-Mod, to qualified policyholders. The rating percentage is calculated based upon the policyholder's audited payroll and losses for three consecutive policy periods, as reported to the WCIRB by the policyholder's insurance company.

A policyholder may use the request form at the following link to request a free copy of its ratesheet be delivered via email or postal mail. Only policyholders may use this form.

The WCIRB is only permitted to release confidential experience rating information to 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.