Pool Payroll Report

The Pool Payroll Report assists the Pool servicing insurance carriers in accurately tracking estimated policy payroll exposures for businesses which may inherently be subject to fluctuations in wages.

If incomplete or insufficient information is provided, WCRB will use the contact information provided to obtain additional information.

• All of the contact information is required, with the exception of the Title and Telephone Ext.
• Policy number should be entered without any special characters (i.e. dashes) or spaces.
• Complete the contact information, then click the "Create Payroll Report" button.
• Enter the Class Code/Payroll Information, then click the "Validate and Submit Class Code/Payroll Information" button.
• If you have any questions regarding this process, please contact WCRB at 262-796-4586.

Contact Information

NAME		TITLE
TELEPHONE	() -	TELEPHONE EXT
EMAIL		VERIFY EMAIL
EMPLOYER NAME		EMPLOYER ADDRESS
EMPLOYER CITY		EMPLOYER STATE	Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
		EMPLOYER ZIP
INSURANCE CARRIER	MIDDLESEX INSURANCE COMPANY EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS INSURANCE COMPANY OF WAUSAU SOCIETY INSURANCE A MUTUAL CO WEST BEND MUTUAL INSURANCE CO SFM MUTUAL INSURANCE COMPANY
POLICY NUMBER		POLICY EFFECTIVE DATE
COVERAGE ID
REPORTING PERIOD START		REPORTING PERIOD END