Assigned Risk Reinsurance Pool
Annual Premium Call
Section 4.03 of the Articles of
Administration for the Indiana Assigned Risk Reinsurance Pool (“Indiana Pool”) provides
that each Member shall report to the Plan Administrator, in the form and manner
prescribed by the Plan Administrator, the Net Premiums Written by such Member
during each calendar year. Form IN-10 is used for this purpose and must be
filed even if no workers compensation premium was written in
The Take-Out Credit Program continues in effect for the new Indiana Pool. To receive credits you must be enrolled with NCCI. See additional instructions below.
Form IN-3 should be submitted if your contact information has changed.
The necessary forms and
instructions are provided below. To complete
a form, right-click on the appropriate link and download that form. Select
“Save Target As” and when a “Save As” window pops up, click on “Save”. After the “Download Complete” window pops up,
click on “Open”, enter the required information on the form and save the file. Submit the form to the ICRB (c/o
If you have any questions, please call 601-977-9456.
Forms
Member
Company Contact Form IN-3
Instructions