Workers’ Compensation Quote

Workers’ Compensation Quick Quote (PA)

Independent agency in Harrisburg since 1987. Short form — we pull class codes and prior-policy details from the PA rating bureau so you don’t have to.

We shop multiple carriers to help find a competitive rate
Quotes back via email within 24 – 48 hours
Pennsylvania coverage only

Start Quick Quote Call 717-657-9944 Text Us

Looker, Wolfe & Gephart • 44 Oak Park Rd, Harrisburg, PA 17109 • We don’t sell your info

Request your workers’ compensation quote

Business basics, employee counts, payroll estimate, and a quick yes/no on recent claims. No class codes or policy numbers needed.

This field is for validation purposes and should be left unchanged.

Contact name(Required)

First Last

Email(Required)

Phone(Required)

Business name(Required)

DBA (if any)

Business address(Required)

Street Address Address Line 2 City State ZIP Code

Coverage available only in PA

Do you have other business locations?(Required)

Yes

How many other locations?(Required)

Please enter a number from 1 to 5.

If you have more than 5, note them in Comments.

Location 2 address(Required)

Street Address Address Line 2 City State ZIP Code

Coverage available only in PA

Location 3 address(Required)

Street Address Address Line 2 City State ZIP Code

Coverage available only in PA

Location 4 address(Required)

Street Address Address Line 2 City State ZIP Code

Coverage available only in PA

Location 5 address(Required)

Street Address Address Line 2 City State ZIP Code

Coverage available only in PA

Location 6 address(Required)

Street Address Address Line 2 City State ZIP Code

Coverage available only in PA

FEIN / Tax ID(Required)

Helps us pull your PA rating bureau history faster.

Website

Entity type(Required)

Date business began(Required)

Month

Day

Year

Any additional entities or recent ownership changes?(Required)

Yes

Tell us about those entities or ownership changes(Required)

An ERM-14 may be needed.

Any bankruptcy, liquidation, or termination proceedings?(Required)

Yes

Do any owners, partners, or LLC members want to elect workers’ compensation coverage?(Required)

Yes

They are excluded by default in PA unless they elect in.

List who wants to elect coverage (name, title, % ownership, duties)(Required)

No SSN needed here — we’ll confirm later.

Any executive officers to exclude from coverage?(Required)

Yes

Officers are covered by default in PA; exclusion needs LIBC-509/513 and qualifying ownership.

List officers to exclude (name, title, % ownership, duties)(Required)

What does your business do?(Required)

A few sentences is fine. We look up class codes for you.

Any hazardous operations?(Required)

Yes

Which hazardous operations?(Required)

e.g. heights, excavation, driving, construction, manufacturing.

Do you use subcontractors, owner-operators, or independent contractors?(Required)

Yes

Will you provide current COIs showing PA WC coverage?(Required)

Yes

Any temporary workers, PEO/leased employees, or domestic workers?(Required)

Yes

Any work outside Pennsylvania or under federal acts (e.g., USL&H)?(Required)

Yes

# of Full-time Employees(Required)

# of Part-time / Seasonal Employees(Required)

Estimated annual payroll(Required)

Exclude owners you plan to exclude from coverage, if known. Estimates are fine.

Desired effective date(Required)

Employers’ Liability limits(Required)

Any workers’ compensation claims or losses in the last 3 years?(Required)

Yes

Tell us what you know about those losses(Required)

Date, what happened, and amount paid if you know it. Exact details can wait until we talk.

Any prior WC cancellations, non-renewals, or lapses?(Required)

Yes

May we text you about your quote?(Required)

Yes, you may text me about my quote

No, please don’t text me

Consent is not a condition of receiving a quote. Message and data rates may apply. Reply STOP to opt out.

Comments (optional)

Prefer to talk? Call or text 717-657-9944 • agents@lwginsurance.com • Mon–Fri 8–5 • 44 Oak Park Rd, Harrisburg, PA 17109

Would You Like Us To Review Your Policies?

1Products

2Contact Info

3Location

4Documents

5Final Comments

Hello! What would you like a quote for?*
- Auto
- Home / Condo / Renters
- Business Owners Package
- Umbrella
- Rental Property
- Motorcycle
- Boat
- E-Bike (Electric Bicycle)
- Life
Check all that apply. You can tell us if there is something else you need a quote for in just a moment.

Primary Policyholder Name*
First Last
Phone*
Email*

Insured Location Address*
Street Address Address Line 2 City State ZIP Code

This is not required, but if readily available, please upload your most current insurance policy coverage declarations pages in PDF format so we can see the exact coverage limits you'd like us to compare. These can be easily downloaded from your online profile with your current provider (if you have a login), or from your current agent.
Drop files here or

Max. file size: 98 MB.

What led you to request this quote?*
- Internet Search
- Facebook Search/Page
- Referral
Who referred you to us?*
If you have any other questions, comments or requests, please leave them here

Request Your Proposal Here

Are you ready to save time, aggravation, and money? The team at Looker Wolfe & Gephart Insurance Agency Inc. is here and ready to make the process as painless as possible. We look forward to meeting you!

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