Get a Quote
If you are a New York State business and you are paying too much for your workers' compensation insurance please take a few minutes and fill out this online quote form. In some circumstances a Self-Insured Trust administered by NYCM can provide over 20% savings. Simply complete and confidentially submit the following information to NYCM. You will be contacted to secure additional information or receive your quote shortly. (NYCM is currently accepting applications for the Automotive and Construction industry's)
Fields marked with an asterisk (*) are required.
 
Company Name:  
Nature of Business:
Years in Business:
Contact Name:  
Contact Title:
Address 1:  
Address 2:
City:  
State:
Zip:  
Phone:  
Fax:
E-mail:  
Current Broker:
 
Classification Breakdown:
  Class Codes Payroll
1    
2
3
4
5
 
Current workers' comp insurance carrier: If with the NYS Fund, are your enrolled in a Safety Group:
Policy expiration date: If Yes, what is the name of the Safety Group:
 
Current experience mod: What is the best time to reach you:
   
Corporate officers included in policy:
Additional Comments: