Policyholders

Monthly Self-Reporting

Keeping us informed about your payroll is a quick and easy part of being a Builders Mutual policyholder.


Have questions about our Online Monthly Self-Reporting? 

View our Frequently Asked Questions list to find the answers.

Manual Calculation

If you prefer to calculate manually, follow these step by step instructions to complete your Workers’ Compensation Monthly Self-Reporting Worksheet:

  1. If you had no payroll for the Payroll Range and Site indicated, check the box labeled “Check if NO PAYROLL.”
  2. If you did have payroll, complete steps 3 through 14.
  3. Enter the payroll for each class code into column 3.
  4. Take the payroll amount and multiply it by the rate, enter the result in column 5.
  5. Add the premium in column 5 and enter the result in box 6.
  6. Multiply box 6 by the Increased Limits (if any) and enter the result in box 7.
  7. Multiply box 6 by the Deductible Credit (if any) and enter the result in box 8.
  8. Add boxes 6 & 7, subtract box 8 and enter the result in Subtotal box 9.
  9. Multiply box 9 by the Discount Factor Before Modifier in box 10 and enter the result in Subtotal box 11.
  10. Multiply box 11 by the Experience Modifier in box 12, enter the result in box 13.
  11. Multiply box 13 by the Discount Factor After Modifier in box 14, enter the result in Total Premium Due box 15.
  12. Add total payroll entered in column 3, multiply by the Terrorism & Catastrophe rates in box 16 & 17, enter results.
  13. Add boxes 15, 16, & 17 enter the results in box 18 Total Premium Due.
  14. Multiply box 18 by the Surcharge (skip if not DC) and enter the results in box 19.
  15. Add boxes 18, 19, & 20, and enter the results in box 21.

Once your manual calculation is complete, submit payment to Builders Mutual Insurance Company by:

  • Email to msrform@bmico.com
  • Fax to 919-227-0305
  • Mail to BMIC, PO BOX 900017, Raleigh, NC 27675-0017

800-809-4859 Call us for more information