STATE FORMS
REFERENCE

Issuing body

Alabama Department of Labor, Workers’ Compensation Division

Filing method

No current state owner-exclusion filing; qualifying status is handled by statute and the insurance policy.

Fee

No separate filing fee verified

Note

Alabama DOL states that it no longer accepts the former WC-14/WC-15 corporate-officer inclusion/exclusion forms.

Effective

No current state filing date applies to the statutory owner treatment; policy elections take effect under the policy/endorsement.

Renewal

No state-form renewal cycle; review after ownership, entity, employee, or policy changes.

Issuing body

Alaska Department of Labor and Workforce Development, Workers’ Compensation Division

Filing method

No current state owner-waiver filing; qualifying owners are excluded by statute and may be specifically included through the policy.

Fee

No separate filing fee verified

Note

The former executive-officer waiver program was repealed effective August 1, 2019.

Effective

Statutory exclusion applies without an owner-exemption certificate; elective inclusion is tied to the policy period.

Renewal

No state-form renewal cycle; elective inclusion follows the policy period.

Issuing body

Industrial Commission of Arizona / workers’ compensation carrier

Filing method

No universal owner-exemption certificate; owner treatment follows statute, with inclusion/exclusion handled through carrier endorsement where applicable.

Fee

No separate filing fee verified

Note

The sole-proprietor/independent-contractor statement is a relationship/classification document, not a universal owner exemption.

Effective

Carrier endorsement controls any elective personal coverage; statutory exclusions do not wait for an exemption certificate.

Renewal

Tied to the policy/endorsement and ownership status; no universal state-form renewal interval.

Application for Certificate of Non-Coverage

Issuing body

Arkansas Workers’ Compensation Commission

Filing method

Submit the notarized application/affidavit package to AWCC; current materials also provide online payment options.

Fee

$50

Note

The certificate is personal to qualifying applicants and does not excuse coverage for hired employees. Current AWCC materials say applications are generally processed within 10 working days.

Effective

On AWCC issuance/approval of the Certificate of Non-Coverage.

Renewal

No universal duration was located on the current application page; use the expiration shown on the issued certificate and refile as required.

Exemption from Workers’ Compensation (CSLB license record)

Issuing body

California Contractors State License Board

Filing method

Online CSLB exemption service or file the CSLB exemption form with the license/application record.

Fee

No separate filing fee verified

Note

This is the contractor-license no-employee exemption, not the separate Labor Code §3352 carrier waiver for qualifying corporate/LLC owners. Some contractor classifications cannot use the ordinary no-employee CSLB exemption.

Effective

When CSLB accepts and records the exemption for the license/application.

Renewal

No fixed annual renewal interval; the exemption ceases to fit when the licensee hires employees or no longer meets CSLB eligibility.

Notice of Election to Reject Workers’ Compensation Coverage

Issuing body

Colorado Division of Workers’ Compensation / workers’ compensation insurer

Filing method

Written notice on a Division-approved form or substantial equivalent to the insurer; if there is no insurer, file with the Division.

Fee

No separate filing fee verified

Note

The owner rejection is personal and does not remove the company’s duty to cover employees. Current 2026 law changed permitted service mechanics; do not rely on older certified-mail-only instructions.

Effective

Day following receipt by the insurer or Division.

Renewal

Continues while the corporation/LLC policy is in effect or until the owner/member revokes the rejection in writing.

Coverage Election by Employee Who Is an Officer of a Corporation or a Manager of an LLC

Issuing body

Connecticut Workers’ Compensation Commission

Filing method

Electronic Form 6B, GovQA, or mail to the Office of the Chairperson; Form 6B-1 and Form 75 cover other owner types.

Fee

No separate filing fee verified

Note

WCC accepts the form for filing purposes; the filer remains responsible for eligibility and accuracy. Keep the electronic confirmation or date-stamped copy.

Effective

On Commission filing/date stamp of the election for the covered category.

Renewal

No fixed annual renewal; use the same election form to revoke the prior exclusion, and refile when the election facts change.

Workers’ Compensation Coverage Election Record (recommended Form C)

Issuing body

Delaware Department of Insurance / workers’ compensation carrier

Filing method

Written notice and policy endorsement through the carrier; Delaware Form C is a recommended record of the election.

Fee

No separate filing fee verified

Note

Form C is not a state-issued exemption certificate. Contractor-specific exclusions and proof-retention rules are stricter than the ordinary owner election framework.

Effective

After the insurer or its agent receives the written request, with the election implemented through the applicable policy inception/renewal endorsement mechanics.

Renewal

No annual state refiling; the election stays in the policy record until changed at a permitted policy inception or renewal.

Issuing body

District of Columbia Department of Employment Services, Office of Workers’ Compensation

Filing method

No universal owner-exemption filing is published for the sole-proprietor path; D.C. DOES states sole proprietors are not covered while employers with one or more employees must obtain coverage for employees.

Fee

No separate filing fee verified

Note

D.C. does not use a general owner-exemption certificate comparable to Florida or Tennessee for the sole-proprietor rule. Construction-permit proof requirements remain separate, and LLC/corporate-officer treatment must be checked against the Act and current DOES guidance.

Effective

No exemption filing date applies to the sole-proprietor exclusion described by DOES; ordinary employer coverage duties begin when covered employees are present.

Renewal

No owner-exemption renewal cycle for the sole-proprietor exclusion; re-check the Act/DOES after entity, ownership, employee, or permit-status changes.

Notice of Election to Be Exempt

Issuing body

Florida Department of Financial Services, Division of Workers’ Compensation

Filing method

Online DWC Notice of Election to Be Exempt system.

Fee

$50 (construction); $0 (non-construction)

Note

Exemptions are issued to individual qualifying corporate officers/LLC members, not to the business. Construction and non-construction eligibility limits differ.

Effective

When issued by the Division or 30 days after receipt, whichever occurs first, subject to the statute’s special early-policy rule.

Renewal

2 years; renewal application is required. Florida sends an expiration notice at least 60 days before expiration.

Notice of Election or Rejection of Workers’ Compensation Coverage

Issuing body

Georgia State Board of Workers’ Compensation

Filing method

File with the current insurer; when no insurer applies in the stated owner-only scenario, file with the Board.

Fee

No separate filing fee verified

Note

Corporate officers/LLC members still count toward Georgia’s employee threshold even when they reject personal coverage. The form is not a waiver of the employer’s coverage duty.

Effective

Effective on filing with the insurer, or with the Board when the no-insurer filing route applies.

Renewal

No fixed annual renewal; remains until revoked/superseded by a later WC-10 or relevant policy/status change.

Issuing body

Hawaii Department of Labor and Industrial Relations, Disability Compensation Division

Filing method

No universal owner-exemption certificate identified; qualifying owner status is handled through statutory employee exclusions and elective coverage rules.

Fee

No separate filing fee verified

Note

Hawaii generally requires coverage when there is one or more employee; owner exclusions are entity/ownership-specific rather than a blanket form.

Effective

No owner-specific filing effective date identified.

Renewal

No owner-specific state-form renewal cycle.

Election of Coverage

Issuing body

Idaho Industrial Commission / workers’ compensation carrier

Filing method

Written declaration through the insurance company and employer; carriers report the election or revocation using IC-52 or substantially similar format.

Fee

No separate filing fee verified

Note

IC-52 elects coverage for otherwise exempt owners and other exempt categories. Idaho does not recognize a general owner waiver allowing required employee coverage to be avoided.

Effective

Effective date stated in the election/coverage filing and policy record.

Renewal

Continues according to the election/policy until revoked using IC-52 or equivalent carrier reporting.

Issuing body

Illinois Workers’ Compensation Commission / workers’ compensation carrier

Filing method

No IWCC owner opt-out form. Qualifying owner/officer opt-out is handled by written notice to the carrier.

Fee

No separate filing fee verified

Note

The personal opt-out is separate from the employer’s duty to insure employees; construction and extra-hazardous work require separate analysis.

Effective

For qualifying corporate officers, effective on carrier receipt of the withdrawal notice.

Renewal

No state-form renewal cycle; tied to the written carrier election and policy/status changes.

Worker’s Compensation Clearance Certificate Application

Issuing body

Worker’s Compensation Board of Indiana

Filing method

Submit the current WCE-1 clearance application with required payment through the filing method stated on the current Board form.

Fee

$20

Note

The certificate is not valid without the Board stamp. It is a clearance mechanism for listed independent contractors/sole proprietors/partners/LLC members or managers and does not replace coverage for employees.

Effective

When stamped/approved by the Worker’s Compensation Board.

Renewal

1 year; annual reapplication is required.

Nonelection of Workers’ Compensation or Employers’ Liability Coverage

Issuing body

Iowa Department of Inspections, Appeals, and Licensing, Workers’ Compensation Division

Filing method

If no policy exists, use DIAL’s online nonelection filing with two disinterested witnesses; if a policy exists, attach the nonelection to the policy rather than file it with WCD.

Fee

No separate filing fee verified

Note

Available to proprietors, LLCs, LLPs, and partnerships. Corporate officers use the separate rejection process. Nonelection cannot be required as a condition of employment.

Effective

When the written nonelection is attached to the policy, or when the no-policy online filing is completed with WCD; corporate officers use the separate rejection process.

Renewal

No periodic renewal. The nonelection/rejection continues until terminated; a nonelection termination does not affect an injury or disease occurring within one week after the termination notice is filed.

Workers’ Compensation Election (OSCAR filing)

Issuing body

Kansas Department of Labor, Division of Workers Compensation

Filing method

Electronic election through KDOL’s OSCAR system.

Fee

No separate filing fee verified

Note

Kansas allows qualifying non-covered employers/owners and 10%+ corporate owner-employees to make coverage elections; the employer’s underlying subjectivity/payroll rules remain separate.

Effective

KDOL requires the election to be submitted electronically through OSCAR; the public overview does not publish one universal effective-date formula for every election type.

Renewal

No universal annual renewal interval is published for every OSCAR election type; update or terminate the election under the applicable filing/policy procedure when the coverage choice changes.

Employee’s Notice of Rejection of Workers’ Compensation Act

Issuing body

Kentucky Department of Workers’ Claims

Filing method

Original notarized Form 4 is given to the employer and filed with the Department of Workers’ Claims; copies/fax do not satisfy the regulation.

Fee

No separate filing fee verified

Note

Corporate officers are employees and may reject personal coverage with Form 4. Owner-only partnership/LLC treatment follows separate statutory rules.

Effective

When the Department receives the fully completed original Form 4.

Renewal

No annual renewal; remains until withdrawn using Form 5 or superseded by a valid later election.

Issuing body

Louisiana Workforce Commission / workers’ compensation insurer or group fund

Filing method

No Louisiana state exemption certificate. Qualifying owners use written non-election with the insurer/group fund under state law.

Fee

No separate filing fee verified

Note

Louisiana expressly does not issue a state exemption certificate; the written carrier/fund record is the relevant personal non-election evidence.

Effective

As provided by the written insurer/group-fund non-election and policy record.

Renewal

Tied to the written non-election/policy until revoked or status changes; no state certificate renewal cycle.

Application for Waiver

Issuing body

Maine Workers’ Compensation Board

Filing method

Submit Form WCB-2C to the Workers’ Compensation Board for approval.

Fee

No separate filing fee verified

Note

Owners of sole proprietorships, partnerships and LLCs generally do not need a waiver for themselves; WCB-2C is important for qualifying corporate owners and certain relatives.

Effective

Not valid until approved by the Board.

Renewal

Until revoked/rescinded; the form allows revocation on 30 days’ written notice to the Board and employer.

Exclusion Form

Issuing body

Maryland Workers’ Compensation Commission

Filing method

Use CompHub/current Commission filing workflow for §9-206 exclusions; retain/provide the IC-16 election record as directed, including insurer copy when applicable.

Fee

No separate filing fee verified

Note

Qualifying compensated officers/LLC members begin as covered employees and may elect exclusion under specific ownership/category rules. Sole proprietors/partners use different elective-in rules.

Effective

On acceptance/recording of the §9-206 exclusion filing under the Commission workflow.

Renewal

No fixed universal renewal interval identified; refile/review when ownership, entity, officer/member status, or policy facts change.

Affidavit of Exemption for Certain Corporate Officers or Directors

Issuing body

Massachusetts Department of Industrial Accidents

Filing method

Submit by mail, in person, fax, or email to DIA Office of Investigations — Form 153.

Fee

No separate filing fee verified

Note

Available only to qualifying corporate officers/directors owning at least 25%; it does not exempt non-officer employees.

Effective

After DIA approval of the exemption request.

Renewal

Annual carrier confirmation before policy renewal; a new Form 153 is required after specified ownership/officer status changes.

Notice of Exclusion

Issuing body

Michigan Workers’ Disability Compensation Agency

Filing method

File the current WC-337 with the Agency under its owner-only exclusion process.

Fee

No separate filing fee verified

Note

WC-337 is not a generic owner certificate and is not valid unless stamped on file by the Agency. Businesses with employees generally handle qualifying owner exclusions through the policy instead.

Effective

When stamped/filed by the Michigan Workers’ Disability Compensation Agency.

Renewal

No fixed interval stated on the current WC-337 landing page; refile when the exclusion facts or Agency requirements change.

Issuing body

Minnesota Department of Labor and Industry / workers’ compensation insurer

Filing method

No universal owner-exemption certificate; common owner exclusions arise from statute/entity/ownership conditions, with elective coverage handled through the insurer.

Fee

No separate filing fee verified

Note

Certain relative-election forms exist, but they are not a general owner exemption form. Construction has separate 2026 zero-estimated-exposure/wrap-up rules.

Effective

Statutory exclusion does not wait for a general owner filing; elective coverage follows the policy/endorsement.

Renewal

No universal owner-form renewal cycle; policy elections follow the policy and status changes.

Issuing body

Mississippi Workers’ Compensation Commission

Filing method

No current universal MWCC owner-exemption form identified; owner treatment is statutory/entity-specific and voluntary coverage agreements are handled separately.

Fee

No separate filing fee verified

Note

Current official MWCC material does not support inventing a form number, fee, or annual owner-exemption renewal cycle.

Effective

No owner-specific state filing effective rule identified.

Renewal

No owner-specific state-form renewal cycle identified.

Notice of Election to Withdraw (qualifying two-owner corporation)

Issuing body

Missouri Division of Workers’ Compensation

Filing method

File the corporation’s notice of election to withdraw with the Division; current DWC guidance directs applicants to the Division for the required paperwork.

Fee

No separate filing fee verified

Note

This corporate path is limited to a corporation with no more than two owners who are also its only employees. LLC-member rejection is instead a written policy/insurer form.

Effective

The qualifying corporation’s election takes effect from the date the notice is filed with the Division.

Renewal

Continues until the corporation withdraws the election; withdrawal is effective 30 days after filing or a later stated date.

Independent Contractor Exemption Certificate Application

Issuing body

Montana Department of Labor & Industry

Filing method

Apply online through the Montana contractor portal or submit the current ICEC application and supporting business documentation.

Fee

$125 (non-refundable)

Note

ICEC is an independent-contractor status certificate, not a blanket owner waiver for a business or its employees.

Effective

On DLI approval/issuance of the ICEC.

Renewal

2 years; renewal is required to keep the ICEC current.

Issuing body

Nebraska workers’ compensation insurer / employer

Filing method

No universal owner-exemption certificate. Qualifying executive officers are outside coverage by default at the statutory ownership threshold; exempt owners may elect coverage in writing through the corporation/insurer.

Fee

No separate filing fee verified

Note

For the statutory owner election, the written notice is filed with the corporation/insurer rather than a state exemption registry.

Effective

Elective owner coverage becomes effective on insurer receipt of the written election.

Renewal

Continues for the current and subsequent policies issued by that insurer until written termination or the insurer ceases coverage.

Election of Coverage by Employer — Sole Proprietor Coverage

Issuing body

Nevada Department of Business and Industry, Division of Industrial Relations / insurer

Filing method

Submit the applicable Nevada election/rejection form through the insurer and state reporting process; D-45 is the sole-proprietor elective-coverage form.

Fee

No separate filing fee verified

Note

D-45 elects personal coverage; it is not an exemption certificate. Corporate officers/LLC managers use the separate statutory rejection framework and related D-43/D-44 forms.

Effective

Effective date stated on the election/rejection and policy filing.

Renewal

Continues until the election/rejection is withdrawn, rescinded by changed pay/status, or superseded by a later filing.

Exclusion of Executive Officers or Members

Issuing body

New Hampshire Department of Labor / workers’ compensation carrier

Filing method

The carrier files Form 6WCex; an underlying Notice of Workers Compensation Insurance Coverage (6WC) for the same employer must already be on file.

Fee

No separate filing fee verified

Note

If 6WCex is not on file, the listed executive officers/members are not excluded. A carrier change requires a new 6WCex.

Effective

On proper filing with the Department under Lab 306; the filed form in effect controls the exclusion.

Renewal

No fixed annual renewal; a new 6WCex is required when the carrier changes or the excluded roster/election changes.

Issuing body

New Jersey Department of Labor and Workforce Development / workers’ compensation insurer

Filing method

No universal owner-exemption certificate. Sole proprietors, partners, and LLC members may elect personal coverage when a policy is purchased or renewed; corporate officers are generally employees.

Fee

No separate filing fee verified

Note

Owner personal coverage elections do not remove the entity’s separate duty to insure covered workers.

Effective

Elective personal coverage takes effect through the policy/endorsement.

Renewal

Tied to policy purchase/renewal and endorsement status.

Executive Employee Affirmative Election

Issuing body

New Mexico Workers’ Compensation Administration

Filing method

File the applicable WCA insurance-coverage election form; a separate CID Sole Proprietor Affirmative Election applies to the qualifying construction-sole-proprietor lane.

Fee

No separate filing fee verified

Note

Executive owners may still count toward New Mexico’s employee threshold even when personally excluded. Do not substitute the construction sole-proprietor form for the executive-owner election.

Effective

On WCA filing/acceptance of the affirmative election as provided by the form.

Renewal

Continues until revoked; the current Revocation of Prior Election form states a 30-day delay before revocation becomes effective.

Certificate of Attestation of Exemption

Issuing body

New York State Workers’ Compensation Board

Filing method

Generate/file CE-200 through the WCB online exemption service for a specific government license, permit, or contract.

Fee

No separate filing fee verified

Note

CE-200 is transaction-specific proof for government licensing/permit/contract purposes. It is not a private-business owner exemption certificate and is separate from C-105.51 officer exclusions inside insured policies.

Effective

On issuance for the specific government transaction identified on the certificate.

Renewal

No periodic renewal; a new CE-200 is required for each separate license, permit, or contract when the exemption conditions are met.

Issuing body

North Carolina Industrial Commission / workers’ compensation insurer

Filing method

No state owner-exemption certificate. Corporate-officer exclusion is written into the insurance contract; sole proprietors, partners, and LLC members may elect personal coverage through insurer notice.

Fee

No separate filing fee verified

Note

Corporate officers still count toward the general employee threshold even when personally excluded.

Effective

Policy endorsement/insurer notice controls the personal election.

Renewal

Corporate-officer exclusion lasts for the insurance contract period; other owner elections are tied to insurer/policy records.

Elective Coverage Application and Contract

Issuing body

North Dakota Workforce Safety & Insurance

Filing method

Complete the WSI application for insurance and elective coverage contract when required; coordinate with the account underwriter for owner/officer elective coverage.

Fee

No separate filing fee verified

Note

Owners, partners and corporate officers are exempt from Title 65 personal coverage unless elective coverage is purchased. Verification of nonemployment is a separate proof process.

Effective

When WSI approves the completed, signed application and elective coverage contract, when applicable.

Renewal

Continues under the WSI elective-coverage contract until cancelled or changed under WSI procedures; elective-only accounts are eligible for annual payroll reporting rather than a separate exemption renewal.

Application for Ohio Workers’ Compensation Coverage / Elective Coverage Change

Issuing body

Ohio Bureau of Workers’ Compensation

Filing method

Use U-3 when opening coverage and U-3S to add or cancel elective owner coverage after the policy is established.

Fee

$120 non-refundable initial U-3 policy application fee; no separate U-3S filing fee verified

Note

Ohio’s listed owners are generally asking to elect personal coverage, not to obtain an exemption certificate. Premium applies when elective coverage is added.

Effective

For a later U-3S election, elective coverage is added on the date BWC receives the completed application and applicable premiums are charged; initial U-3 coverage begins when the completed application and $120 fee are successfully submitted/received.

Renewal

Elective coverage renews each July and continues until BWC receives a written cancellation request or coverage otherwise lapses/changes.

Issuing body

Oklahoma Workers’ Compensation Commission / workers’ compensation insurer

Filing method

No universal Oklahoma owner-exemption certificate; qualifying owners are excluded by statute and may affirmatively elect coverage.

Fee

No separate filing fee verified

Note

OMES Form D312 is a state-procurement affidavit and is not the general private-sector owner exemption form.

Effective

Statutory owner exclusion applies without a universal state exemption filing; elective inclusion follows the policy/election.

Renewal

No universal owner-form renewal cycle; elective coverage follows the policy/election.

Issuing body

Oregon Workers’ Compensation Division / workers’ compensation insurer

Filing method

No universal owner-exemption certificate; Oregon uses subject/nonsubject-worker rules under ORS 656.027, with construction-specific limits.

Fee

No separate filing fee verified

Note

Owner treatment depends on entity, ownership and work performed. Direct construction work can change partner/LLC/member treatment.

Effective

Statutory nonsubject status applies without a universal owner filing; elective coverage follows the policy.

Renewal

No universal owner-form renewal cycle.

Executive Officer Exclusion Application and Declaration

Issuing body

Pennsylvania Department of Labor & Industry / insurer

Filing method

Qualifying corporate officer files LIBC-509 and LIBC-513 with the carrier when other employees are insured; if no policy covers other employees, follow DLI Compliance filing instructions.

Fee

No separate filing fee verified

Note

Sole proprietors/general partners and member-only LLCs may be outside personal coverage without these corporate forms. Filing destination depends on whether a policy covers other employees.

Effective

On acceptance/endorsement of the qualifying executive-officer exclusion under the applicable carrier/DLI workflow.

Renewal

Tied to the exclusion/policy and officer/ownership facts; refile when the relevant policy or eligibility changes.

Notice of Claim of Common Law Rights

Issuing body

Rhode Island Department of Labor and Training, Division of Workers’ Compensation

Filing method

File the state DWC-11 waiver form with DLT; current forms are available on DLT’s Insurance Coverage and Exemption Forms page.

Fee

$50

Note

DWC-11 is the corporate-officer/common-law-right waiver. DWC-11-IC is a separate independent-contractor filing and should not be substituted for the owner/officer waiver.

Effective

On DLT filing/acceptance of the DWC-11 as provided by the current form/statute.

Renewal

No fixed annual renewal stated for DWC-11; it remains until rescinded using DWC-11R or the qualifying status changes.

Corporate Officer Notice to Reject

Issuing body

South Carolina Workers’ Compensation Commission

Filing method

Corporate officer signs/notarizes Form 5 and provides it to the employer and employer’s insurance carrier as required by the form/regulation.

Fee

$0

Note

Form 5 is for corporate officers; no general LLC-member Form 5 path is inferred. The Commission forms list currently shows no filing fee for Form 5.

Effective

No earlier than the day after the corporate officer signs the notice, subject to the required notice mechanics.

Renewal

No fixed annual renewal; remains until revoked/superseded or policy/status facts change under the applicable rules.

Issuing body

South Dakota Department of Labor and Regulation / workers’ compensation insurer

Filing method

No universal state owner-exemption certificate; South Dakota does not require every employer to carry workers’ compensation by a blanket statewide mandate. Owner/officer rejection, where relevant, is handled under the policy/statute.

Fee

No separate filing fee verified

Note

The Independent Contractor Affidavit of Exempt Status is a classification document, not a universal owner waiver.

Effective

No universal owner-specific filing effective rule.

Renewal

No universal owner-specific state-form renewal cycle.

Initial Workers’ Compensation Exemption Registration Application

Issuing body

Tennessee Bureau of Workers’ Compensation

Filing method

E-file, print-and-mail, paper submission, or walk-in to the Exemption Registry with the required fee.

Fee

$50 with active contractor license; $100 without active contractor license

Note

The registry is for eligible construction business owners and exempts only the listed individual, not employees or the business entity. Subsequent registration uses LB-4530 and costs $20.

Effective

On Bureau approval/registration in the Workers’ Compensation Exemption Registry.

Renewal

2 years; renewal opens 60 days before expiration. Subsequent exemption registration fee is $20.

Issuing body

Texas Department of Insurance, Division of Workers’ Compensation / workers’ compensation insurer

Filing method

No general owner-exemption certificate. Most private employers may choose whether to carry workers’ compensation; owner/officer exclusions inside an insured policy are handled by the policy/endorsement.

Fee

No separate filing fee verified

Note

DWC Form-005 is a non-subscriber notice, not an owner exemption certificate. Public-project construction is a separate statutory exception to the otherwise optional private-employer framework.

Effective

Policy exclusions take effect under the applicable endorsement; non-subscriber reporting follows its own filing rules.

Renewal

Tied to the policy/endorsement or non-subscriber reporting status; no owner-certificate renewal cycle.

Workers’ Compensation Coverage Waiver

Issuing body

Utah Labor Commission, Division of Industrial Accidents

Filing method

Apply through the Utah WCCW online process.

Fee

$50 (nonrefundable)

Note

WCCW is an owner/no-employee waiver for qualifying owners and certain independent contractors. Owner-operator motor carriers have additional occupational-accident proof requirements.

Effective

On Labor Commission approval/issuance of the waiver.

Renewal

1 year; reapply for a new waiver to continue after expiration. The waiver may be revoked earlier if eligibility is lost.

Application to Exclude Corporate Officers or LLC Members From Workers’ Compensation Coverage

Issuing body

Vermont Department of Labor

Filing method

Submit Form 29 with required organizational documentation for Commissioner approval.

Fee

No separate filing fee verified

Note

Form 29 applies to qualifying corporate officers and LLC managers/members; sole proprietors/partners use a different statutory framework.

Effective

After Commissioner approval, and no earlier than the date the Commissioner received a complete application with the required minutes or affidavit.

Renewal

Until rescinded; the approved exclusion remains effective without a fixed annual renewal interval.

Rejection of Coverage

Issuing body

Virginia Workers’ Compensation Commission

Filing method

File electronically, by mail, or by fax with the Commission; a valid workers’ compensation policy is required for this rejection route.

Fee

No separate filing fee verified

Note

Form 16A is for an executive officer or elected/appointed LLC manager who meets the rule; an LLC member title alone is not enough. It rejects accident/death coverage but does not reject occupational-disease coverage.

Effective

At the later statutory point tied to policy inception and delivery/filing of the rejection notice.

Renewal

Continues until revoked with Form 17A.

Application for Elective Coverage

Issuing body

Washington State Department of Labor & Industries

Filing method

Submit the Application for Elective Coverage to L&I for an otherwise excluded owner/person.

Fee

No separate filing fee verified

Note

Washington owner exclusions arise from statute/entity/management structure; F213-042-000 elects coverage and does not create the exclusion.

Effective

12:01 a.m. on the day after L&I receives the application unless a later effective date is requested/accepted.

Renewal

Continues until cancelled under L&I elective-coverage procedures.

Application for Verification of Statutory Exemption from WV Workers’ Compensation Coverage

Issuing body

West Virginia Offices of the Insurance Commissioner, Employer Coverage Unit

Filing method

Submit the notarized exemption application to the Employer Coverage Unit and pay the required application fee.

Fee

$25

Note

This is a full employer statutory-exemption verification process. A personal owner/officer exclusion alone does not make the business fully exempt.

Effective

On the effective date assigned by the Office of the Insurance Commissioner after review/approval.

Renewal

No universal renewal interval stated on the current application page; reapply/reverify when the employer’s exemption facts materially change.

Corporate Officer Option Notice

Issuing body

Wisconsin Department of Workforce Development, Worker’s Compensation Division

Filing method

File the Corporate Officer Option Notice with the Wisconsin Worker’s Compensation Division.

Fee

No separate filing fee verified

Note

This narrow option applies to a closely held corporation with no more than two corporate officers and no other employees. It is not a general owner exclusion for every corporation/LLC.

Effective

On filing/acceptance of the option notice for a qualifying corporation.

Renewal

Until rescinded in writing to the Division or the corporation obtains a workers’ compensation insurance policy.

Affidavit of Coverage

Issuing body

Wyoming Department of Workforce Services, Workers’ Compensation Employer Services

Filing method

Make a written request using the Affidavit of Coverage supplied by the Division; Employer Services provides the form/process.

Fee

No separate filing fee verified

Note

Owners are not automatically covered. Corporate officers, LLC members, sole proprietors and partners may elect personal coverage. Corporate officer coverage is tied to the office/position, not the individual.

Effective

On the Division-approved effective date shown for the elected coverage.

Renewal

Owner/officer elective coverage is subject to Wyoming’s minimum coverage commitment; current employer guidance requires status updates, including officer changes within 30 days.