Form 4 (Kentucky): the workers' comp owner exemption
Employee’s Notice of Rejection of Workers’ Compensation Act. Who can file it, where to get it, how to file, the fee, when it takes effect, and how often it renews — from Kentucky Department of Workers’ Claims.
Form 4 filing snapshot
FormForm 4 — Employee’s Notice of Rejection of Workers’ Compensation Act
Issuing bodyKentucky Department of Workers’ Claims
Filing methodOriginal notarized Form 4 is given to the employer and filed with the Department of Workers’ Claims; copies/fax do not satisfy the regulation.
FeeNo separate filing fee verified
Common mistakeCorporate officers are employees and may reject personal coverage with Form 4. Owner-only partnership/LLC treatment follows separate statutory rules.
When it takes effectWhen the Department receives the fully completed original Form 4.
RenewalNo annual renewal; remains until withdrawn using Form 5 or superseded by a valid later election.
Watch out forForm 4 is a corporate-officer rejection; owner-only partnership/LLC treatment follows separate rules.
Which Kentucky owners can use the Form 4
Sole proprietorA sole proprietor with no employees has no separate employee to insure, but Form 4 is an employee rejection mechanism rather than a generic sole-proprietor certificate. Hiring any subject worker invokes Kentucky's one-worker rule.
LLC memberAn owner-only LLC composed solely of qualified members can be exempt from maintaining coverage in the circumstances described by DWC. A qualified member must have governing documents showing a meaningful contribution plus substantial participation in profits/losses and decision-making. Coverage is required for a non-qualified member.
PartnerAn owner-only partnership composed solely of qualified partners can be exempt under the same DWC framework. The partnership must be able to produce the partnership agreement on request to demonstrate the qualified-owner status.
Corporate officerA corporate officer is an employee under Kentucky law and may reject the Act by filing an original notarized Form 4 with DWC. The rejection is not effective until the completed original is filed with the Department.
Employee threshold: Kentucky requires an employer with one or more workers to maintain workers' compensation coverage. Family members, temporary workers, and part-time workers are not excluded merely because of that status. In construction: Kentucky does not publish a separate construction employee-count trigger; the one-worker rule still applies. A no-employee building contractor can use a building-permit Affidavit of Exemption, but the Department expressly warns that this affidavit is different from Form 4 and does not create a blanket workers' compensation exemption once workers are present.
Read the full context in the Kentucky workers' comp exemption guide, or run the eligibility screener to check your entity type first.
Form 4 (Kentucky): frequently asked questions
- Where do I get the Form 4 form in Kentucky?
- The Form 4 (Employee’s Notice of Rejection of Workers’ Compensation Act) is issued by Kentucky Department of Workers’ Claims. Original notarized Form 4 is given to the employer and filed with the Department of Workers’ Claims; copies/fax do not satisfy the regulation. Use the official link on this page rather than a third-party copy, which may be out of date.
- Is there a fee to file the Form 4 in Kentucky?
- No separate filing fee has been verified for this form.
- How often does the Form 4 exemption renew in Kentucky?
- No annual renewal; remains until withdrawn using Form 5 or superseded by a valid later election. Watch out: Form 4 is a corporate-officer rejection; owner-only partnership/LLC treatment follows separate rules.
Where this comes from
The Form 4 entry is anchored to Kentucky Department of Workers’ Claims — the state agency that issues and processes the form — not a generalized summary. Source-checked 2026-09-02.