Form (Missouri): the workers' comp owner exemption
Notice of Election to Withdraw (qualifying two-owner corporation). Who can file it, where to get it, how to file, the fee, when it takes effect, and how often it renews — from Missouri Division of Workers’ Compensation.
Form filing snapshot
FormForm — Notice of Election to Withdraw (qualifying two-owner corporation)
Issuing bodyMissouri Division of Workers’ Compensation
Filing methodFile the corporation’s notice of election to withdraw with the Division; current DWC guidance directs applicants to the Division for the required paperwork.
FeeNo separate filing fee verified
Common mistakeThis 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.
When it takes effectThe qualifying corporation’s election takes effect from the date the notice is filed with the Division.
RenewalContinues until the corporation withdraws the election; withdrawal is effective 30 days after filing or a later stated date.
Watch out forMissouri has different rules for construction, LLC members and narrow owner-employee corporation paths.
Get the Form from Missouri Division of Workers’ Compensation
Which Missouri owners can use the Form
Sole proprietorThe sole proprietor is not personally covered by default and does not count themself toward the five-person trigger; the proprietor may elect personal coverage with the insurer. Employees of the proprietorship still count normally.
LLC memberLLC members count toward the employer's coverage threshold and are presumed covered under the policy. A member may individually reject personal coverage in writing to the LLC and insurer, but that personal rejection does not erase the LLC's obligation to carry coverage when the company otherwise meets the statutory trigger.
PartnerA partner is not personally covered by default and does not count themself toward the general threshold; the partner may elect personal coverage with the insurer. Partnership employees remain covered when the business is subject to the law.
Corporate officerCorporate officers count as employees. A corporation with no more than two owners who are also its only employees has a separate company-level withdrawal path by notice to the Division. Current DOL materials also describe an individual rejection for a qualifying S-corporation shareholder owning at least 40%.
Employee threshold: Missouri generally requires workers' compensation insurance when an employer has five or more employees. Corporate officers and LLC members count toward that number; sole proprietors and partners do not count themselves. In construction: Construction industry employers that erect, demolish, alter, or repair improvements must carry workers' compensation if they have one or more employees. The one-worker construction trigger is materially stricter than Missouri's general five-employee rule.
Read the full context in the Missouri workers' comp exemption guide, or run the eligibility screener to check your entity type first.
Form (Missouri): frequently asked questions
- Where do I get the Form form in Missouri?
- The Form (Notice of Election to Withdraw (qualifying two-owner corporation)) is issued by Missouri Division of Workers’ Compensation. File the corporation’s notice of election to withdraw with the Division; current DWC guidance directs applicants to the Division for the required paperwork. 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 in Missouri?
- No separate filing fee has been verified for this form.
- How often does the Form exemption renew in Missouri?
- Continues until the corporation withdraws the election; withdrawal is effective 30 days after filing or a later stated date. Watch out: Missouri has different rules for construction, LLC members and narrow owner-employee corporation paths.
Where this comes from
The Form entry is anchored to Missouri Division of Workers’ Compensation — the state agency that issues and processes the form — not a generalized summary. Source-checked 2026-09-02.