Form (North Dakota): the workers' comp owner exemption
Elective Coverage Application and Contract. Who can file it, where to get it, how to file, the fee, when it takes effect, and how often it renews — from North Dakota Workforce Safety & Insurance.
Form filing snapshot
FormForm — Elective Coverage Application and Contract
Issuing bodyNorth Dakota Workforce Safety & Insurance
Filing methodComplete the WSI application for insurance and elective coverage contract when required; coordinate with the account underwriter for owner/officer elective coverage.
FeeNo separate filing fee verified
Common mistakeOwners, partners and corporate officers are exempt from Title 65 personal coverage unless elective coverage is purchased. Verification of nonemployment is a separate proof process.
When it takes effectWhen WSI approves the completed, signed application and elective coverage contract, when applicable.
RenewalContinues 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.
Watch out forVerification of Nonemployment is no-employee proof, not a permanent owner exemption certificate.
Which North Dakota owners can use the Form
Sole proprietorAn owner is exempt from mandatory personal coverage and may elect WSI coverage. This does not remove the duty to insure non-exempt employees before they begin work.
LLC memberWSI's owner category and employer guidance treat business owners in an LLC as eligible for elective rather than mandatory personal coverage. Use WSI's current elective-coverage process rather than assuming the LLC itself is exempt when it hires employees.
PartnerA partner is exempt from mandatory personal coverage and may purchase elective WSI coverage. Employees of the partnership remain subject to the ordinary coverage rule.
Corporate officerA corporate officer is listed among the categories exempt from mandatory personal coverage and may elect WSI coverage. The election becomes effective only after WSI approves the completed application and elective coverage contract when applicable.
Employee threshold: With limited exceptions, an employer must insure full-time, part-time, seasonal, and occasional employees with WSI before the employees begin working. WSI is North Dakota's exclusive workers' compensation provider. In construction: WSI does not publish a separate general construction head-count threshold: an employee must be insured before work begins. An owner-only contractor seeking licensing proof may use WSI's Verification of Nonemployment process if the business truly has no employees and otherwise is not required to secure coverage.
Read the full context in the North Dakota workers' comp exemption guide, or run the eligibility screener to check your entity type first.
Form (North Dakota): frequently asked questions
- Where do I get the Form form in North Dakota?
- The Form (Elective Coverage Application and Contract) is issued by North Dakota Workforce Safety & Insurance. Complete the WSI application for insurance and elective coverage contract when required; coordinate with the account underwriter for owner/officer elective coverage. 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 North Dakota?
- No separate filing fee has been verified for this form.
- How often does the Form exemption renew in North Dakota?
- 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. Watch out: Verification of Nonemployment is no-employee proof, not a permanent owner exemption certificate.
Where this comes from
The Form entry is anchored to North Dakota Workforce Safety & Insurance — the state agency that issues and processes the form — not a generalized summary. Source-checked 2026-09-02.