LIBC-509 + LIBC-513 form (Pennsylvania): the workers' comp owner exemption
Executive Officer Exclusion Application and Declaration. Who can file it, where to get it, how to file, the fee, when it takes effect, and how often it renews — from Pennsylvania Department of Labor & Industry / insurer.
LIBC-509 + LIBC-513 filing snapshot
FormLIBC-509 + LIBC-513 — Executive Officer Exclusion Application and Declaration
Issuing bodyPennsylvania Department of Labor & Industry / insurer
Filing methodQualifying 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.
FeeNo separate filing fee verified
Common mistakeSole 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.
When it takes effectOn acceptance/endorsement of the qualifying executive-officer exclusion under the applicable carrier/DLI workflow.
RenewalTied to the exclusion/policy and officer/ownership facts; refile when the relevant policy or eligibility changes.
Watch out forSole proprietors/general partners/member-only LLCs use different owner exclusions; LIBC-509/513 are corporate-officer forms.
Get the LIBC-509 + LIBC-513 from Pennsylvania Department of Labor & Industry / insurer
Which Pennsylvania owners can use the LIBC-509 + LIBC-513
Sole proprietorA sole proprietor with no other employees is listed as excluded from the mandatory coverage requirement; owner coverage may be elected voluntarily.
LLC memberAn LLC whose only workers are members is listed as excluded from the mandatory coverage requirement. Adding a non-member employee changes the analysis.
PartnerGeneral partners with no other employees are listed as excluded from mandatory coverage; owner coverage may be elected voluntarily.
Corporate officerA qualifying executive officer uses LIBC-509 with LIBC-513. Nonprofit unpaid voluntary officers, qualifying S-corporation officers with ownership interest, and qualifying C-corporation officers with at least 5% interest have specified exclusion paths.
Employee threshold: Workers' compensation is generally mandatory when an employer has at least one employee unless all workers fall within an exclusion. State guidance lists sole proprietors/general partners with no other employees and LLCs whose only workers are members among excluded situations. In construction: No separate construction head-count threshold is stated in the cited employer guidance. Contractors seeking building permits must provide workers' compensation proof or a qualifying no-employee affidavit, and construction worker classification is subject to the Construction Workplace Misclassification Act.
Read the full context in the Pennsylvania workers' comp exemption guide, or run the eligibility screener to check your entity type first.
LIBC-509 + LIBC-513 form (Pennsylvania): frequently asked questions
- Where do I get the LIBC-509 + LIBC-513 form in Pennsylvania?
- The LIBC-509 + LIBC-513 (Executive Officer Exclusion Application and Declaration) is issued by Pennsylvania Department of Labor & Industry / insurer. 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. 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 LIBC-509 + LIBC-513 in Pennsylvania?
- No separate filing fee has been verified for this form.
- How often does the LIBC-509 + LIBC-513 exemption renew in Pennsylvania?
- Tied to the exclusion/policy and officer/ownership facts; refile when the relevant policy or eligibility changes. Watch out: Sole proprietors/general partners/member-only LLCs use different owner exclusions; LIBC-509/513 are corporate-officer forms.
Where this comes from
The LIBC-509 + LIBC-513 entry is anchored to Pennsylvania Department of Labor & Industry / insurer — the state agency that issues and processes the form — not a generalized summary. Source-checked 2026-09-02.