{ "dataset": "Workers' Comp Owner-Exemption Forms by State", "source": "https://workcompexemptdesk.pro/forms", "license": "https://workcompexemptdesk.pro/terms", "sourceChecked": "2026-09-02", "jurisdictions": [ { "jurisdiction": "Alabama", "stateSlug": "alabama", "hasForm": false, "formNumber": null, "formName": null, "issuingBody": "Alabama Department of Labor, Workers’ Compensation Division", "filingMethod": "No current state owner-exclusion filing; qualifying status is handled by statute and the insurance policy.", "fee": null, "processingNote": "Alabama DOL states that it no longer accepts the former WC-14/WC-15 corporate-officer inclusion/exclusion forms.", "effectiveRule": "No current state filing date applies to the statutory owner treatment; policy elections take effect under the policy/endorsement.", "renewalRule": "No state-form renewal cycle; review after ownership, entity, employee, or policy changes.", "officialUrl": "https://labor.alabama.gov/docs/forms/wc_corporate_exclusions-inclusions.pdf", "sources": [ { "label": "Alabama DOL — corporate exclusions/inclusions notice", "url": "https://labor.alabama.gov/docs/forms/wc_corporate_exclusions-inclusions.pdf" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Alaska", "stateSlug": "alaska", "hasForm": false, "formNumber": null, "formName": null, "issuingBody": "Alaska Department of Labor and Workforce Development, Workers’ Compensation Division", "filingMethod": "No current state owner-waiver filing; qualifying owners are excluded by statute and may be specifically included through the policy.", "fee": null, "processingNote": "The former executive-officer waiver program was repealed effective August 1, 2019.", "effectiveRule": "Statutory exclusion applies without an owner-exemption certificate; elective inclusion is tied to the policy period.", "renewalRule": "No state-form renewal cycle; elective inclusion follows the policy period.", "officialUrl": "https://www.labor.alaska.gov/wc/er-profit.html", "sources": [ { "label": "Alaska DOLWD — employers / owner treatment", "url": "https://www.labor.alaska.gov/wc/er-profit.html" }, { "label": "Alaska DOLWD — Bulletin 19-02", "url": "https://www.labor.alaska.gov/wc/bulletins/19-02.pdf" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Arizona", "stateSlug": "arizona", "hasForm": false, "formNumber": null, "formName": null, "issuingBody": "Industrial Commission of Arizona / workers’ compensation carrier", "filingMethod": "No universal owner-exemption certificate; owner treatment follows statute, with inclusion/exclusion handled through carrier endorsement where applicable.", "fee": null, "processingNote": "The sole-proprietor/independent-contractor statement is a relationship/classification document, not a universal owner exemption.", "effectiveRule": "Carrier endorsement controls any elective personal coverage; statutory exclusions do not wait for an exemption certificate.", "renewalRule": "Tied to the policy/endorsement and ownership status; no universal state-form renewal interval.", "officialUrl": "https://www.azleg.gov/ars/23/00901.htm", "sources": [ { "label": "Arizona Revised Statutes §23-901", "url": "https://www.azleg.gov/ars/23/00901.htm" }, { "label": "Industrial Commission of Arizona — sole proprietor/independent contractor statement", "url": "https://www.azica.gov/claims-filing-sole-proprietorindependent-contractor-statement" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Arkansas", "stateSlug": "arkansas", "hasForm": true, "formNumber": "AR-A", "formName": "Application for Certificate of Non-Coverage", "issuingBody": "Arkansas Workers’ Compensation Commission", "filingMethod": "Submit the notarized application/affidavit package to AWCC; current materials also provide online payment options.", "fee": "$50", "processingNote": "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.", "effectiveRule": "On AWCC issuance/approval of the Certificate of Non-Coverage.", "renewalRule": "No universal duration was located on the current application page; use the expiration shown on the issued certificate and refile as required.", "officialUrl": "https://labor.arkansas.gov/workers-comp/awcc-certificates-of-noncoverage/", "sources": [ { "label": "Arkansas AWCC — Certificates of Non-Coverage", "url": "https://labor.arkansas.gov/workers-comp/awcc-certificates-of-noncoverage/" }, { "label": "Arkansas AWCC — Form AR-A", "url": "https://www.labor.arkansas.gov/wp-content/uploads/forma_with_aff.pdf" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "California", "stateSlug": "california", "hasForm": true, "formNumber": "Form 32", "formName": "Exemption from Workers’ Compensation (CSLB license record)", "issuingBody": "California Contractors State License Board", "filingMethod": "Online CSLB exemption service or file the CSLB exemption form with the license/application record.", "fee": null, "processingNote": "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.", "effectiveRule": "When CSLB accepts and records the exemption for the license/application.", "renewalRule": "No fixed annual renewal interval; the exemption ceases to fit when the licensee hires employees or no longer meets CSLB eligibility.", "officialUrl": "https://www.cslb.ca.gov/OnlineServices/WebApplication/InteractivePDFs/WorkersCompensationExemption.aspx", "sources": [ { "label": "CSLB — Online Workers’ Compensation Exemption", "url": "https://www.cslb.ca.gov/OnlineServices/WebApplication/InteractivePDFs/WorkersCompensationExemption.aspx" }, { "label": "CSLB — Workers’ Compensation Requirements", "url": "https://www.cslb.ca.gov/contractors/maintain_license/workers_compensation.aspx" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Colorado", "stateSlug": "colorado", "hasForm": true, "formNumber": null, "formName": "Notice of Election to Reject Workers’ Compensation Coverage", "issuingBody": "Colorado Division of Workers’ Compensation / workers’ compensation insurer", "filingMethod": "Written notice on a Division-approved form or substantial equivalent to the insurer; if there is no insurer, file with the Division.", "fee": null, "processingNote": "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.", "effectiveRule": "Day following receipt by the insurer or Division.", "renewalRule": "Continues while the corporation/LLC policy is in effect or until the owner/member revokes the rejection in writing.", "officialUrl": "https://cdle.colorado.gov/dwc", "sources": [ { "label": "Colorado DWC — Division home", "url": "https://cdle.colorado.gov/dwc" }, { "label": "Colorado General Assembly — 2026 workers’ compensation act change", "url": "https://leg.colorado.gov/bill_files/116560/download" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Connecticut", "stateSlug": "connecticut", "hasForm": true, "formNumber": "Form 6B", "formName": "Coverage Election by Employee Who Is an Officer of a Corporation or a Manager of an LLC", "issuingBody": "Connecticut Workers’ Compensation Commission", "filingMethod": "Electronic Form 6B, GovQA, or mail to the Office of the Chairperson; Form 6B-1 and Form 75 cover other owner types.", "fee": null, "processingNote": "WCC accepts the form for filing purposes; the filer remains responsible for eligibility and accuracy. Keep the electronic confirmation or date-stamped copy.", "effectiveRule": "On Commission filing/date stamp of the election for the covered category.", "renewalRule": "No fixed annual renewal; use the same election form to revoke the prior exclusion, and refile when the election facts change.", "officialUrl": "https://portal.ct.gov/wcc/knowledge-base/articles/forms/coverage-election-forms", "sources": [ { "label": "Connecticut WCC — Coverage Election Forms", "url": "https://portal.ct.gov/wcc/knowledge-base/articles/forms/coverage-election-forms" }, { "label": "Connecticut WCC — Form 6B/6B-1/75 directions", "url": "https://portal.ct.gov/wcc/-/media/wcc/forms/coverage-election-forms/6b6b175dir.pdf" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Delaware", "stateSlug": "delaware", "hasForm": true, "formNumber": "Form C", "formName": "Workers’ Compensation Coverage Election Record (recommended Form C)", "issuingBody": "Delaware Department of Insurance / workers’ compensation carrier", "filingMethod": "Written notice and policy endorsement through the carrier; Delaware Form C is a recommended record of the election.", "fee": null, "processingNote": "Form C is not a state-issued exemption certificate. Contractor-specific exclusions and proof-retention rules are stricter than the ordinary owner election framework.", "effectiveRule": "After the insurer or its agent receives the written request, with the election implemented through the applicable policy inception/renewal endorsement mechanics.", "renewalRule": "No annual state refiling; the election stays in the policy record until changed at a permitted policy inception or renewal.", "officialUrl": "https://insurance.delaware.gov/wp-content/uploads/sites/15/2016/11/formbull2.pdf", "sources": [ { "label": "Delaware DOI — Form C / Bulletin No. 2", "url": "https://insurance.delaware.gov/wp-content/uploads/sites/15/2016/11/formbull2.pdf" }, { "label": "Delaware Code Title 19, Chapter 23", "url": "https://delcode.delaware.gov/title19/c023/sc01/" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Florida", "stateSlug": "florida", "hasForm": true, "formNumber": "DWC-250", "formName": "Notice of Election to Be Exempt", "issuingBody": "Florida Department of Financial Services, Division of Workers’ Compensation", "filingMethod": "Online DWC Notice of Election to Be Exempt system.", "fee": "$50 (construction); $0 (non-construction)", "processingNote": "Exemptions are issued to individual qualifying corporate officers/LLC members, not to the business. Construction and non-construction eligibility limits differ.", "effectiveRule": "When issued by the Division or 30 days after receipt, whichever occurs first, subject to the statute’s special early-policy rule.", "renewalRule": "2 years; renewal application is required. Florida sends an expiration notice at least 60 days before expiration.", "officialUrl": "https://www.myfloridacfo.com/division/wc/employer/exemptions", "sources": [ { "label": "Florida DFS — Exemptions", "url": "https://www.myfloridacfo.com/division/wc/employer/exemptions" }, { "label": "Florida Statutes §440.05", "url": "https://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499%2F0440%2FSections%2F0440.05.html" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Georgia", "stateSlug": "georgia", "hasForm": true, "formNumber": "WC-10", "formName": "Notice of Election or Rejection of Workers’ Compensation Coverage", "issuingBody": "Georgia State Board of Workers’ Compensation", "filingMethod": "File with the current insurer; when no insurer applies in the stated owner-only scenario, file with the Board.", "fee": null, "processingNote": "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.", "effectiveRule": "Effective on filing with the insurer, or with the Board when the no-insurer filing route applies.", "renewalRule": "No fixed annual renewal; remains until revoked/superseded by a later WC-10 or relevant policy/status change.", "officialUrl": "https://sbwc.georgia.gov/document/board-form/wc-10/download", "sources": [ { "label": "Georgia SBWC — WC-10", "url": "https://sbwc.georgia.gov/document/board-form/wc-10/download" }, { "label": "Georgia SBWC — Employer Information", "url": "https://sbwc.georgia.gov/employer-information" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Hawaii", "stateSlug": "hawaii", "hasForm": false, "formNumber": null, "formName": null, "issuingBody": "Hawaii Department of Labor and Industrial Relations, Disability Compensation Division", "filingMethod": "No universal owner-exemption certificate identified; qualifying owner status is handled through statutory employee exclusions and elective coverage rules.", "fee": null, "processingNote": "Hawaii generally requires coverage when there is one or more employee; owner exclusions are entity/ownership-specific rather than a blanket form.", "effectiveRule": "No owner-specific filing effective date identified.", "renewalRule": "No owner-specific state-form renewal cycle.", "officialUrl": "https://labor.hawaii.gov/dcd/frequently-asked-questions/", "sources": [ { "label": "Hawaii DCD — Workers’ Compensation FAQ", "url": "https://labor.hawaii.gov/dcd/frequently-asked-questions/" }, { "label": "Hawaii Revised Statutes §386-1", "url": "https://data.capitol.hawaii.gov/hrscurrent/Vol07_Ch0346-0398/HRS0386/HRS_0386-0001.htm" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Idaho", "stateSlug": "idaho", "hasForm": true, "formNumber": "IC-52", "formName": "Election of Coverage", "issuingBody": "Idaho Industrial Commission / workers’ compensation carrier", "filingMethod": "Written declaration through the insurance company and employer; carriers report the election or revocation using IC-52 or substantially similar format.", "fee": null, "processingNote": "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.", "effectiveRule": "Effective date stated in the election/coverage filing and policy record.", "renewalRule": "Continues according to the election/policy until revoked using IC-52 or equivalent carrier reporting.", "officialUrl": "https://iic.idaho.gov/find-a-form/", "sources": [ { "label": "Idaho Industrial Commission — Employer Coverage Forms", "url": "https://iic.idaho.gov/find-a-form/" }, { "label": "Idaho Industrial Commission — IC-52 Election of Coverage", "url": "https://iic.idaho.gov/wp-content/uploads/2018/01/IC52-Election-of-Coverage-Form.pdf" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Illinois", "stateSlug": "illinois", "hasForm": false, "formNumber": null, "formName": null, "issuingBody": "Illinois Workers’ Compensation Commission / workers’ compensation carrier", "filingMethod": "No IWCC owner opt-out form. Qualifying owner/officer opt-out is handled by written notice to the carrier.", "fee": null, "processingNote": "The personal opt-out is separate from the employer’s duty to insure employees; construction and extra-hazardous work require separate analysis.", "effectiveRule": "For qualifying corporate officers, effective on carrier receipt of the withdrawal notice.", "renewalRule": "No state-form renewal cycle; tied to the written carrier election and policy/status changes.", "officialUrl": "https://iwcc.illinois.gov/about/insurance.html", "sources": [ { "label": "Illinois Workers’ Compensation Commission — Insurance", "url": "https://iwcc.illinois.gov/about/insurance.html" }, { "label": "Illinois Workers’ Compensation Act 820 ILCS 305/3", "url": "https://my.ilga.gov/legislation/ilcs/fulltext?DocName=082003050K3" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Indiana", "stateSlug": "indiana", "hasForm": true, "formNumber": "WCE-1 / State Form 45899", "formName": "Worker’s Compensation Clearance Certificate Application", "issuingBody": "Worker’s Compensation Board of Indiana", "filingMethod": "Submit the current WCE-1 clearance application with required payment through the filing method stated on the current Board form.", "fee": "$20", "processingNote": "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.", "effectiveRule": "When stamped/approved by the Worker’s Compensation Board.", "renewalRule": "1 year; annual reapplication is required.", "officialUrl": "https://www.in.gov/wcb/employer-information/independent-contractors/", "sources": [ { "label": "Indiana WCB — Independent Contractors / WCE-1", "url": "https://www.in.gov/wcb/employer-information/independent-contractors/" }, { "label": "Indiana WCE-1 — State Form 45899", "url": "https://forms.in.gov/Download.aspx?id=7134" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Iowa", "stateSlug": "iowa", "hasForm": true, "formNumber": null, "formName": "Nonelection of Workers’ Compensation or Employers’ Liability Coverage", "issuingBody": "Iowa Department of Inspections, Appeals, and Licensing, Workers’ Compensation Division", "filingMethod": "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": null, "processingNote": "Available to proprietors, LLCs, LLPs, and partnerships. Corporate officers use the separate rejection process. Nonelection cannot be required as a condition of employment.", "effectiveRule": "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.", "renewalRule": "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.", "officialUrl": "https://dial.iowa.gov/hearings/workers-comp/compliance/reporting/nonelection-workers-comp-or-liability-coverage", "sources": [ { "label": "Iowa DIAL — Nonelection of Workers’ Comp or Liability Coverage", "url": "https://dial.iowa.gov/hearings/workers-comp/compliance/reporting/nonelection-workers-comp-or-liability-coverage" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Kansas", "stateSlug": "kansas", "hasForm": true, "formNumber": null, "formName": "Workers’ Compensation Election (OSCAR filing)", "issuingBody": "Kansas Department of Labor, Division of Workers Compensation", "filingMethod": "Electronic election through KDOL’s OSCAR system.", "fee": null, "processingNote": "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.", "effectiveRule": "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.", "renewalRule": "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.", "officialUrl": "https://www.dol.ks.gov/workers-compensation/overview", "sources": [ { "label": "Kansas DOL — Workers Compensation Division overview", "url": "https://www.dol.ks.gov/workers-compensation/overview" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Kentucky", "stateSlug": "kentucky", "hasForm": true, "formNumber": "Form 4", "formName": "Employee’s Notice of Rejection of Workers’ Compensation Act", "issuingBody": "Kentucky Department of Workers’ Claims", "filingMethod": "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": null, "processingNote": "Corporate officers are employees and may reject personal coverage with Form 4. Owner-only partnership/LLC treatment follows separate statutory rules.", "effectiveRule": "When the Department receives the fully completed original Form 4.", "renewalRule": "No annual renewal; remains until withdrawn using Form 5 or superseded by a valid later election.", "officialUrl": "https://elc.ky.gov/Workers-Compensation/Pages/Security-Compliance.aspx", "sources": [ { "label": "Kentucky ELC — Security and Compliance", "url": "https://elc.ky.gov/Workers-Compensation/Pages/Security-Compliance.aspx" }, { "label": "Kentucky 120 KAR 1:130", "url": "https://apps.legislature.ky.gov/law/kar/titles/120/001/130/" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Louisiana", "stateSlug": "louisiana", "hasForm": false, "formNumber": null, "formName": null, "issuingBody": "Louisiana Workforce Commission / workers’ compensation insurer or group fund", "filingMethod": "No Louisiana state exemption certificate. Qualifying owners use written non-election with the insurer/group fund under state law.", "fee": null, "processingNote": "Louisiana expressly does not issue a state exemption certificate; the written carrier/fund record is the relevant personal non-election evidence.", "effectiveRule": "As provided by the written insurer/group-fund non-election and policy record.", "renewalRule": "Tied to the written non-election/policy until revoked or status changes; no state certificate renewal cycle.", "officialUrl": "https://www.laworks.net/WorkersComp/OWC_EmployerMenu.asp", "sources": [ { "label": "Louisiana Workforce Commission — Office of Workers’ Compensation employer resources", "url": "https://www.laworks.net/WorkersComp/OWC_EmployerMenu.asp" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Maine", "stateSlug": "maine", "hasForm": true, "formNumber": "WCB-2C", "formName": "Application for Waiver", "issuingBody": "Maine Workers’ Compensation Board", "filingMethod": "Submit Form WCB-2C to the Workers’ Compensation Board for approval.", "fee": null, "processingNote": "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.", "effectiveRule": "Not valid until approved by the Board.", "renewalRule": "Until revoked/rescinded; the form allows revocation on 30 days’ written notice to the Board and employer.", "officialUrl": "https://www.maine.gov/wcb/Departments/coverage/waivers.html", "sources": [ { "label": "Maine WCB — Waivers", "url": "https://www.maine.gov/wcb/Departments/coverage/waivers.html" }, { "label": "Maine WCB — Form WCB-2C", "url": "https://www.maine.gov/wcb/forms/WCB-2C.pdf" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Maryland", "stateSlug": "maryland", "hasForm": true, "formNumber": "IC-16", "formName": "Exclusion Form", "issuingBody": "Maryland Workers’ Compensation Commission", "filingMethod": "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": null, "processingNote": "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.", "effectiveRule": "On acceptance/recording of the §9-206 exclusion filing under the Commission workflow.", "renewalRule": "No fixed universal renewal interval identified; refile/review when ownership, entity, officer/member status, or policy facts change.", "officialUrl": "https://comphub.wcc.state.md.us/Web/Public/Exclusion", "sources": [ { "label": "Maryland WCC — CompHub Exclusion workflow", "url": "https://comphub.wcc.state.md.us/Web/Public/Exclusion" }, { "label": "Maryland WCC — IC-16 Exclusion Form", "url": "https://wcc.state.md.us/PDF/PDF_Forms/exclusion.pdf" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Massachusetts", "stateSlug": "massachusetts", "hasForm": true, "formNumber": "Form 153", "formName": "Affidavit of Exemption for Certain Corporate Officers or Directors", "issuingBody": "Massachusetts Department of Industrial Accidents", "filingMethod": "Submit by mail, in person, fax, or email to DIA Office of Investigations — Form 153.", "fee": null, "processingNote": "Available only to qualifying corporate officers/directors owning at least 25%; it does not exempt non-officer employees.", "effectiveRule": "After DIA approval of the exemption request.", "renewalRule": "Annual carrier confirmation before policy renewal; a new Form 153 is required after specified ownership/officer status changes.", "officialUrl": "https://www.mass.gov/how-to/request-an-exemption-from-workers-compensation-coverage", "sources": [ { "label": "Massachusetts DIA — Request an exemption", "url": "https://www.mass.gov/how-to/request-an-exemption-from-workers-compensation-coverage" }, { "label": "Massachusetts DIA — Form 153", "url": "https://www.mass.gov/doc/form-153-affidavit-of-exemption-for-certain-corporate-officers/download" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Michigan", "stateSlug": "michigan", "hasForm": true, "formNumber": "WC-337", "formName": "Notice of Exclusion", "issuingBody": "Michigan Workers’ Disability Compensation Agency", "filingMethod": "File the current WC-337 with the Agency under its owner-only exclusion process.", "fee": null, "processingNote": "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.", "effectiveRule": "When stamped/filed by the Michigan Workers’ Disability Compensation Agency.", "renewalRule": "No fixed interval stated on the current WC-337 landing page; refile when the exclusion facts or Agency requirements change.", "officialUrl": "https://www.michigan.gov/leo/bureaus-agencies/wdca/forms/insurance/wc-337-notice-of-exclusion", "sources": [ { "label": "Michigan WDCA — WC-337 Notice of Exclusion", "url": "https://www.michigan.gov/leo/bureaus-agencies/wdca/forms/insurance/wc-337-notice-of-exclusion" }, { "label": "Michigan WDCA — Insurance Requirements", "url": "https://www.michigan.gov/leo/bureaus-agencies/wdca/Insurance-Requirements/Pages/workers-disability-compensation-insurance-requirements" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Minnesota", "stateSlug": "minnesota", "hasForm": false, "formNumber": null, "formName": null, "issuingBody": "Minnesota Department of Labor and Industry / workers’ compensation insurer", "filingMethod": "No universal owner-exemption certificate; common owner exclusions arise from statute/entity/ownership conditions, with elective coverage handled through the insurer.", "fee": null, "processingNote": "Certain relative-election forms exist, but they are not a general owner exemption form. Construction has separate 2026 zero-estimated-exposure/wrap-up rules.", "effectiveRule": "Statutory exclusion does not wait for a general owner filing; elective coverage follows the policy/endorsement.", "renewalRule": "No universal owner-form renewal cycle; policy elections follow the policy and status changes.", "officialUrl": "https://www.dli.mn.gov/business/workers-compensation/work-comp-forms", "sources": [ { "label": "Minnesota DLI — Workers’ compensation forms", "url": "https://www.dli.mn.gov/business/workers-compensation/work-comp-forms" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Mississippi", "stateSlug": "mississippi", "hasForm": false, "formNumber": null, "formName": null, "issuingBody": "Mississippi Workers’ Compensation Commission", "filingMethod": "No current universal MWCC owner-exemption form identified; owner treatment is statutory/entity-specific and voluntary coverage agreements are handled separately.", "fee": null, "processingNote": "Current official MWCC material does not support inventing a form number, fee, or annual owner-exemption renewal cycle.", "effectiveRule": "No owner-specific state filing effective rule identified.", "renewalRule": "No owner-specific state-form renewal cycle identified.", "officialUrl": "https://mwcc.ms.gov/pdf/MSAdjusterGuidebook.pdf", "sources": [ { "label": "Mississippi Workers’ Compensation Commission — Adjuster Guidebook", "url": "https://mwcc.ms.gov/pdf/MSAdjusterGuidebook.pdf" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Missouri", "stateSlug": "missouri", "hasForm": true, "formNumber": null, "formName": "Notice of Election to Withdraw (qualifying two-owner corporation)", "issuingBody": "Missouri Division of Workers’ Compensation", "filingMethod": "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": null, "processingNote": "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.", "effectiveRule": "The qualifying corporation’s election takes effect from the date the notice is filed with the Division.", "renewalRule": "Continues until the corporation withdraws the election; withdrawal is effective 30 days after filing or a later stated date.", "officialUrl": "https://labor.mo.gov/dwc/units", "sources": [ { "label": "Missouri DWC — Division Units / corporate withdrawal", "url": "https://labor.mo.gov/dwc/units" }, { "label": "Missouri DWC — Corporation exemption procedure FAQ", "url": "https://labor.mo.gov/faqs/knowledge-base/what-procedure-does-corporation-need-follow-order-be-exempt-workers" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Montana", "stateSlug": "montana", "hasForm": true, "formNumber": "ICEC", "formName": "Independent Contractor Exemption Certificate Application", "issuingBody": "Montana Department of Labor & Industry", "filingMethod": "Apply online through the Montana contractor portal or submit the current ICEC application and supporting business documentation.", "fee": "$125 (non-refundable)", "processingNote": "ICEC is an independent-contractor status certificate, not a blanket owner waiver for a business or its employees.", "effectiveRule": "On DLI approval/issuance of the ICEC.", "renewalRule": "2 years; renewal is required to keep the ICEC current.", "officialUrl": "https://erd.dli.mt.gov/_docs/Registration/ICEC-Application.pdf", "sources": [ { "label": "Montana DLI — ICEC Application", "url": "https://erd.dli.mt.gov/_docs/Registration/ICEC-Application.pdf" }, { "label": "Montana DLI — Independent Contractor resources", "url": "https://erd.dli.mt.gov/work-comp-regulations/montana-contractor/independent-contractor/" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Nebraska", "stateSlug": "nebraska", "hasForm": false, "formNumber": null, "formName": null, "issuingBody": "Nebraska workers’ compensation insurer / employer", "filingMethod": "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": null, "processingNote": "For the statutory owner election, the written notice is filed with the corporation/insurer rather than a state exemption registry.", "effectiveRule": "Elective owner coverage becomes effective on insurer receipt of the written election.", "renewalRule": "Continues for the current and subsequent policies issued by that insurer until written termination or the insurer ceases coverage.", "officialUrl": "https://nebraskalegislature.gov/laws/statutes.php?statute=48-115", "sources": [ { "label": "Nebraska Legislature — §48-115 employee/owner definitions", "url": "https://nebraskalegislature.gov/laws/statutes.php?statute=48-115" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Nevada", "stateSlug": "nevada", "hasForm": true, "formNumber": "D-45", "formName": "Election of Coverage by Employer — Sole Proprietor Coverage", "issuingBody": "Nevada Department of Business and Industry, Division of Industrial Relations / insurer", "filingMethod": "Submit the applicable Nevada election/rejection form through the insurer and state reporting process; D-45 is the sole-proprietor elective-coverage form.", "fee": null, "processingNote": "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.", "effectiveRule": "Effective date stated on the election/rejection and policy filing.", "renewalRule": "Continues until the election/rejection is withdrawn, rescinded by changed pay/status, or superseded by a later filing.", "officialUrl": "https://dir.nv.gov/WCS/Workers__Compensation_Forms_and_Worksheets/", "sources": [ { "label": "Nevada DIR — Workers’ Compensation forms", "url": "https://dir.nv.gov/WCS/Workers__Compensation_Forms_and_Worksheets/" }, { "label": "Nevada D-45 — Sole Proprietor Coverage", "url": "https://dir.nv.gov/uploadedFiles/dirnvgov/content/WCS/D-45%20Election%20of%20Coverage%20Sole%20Proprietor.pdf" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "New Hampshire", "stateSlug": "new-hampshire", "hasForm": true, "formNumber": "6WCex", "formName": "Exclusion of Executive Officers or Members", "issuingBody": "New Hampshire Department of Labor / workers’ compensation carrier", "filingMethod": "The carrier files Form 6WCex; an underlying Notice of Workers Compensation Insurance Coverage (6WC) for the same employer must already be on file.", "fee": null, "processingNote": "If 6WCex is not on file, the listed executive officers/members are not excluded. A carrier change requires a new 6WCex.", "effectiveRule": "On proper filing with the Department under Lab 306; the filed form in effect controls the exclusion.", "renewalRule": "No fixed annual renewal; a new 6WCex is required when the carrier changes or the excluded roster/election changes.", "officialUrl": "https://www.gc.nh.gov/rules/state_agencies/lab300.html", "sources": [ { "label": "New Hampshire Lab 300 — Form 6WCex rules", "url": "https://www.gc.nh.gov/rules/state_agencies/lab300.html" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "New Jersey", "stateSlug": "new-jersey", "hasForm": false, "formNumber": null, "formName": null, "issuingBody": "New Jersey Department of Labor and Workforce Development / workers’ compensation insurer", "filingMethod": "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": null, "processingNote": "Owner personal coverage elections do not remove the entity’s separate duty to insure covered workers.", "effectiveRule": "Elective personal coverage takes effect through the policy/endorsement.", "renewalRule": "Tied to policy purchase/renewal and endorsement status.", "officialUrl": "https://www.nj.gov/labor/workerscompensation/employer-requirements/", "sources": [ { "label": "New Jersey DOL — Employer Workers’ Compensation Requirements", "url": "https://www.nj.gov/labor/workerscompensation/employer-requirements/" }, { "label": "New Jersey WC-373 Employer Coverage Requirements", "url": "https://www.nj.gov/labor/forms_pdfs/wc/pdf/WC-373.pdf" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "New Mexico", "stateSlug": "new-mexico", "hasForm": true, "formNumber": null, "formName": "Executive Employee Affirmative Election", "issuingBody": "New Mexico Workers’ Compensation Administration", "filingMethod": "File the applicable WCA insurance-coverage election form; a separate CID Sole Proprietor Affirmative Election applies to the qualifying construction-sole-proprietor lane.", "fee": null, "processingNote": "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.", "effectiveRule": "On WCA filing/acceptance of the affirmative election as provided by the form.", "renewalRule": "Continues until revoked; the current Revocation of Prior Election form states a 30-day delay before revocation becomes effective.", "officialUrl": "https://www.workerscomp.nm.gov/forms/", "sources": [ { "label": "New Mexico WCA — Forms", "url": "https://www.workerscomp.nm.gov/forms/" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "New York", "stateSlug": "new-york", "hasForm": true, "formNumber": "CE-200", "formName": "Certificate of Attestation of Exemption", "issuingBody": "New York State Workers’ Compensation Board", "filingMethod": "Generate/file CE-200 through the WCB online exemption service for a specific government license, permit, or contract.", "fee": null, "processingNote": "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.", "effectiveRule": "On issuance for the specific government transaction identified on the certificate.", "renewalRule": "No periodic renewal; a new CE-200 is required for each separate license, permit, or contract when the exemption conditions are met.", "officialUrl": "https://www.wcb.ny.gov/content/ebiz/wc_db_exemptions/exemption-certificates.jsp", "sources": [ { "label": "NYS WCB — Exemption Certificates / CE-200", "url": "https://www.wcb.ny.gov/content/ebiz/wc_db_exemptions/exemption-certificates.jsp" }, { "label": "NYS WCB — Permits, licenses and contracts", "url": "https://www.wcb.ny.gov/content/main/coverage-requirements-wc/permits-licenses-contracts.jsp" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "North Carolina", "stateSlug": "north-carolina", "hasForm": false, "formNumber": null, "formName": null, "issuingBody": "North Carolina Industrial Commission / workers’ compensation insurer", "filingMethod": "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": null, "processingNote": "Corporate officers still count toward the general employee threshold even when personally excluded.", "effectiveRule": "Policy endorsement/insurer notice controls the personal election.", "renewalRule": "Corporate-officer exclusion lasts for the insurance contract period; other owner elections are tied to insurer/policy records.", "officialUrl": "https://www.ic.nc.gov/workers-compensation-claims/employers", "sources": [ { "label": "North Carolina Industrial Commission — Employers", "url": "https://www.ic.nc.gov/workers-compensation-claims/employers" }, { "label": "N.C. Gen. Stat. §97-2", "url": "https://www3.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_97/GS_97-2.html" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "North Dakota", "stateSlug": "north-dakota", "hasForm": true, "formNumber": null, "formName": "Elective Coverage Application and Contract", "issuingBody": "North Dakota Workforce Safety & Insurance", "filingMethod": "Complete the WSI application for insurance and elective coverage contract when required; coordinate with the account underwriter for owner/officer elective coverage.", "fee": null, "processingNote": "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.", "effectiveRule": "When WSI approves the completed, signed application and elective coverage contract, when applicable.", "renewalRule": "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.", "officialUrl": "https://www.workforcesafety.com/employers/insurance-coverage-information/coverage-types", "sources": [ { "label": "North Dakota WSI — Coverage Types", "url": "https://www.workforcesafety.com/employers/insurance-coverage-information/coverage-types" }, { "label": "North Dakota WSI — Common Questions", "url": "https://www.workforcesafety.com/employers/common-questions" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Ohio", "stateSlug": "ohio", "hasForm": true, "formNumber": "U-3 / U-3S", "formName": "Application for Ohio Workers’ Compensation Coverage / Elective Coverage Change", "issuingBody": "Ohio Bureau of Workers’ Compensation", "filingMethod": "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", "processingNote": "Ohio’s listed owners are generally asking to elect personal coverage, not to obtain an exemption certificate. Premium applies when elective coverage is added.", "effectiveRule": "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.", "renewalRule": "Elective coverage renews each July and continues until BWC receives a written cancellation request or coverage otherwise lapses/changes.", "officialUrl": "https://dam.assets.ohio.gov/image/upload/info.bwc.ohio.gov/forms/U-3.pdf", "sources": [ { "label": "Ohio BWC — U-3 Application", "url": "https://dam.assets.ohio.gov/image/upload/info.bwc.ohio.gov/forms/U-3.pdf" }, { "label": "Ohio BWC — U-3S", "url": "https://dam.assets.ohio.gov/image/upload/info.bwc.ohio.gov/forms/U-3S.pdf" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Oklahoma", "stateSlug": "oklahoma", "hasForm": false, "formNumber": null, "formName": null, "issuingBody": "Oklahoma Workers’ Compensation Commission / workers’ compensation insurer", "filingMethod": "No universal Oklahoma owner-exemption certificate; qualifying owners are excluded by statute and may affirmatively elect coverage.", "fee": null, "processingNote": "OMES Form D312 is a state-procurement affidavit and is not the general private-sector owner exemption form.", "effectiveRule": "Statutory owner exclusion applies without a universal state exemption filing; elective inclusion follows the policy/election.", "renewalRule": "No universal owner-form renewal cycle; elective coverage follows the policy/election.", "officialUrl": "https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os85A.pdf", "sources": [ { "label": "Oklahoma Statutes Title 85A", "url": "https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os85A.pdf" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Oregon", "stateSlug": "oregon", "hasForm": false, "formNumber": null, "formName": null, "issuingBody": "Oregon Workers’ Compensation Division / workers’ compensation insurer", "filingMethod": "No universal owner-exemption certificate; Oregon uses subject/nonsubject-worker rules under ORS 656.027, with construction-specific limits.", "fee": null, "processingNote": "Owner treatment depends on entity, ownership and work performed. Direct construction work can change partner/LLC/member treatment.", "effectiveRule": "Statutory nonsubject status applies without a universal owner filing; elective coverage follows the policy.", "renewalRule": "No universal owner-form renewal cycle.", "officialUrl": "https://www.oregon.gov/DCBS/wbf/Pages/workers-compensation-coverage.aspx", "sources": [ { "label": "Oregon DCBS — Workers’ compensation coverage", "url": "https://www.oregon.gov/DCBS/wbf/Pages/workers-compensation-coverage.aspx" }, { "label": "Oregon Legislature — ORS 656.027", "url": "https://www.oregonlegislature.gov/bills_laws/ors/ors656.html" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Pennsylvania", "stateSlug": "pennsylvania", "hasForm": true, "formNumber": "LIBC-509 + LIBC-513", "formName": "Executive Officer Exclusion Application and Declaration", "issuingBody": "Pennsylvania Department of Labor & Industry / insurer", "filingMethod": "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": null, "processingNote": "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.", "effectiveRule": "On acceptance/endorsement of the qualifying executive-officer exclusion under the applicable carrier/DLI workflow.", "renewalRule": "Tied to the exclusion/policy and officer/ownership facts; refile when the relevant policy or eligibility changes.", "officialUrl": "https://www.pa.gov/agencies/dli/programs-services/workers-compensation/state-workers--insurance-fund-home/swif-underwriting/forms-509-and-513", "sources": [ { "label": "Pennsylvania DLI — Forms LIBC-509 and LIBC-513", "url": "https://www.pa.gov/agencies/dli/programs-services/workers-compensation/state-workers--insurance-fund-home/swif-underwriting/forms-509-and-513" }, { "label": "Pennsylvania DLI — Workers’ Compensation Compliance", "url": "https://www.pa.gov/agencies/dli/resources/for-employers-and-educators/workers--compensation-for-employers/workers--compensation-compliance" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Rhode Island", "stateSlug": "rhode-island", "hasForm": true, "formNumber": "DWC-11", "formName": "Notice of Claim of Common Law Rights", "issuingBody": "Rhode Island Department of Labor and Training, Division of Workers’ Compensation", "filingMethod": "File the state DWC-11 waiver form with DLT; current forms are available on DLT’s Insurance Coverage and Exemption Forms page.", "fee": "$50", "processingNote": "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.", "effectiveRule": "On DLT filing/acceptance of the DWC-11 as provided by the current form/statute.", "renewalRule": "No fixed annual renewal stated for DWC-11; it remains until rescinded using DWC-11R or the qualifying status changes.", "officialUrl": "https://dlt.ri.gov/forms-applications", "sources": [ { "label": "Rhode Island DLT — Forms & Applications", "url": "https://dlt.ri.gov/forms-applications" }, { "label": "Rhode Island DLT — 2024 DWC-11 fee notice", "url": "https://dlt.ri.gov/sites/g/files/xkgbur571/files/2024-05/2024-02%20Waiver%20Fee%20Increase.pdf" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "South Carolina", "stateSlug": "south-carolina", "hasForm": true, "formNumber": "Form 5", "formName": "Corporate Officer Notice to Reject", "issuingBody": "South Carolina Workers’ Compensation Commission", "filingMethod": "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", "processingNote": "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.", "effectiveRule": "No earlier than the day after the corporate officer signs the notice, subject to the required notice mechanics.", "renewalRule": "No fixed annual renewal; remains until revoked/superseded or policy/status facts change under the applicable rules.", "officialUrl": "https://wcc.sc.gov/sites/wcc/files/Documents/Header/Forms/Form5.pdf", "sources": [ { "label": "South Carolina WCC — Form 5 Corporate Officer Notice to Reject", "url": "https://wcc.sc.gov/sites/wcc/files/Documents/Header/Forms/Form5.pdf" }, { "label": "South Carolina WCC — Forms and filing fees", "url": "https://wcc.sc.gov/forms" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "South Dakota", "stateSlug": "south-dakota", "hasForm": false, "formNumber": null, "formName": null, "issuingBody": "South Dakota Department of Labor and Regulation / workers’ compensation insurer", "filingMethod": "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": null, "processingNote": "The Independent Contractor Affidavit of Exempt Status is a classification document, not a universal owner waiver.", "effectiveRule": "No universal owner-specific filing effective rule.", "renewalRule": "No universal owner-specific state-form renewal cycle.", "officialUrl": "https://dlr.sd.gov/workers_compensation/coverage.aspx", "sources": [ { "label": "South Dakota DLR — Workers’ Compensation Coverage", "url": "https://dlr.sd.gov/workers_compensation/coverage.aspx" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Tennessee", "stateSlug": "tennessee", "hasForm": true, "formNumber": "LB-4523", "formName": "Initial Workers’ Compensation Exemption Registration Application", "issuingBody": "Tennessee Bureau of Workers’ Compensation", "filingMethod": "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", "processingNote": "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.", "effectiveRule": "On Bureau approval/registration in the Workers’ Compensation Exemption Registry.", "renewalRule": "2 years; renewal opens 60 days before expiration. Subsequent exemption registration fee is $20.", "officialUrl": "https://www.tn.gov/content/tn/workforce/injuries-at-work/employers/employers/wc-exemption-registry.html", "sources": [ { "label": "Tennessee BWC — Exemption Registry", "url": "https://www.tn.gov/content/tn/workforce/injuries-at-work/employers/employers/wc-exemption-registry.html" }, { "label": "Tennessee BWC — Forms and FAQs", "url": "https://www.tn.gov/workforce/injuries-at-work/employers/employers/wc-exemption-registry/exemption-registry-forms-and-faqs.html.html" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Texas", "stateSlug": "texas", "hasForm": false, "formNumber": null, "formName": null, "issuingBody": "Texas Department of Insurance, Division of Workers’ Compensation / workers’ compensation insurer", "filingMethod": "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": null, "processingNote": "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.", "effectiveRule": "Policy exclusions take effect under the applicable endorsement; non-subscriber reporting follows its own filing rules.", "renewalRule": "Tied to the policy/endorsement or non-subscriber reporting status; no owner-certificate renewal cycle.", "officialUrl": "https://www.tdi.texas.gov/wc/employer/", "sources": [ { "label": "Texas DWC — Employer Resources", "url": "https://www.tdi.texas.gov/wc/employer/" }, { "label": "Texas DWC — Non-subscriber reporting", "url": "https://www.tdi.texas.gov/wc/nonsubscriber.html" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Utah", "stateSlug": "utah", "hasForm": true, "formNumber": "WCCW", "formName": "Workers’ Compensation Coverage Waiver", "issuingBody": "Utah Labor Commission, Division of Industrial Accidents", "filingMethod": "Apply through the Utah WCCW online process.", "fee": "$50 (nonrefundable)", "processingNote": "WCCW is an owner/no-employee waiver for qualifying owners and certain independent contractors. Owner-operator motor carriers have additional occupational-accident proof requirements.", "effectiveRule": "On Labor Commission approval/issuance of the waiver.", "renewalRule": "1 year; reapply for a new waiver to continue after expiration. The waiver may be revoked earlier if eligibility is lost.", "officialUrl": "https://laborcommission.utah.gov/divisions/industrial-accidents/employers/wccw/", "sources": [ { "label": "Utah Labor Commission — Workers’ Compensation Coverage Waivers", "url": "https://laborcommission.utah.gov/divisions/industrial-accidents/employers/wccw/" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Vermont", "stateSlug": "vermont", "hasForm": true, "formNumber": "Form 29", "formName": "Application to Exclude Corporate Officers or LLC Members From Workers’ Compensation Coverage", "issuingBody": "Vermont Department of Labor", "filingMethod": "Submit Form 29 with required organizational documentation for Commissioner approval.", "fee": null, "processingNote": "Form 29 applies to qualifying corporate officers and LLC managers/members; sole proprietors/partners use a different statutory framework.", "effectiveRule": "After Commissioner approval, and no earlier than the date the Commissioner received a complete application with the required minutes or affidavit.", "renewalRule": "Until rescinded; the approved exclusion remains effective without a fixed annual renewal interval.", "officialUrl": "https://labor.vermont.gov/sites/labor/files/doc_library/Form29-11-22-FillIn.pdf", "sources": [ { "label": "Vermont DOL — Form 29", "url": "https://labor.vermont.gov/sites/labor/files/doc_library/Form29-11-22-FillIn.pdf" }, { "label": "Vermont Statutes §601", "url": "https://legislature.vermont.gov/statutes/section/21/009/00601" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Virginia", "stateSlug": "virginia", "hasForm": true, "formNumber": "Form 16A", "formName": "Rejection of Coverage", "issuingBody": "Virginia Workers’ Compensation Commission", "filingMethod": "File electronically, by mail, or by fax with the Commission; a valid workers’ compensation policy is required for this rejection route.", "fee": null, "processingNote": "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.", "effectiveRule": "At the later statutory point tied to policy inception and delivery/filing of the rejection notice.", "renewalRule": "Continues until revoked with Form 17A.", "officialUrl": "https://workcomp.virginia.gov/forms/rejection-coverage-form-16a", "sources": [ { "label": "Virginia WCC — Rejection of Coverage Form 16A", "url": "https://workcomp.virginia.gov/forms/rejection-coverage-form-16a" }, { "label": "Virginia WCC — Employer Insurance Information", "url": "https://workcomp.virginia.gov/workers-compensation-insurance-information-employers" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Washington", "stateSlug": "washington", "hasForm": true, "formNumber": "F213-042-000", "formName": "Application for Elective Coverage", "issuingBody": "Washington State Department of Labor & Industries", "filingMethod": "Submit the Application for Elective Coverage to L&I for an otherwise excluded owner/person.", "fee": null, "processingNote": "Washington owner exclusions arise from statute/entity/management structure; F213-042-000 elects coverage and does not create the exclusion.", "effectiveRule": "12:01 a.m. on the day after L&I receives the application unless a later effective date is requested/accepted.", "renewalRule": "Continues until cancelled under L&I elective-coverage procedures.", "officialUrl": "https://www.lni.wa.gov/forms-publications/F213-042-000.pdf", "sources": [ { "label": "Washington L&I — Application for Elective Coverage F213-042-000", "url": "https://www.lni.wa.gov/forms-publications/F213-042-000.pdf" }, { "label": "Washington L&I — Corporate Officers", "url": "https://www.lni.wa.gov/insurance/insurance-requirements/do-i-need-a-workers-comp-account/corporate-officers" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "West Virginia", "stateSlug": "west-virginia", "hasForm": true, "formNumber": null, "formName": "Application for Verification of Statutory Exemption from WV Workers’ Compensation Coverage", "issuingBody": "West Virginia Offices of the Insurance Commissioner, Employer Coverage Unit", "filingMethod": "Submit the notarized exemption application to the Employer Coverage Unit and pay the required application fee.", "fee": "$25", "processingNote": "This is a full employer statutory-exemption verification process. A personal owner/officer exclusion alone does not make the business fully exempt.", "effectiveRule": "On the effective date assigned by the Office of the Insurance Commissioner after review/approval.", "renewalRule": "No universal renewal interval stated on the current application page; reapply/reverify when the employer’s exemption facts materially change.", "officialUrl": "https://www.wvinsurance.gov/Employer-Coverage", "sources": [ { "label": "West Virginia OIC — Employer Coverage", "url": "https://www.wvinsurance.gov/Employer-Coverage" }, { "label": "West Virginia OIC — Exemption Application", "url": "https://www.wvinsurance.gov/Portals/0/pdf/wc/forms/Application%20for%20Exemption%2002-25-2011.pdf?ver=2016-04-27-121840-647" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Wisconsin", "stateSlug": "wisconsin", "hasForm": true, "formNumber": "WKC-7602-E", "formName": "Corporate Officer Option Notice", "issuingBody": "Wisconsin Department of Workforce Development, Worker’s Compensation Division", "filingMethod": "File the Corporate Officer Option Notice with the Wisconsin Worker’s Compensation Division.", "fee": null, "processingNote": "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.", "effectiveRule": "On filing/acceptance of the option notice for a qualifying corporation.", "renewalRule": "Until rescinded in writing to the Division or the corporation obtains a workers’ compensation insurance policy.", "officialUrl": "https://dwd.wisconsin.gov/dwd/forms/WKC/wkc-7602-e.htm", "sources": [ { "label": "Wisconsin DWD — WKC-7602-E Corporate Officer Option Notice", "url": "https://dwd.wisconsin.gov/dwd/forms/WKC/wkc-7602-e.htm" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "Wyoming", "stateSlug": "wyoming", "hasForm": true, "formNumber": null, "formName": "Affidavit of Coverage", "issuingBody": "Wyoming Department of Workforce Services, Workers’ Compensation Employer Services", "filingMethod": "Make a written request using the Affidavit of Coverage supplied by the Division; Employer Services provides the form/process.", "fee": null, "processingNote": "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.", "effectiveRule": "On the Division-approved effective date shown for the elected coverage.", "renewalRule": "Owner/officer elective coverage is subject to Wyoming’s minimum coverage commitment; current employer guidance requires status updates, including officer changes within 30 days.", "officialUrl": "https://dws.wyo.gov/dws-division/workers-compensation/employers/wage-reporting-and-coverage/", "sources": [ { "label": "Wyoming DWS — Wage Reporting & Coverage", "url": "https://dws.wyo.gov/dws-division/workers-compensation/employers/wage-reporting-and-coverage/" } ], "lastVerified": "2026-09-02" }, { "jurisdiction": "District of Columbia", "stateSlug": "district-of-columbia", "hasForm": false, "formNumber": null, "formName": null, "issuingBody": "District of Columbia Department of Employment Services, Office of Workers’ Compensation", "filingMethod": "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": null, "processingNote": "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.", "effectiveRule": "No exemption filing date applies to the sole-proprietor exclusion described by DOES; ordinary employer coverage duties begin when covered employees are present.", "renewalRule": "No owner-exemption renewal cycle for the sole-proprietor exclusion; re-check the Act/DOES after entity, ownership, employee, or permit-status changes.", "officialUrl": "https://does.dc.gov/sites/default/files/dc/sites/does/page_content/attachments/OWC%20Employer%20brochure.pdf", "sources": [ { "label": "D.C. DOES — Office of Workers’ Compensation employer brochure", "url": "https://does.dc.gov/sites/default/files/dc/sites/does/page_content/attachments/OWC%20Employer%20brochure.pdf" }, { "label": "D.C. Code — Workers’ Compensation chapter", "url": "https://code.dccouncil.gov/us/dc/council/code/titles/32/chapters/15/index.full.html" } ], "lastVerified": "2026-09-02" } ] }