Form (West Virginia): the workers' comp owner exemption
Application for Verification of Statutory Exemption from WV Workers’ Compensation Coverage. Who can file it, where to get it, how to file, the fee, when it takes effect, and how often it renews — from West Virginia Offices of the Insurance Commissioner, Employer Coverage Unit.
Form filing snapshot
FormForm — Application for Verification of Statutory Exemption from WV Workers’ Compensation Coverage
Issuing bodyWest Virginia Offices of the Insurance Commissioner, Employer Coverage Unit
Filing methodSubmit the notarized exemption application to the Employer Coverage Unit and pay the required application fee.
Fee$25
Common mistakeThis is a full employer statutory-exemption verification process. A personal owner/officer exclusion alone does not make the business fully exempt.
When it takes effectOn the effective date assigned by the Office of the Insurance Commissioner after review/approval.
RenewalNo universal renewal interval stated on the current application page; reapply/reverify when the employer’s exemption facts materially change.
Watch out forThe $25 application verifies a business-level statutory exemption; listing exempt owners alone does not entitle the employer to an exemption letter.
Get the Form from West Virginia Offices of the Insurance Commissioner
Which West Virginia owners can use the Form
Sole proprietorA sole-proprietorship employer may elect not to include the owner as an employee. This owner election is different from proving that the entire business qualifies for a statutory exemption from maintaining a policy.
LLC memberAn LLC may elect not to include no more than four people acting as managers, officers, or members. The owner election is personal; employees who are not within an exclusion still require employer-level coverage.
PartnerA partnership may elect not to include a partner as an employee. The partnership still needs to test whether it regularly employs other people who make the business subject to the chapter.
Corporate officerA corporation or association may elect not to include corporate officers or board members, but §23-2-1 contains a dual-capacity limitation for officers beyond the principal positions. A title alone does not automatically exclude an officer who is actually performing separate employee work under the statute's detailed conditions.
Employee threshold: West Virginia generally subjects a business that regularly employs another person to workers' compensation requirements. The statute separately exempts defined categories such as casual employers whose workforce does not exceed three and whose temporary, intermittent, sporadic employment does not exceed 10 calendar days in a quarter, plus other listed employment categories. In construction: West Virginia does not use a separate numeric construction threshold in §23-2-1 for the owner exclusions discussed here. Contractor compliance still matters: the OIC exemption application warns that subcontractors must provide continuing proof of coverage to prime contractors and report cancellation or expiration during the contract term.
Read the full context in the West Virginia workers' comp exemption guide, or run the eligibility screener to check your entity type first.
Form (West Virginia): frequently asked questions
- Where do I get the Form form in West Virginia?
- The Form (Application for Verification of Statutory Exemption from WV Workers’ Compensation Coverage) is issued by West Virginia Offices of the Insurance Commissioner, Employer Coverage Unit. Submit the notarized exemption application to the Employer Coverage Unit and pay the required application fee. 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 West Virginia?
- $25
- How often does the Form exemption renew in West Virginia?
- No universal renewal interval stated on the current application page; reapply/reverify when the employer’s exemption facts materially change. Watch out: The $25 application verifies a business-level statutory exemption; listing exempt owners alone does not entitle the employer to an exemption letter.
Where this comes from
The Form entry is anchored to West Virginia Offices of the Insurance Commissioner, Employer Coverage Unit — the state agency that issues and processes the form — not a generalized summary. Source-checked 2026-09-02.