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Workers' Comp Exemption- Workers Compensation Exemptions

    https://www.workerscompensationshop.com/workers-compensation-election-rejection-of-coverage
    Generally, executive officers of a corporation are automatically included for coverage under each states' workers comp laws. Officers must file for exclusion from the policy. Partners and sole-proprietors are generally exempt from coverage, but they may elect to be included on the policy.

Application To Exclude Corporate Officers or LLC Members ...

    https://labor.vermont.gov/sites/labor/files/doc_library/Form%2029%20%E2%80%93%20Application%20for%20Exclusion%20from%20Provisions%20of%20the%20Workers%E2%80%99%20Comp%20Act%20%E2%80%93rev%202-13.pdf
     Officer/Member Exclusion. Vermont law permits corporate officers or LLC members to exclude up to four (4) officers or members from protection under the Vermont Workers’ Compensation Act. Corporate officer refers to the President, Vice President, Secretary of the Corporation, Clerk or Treasurer. A Limited Liability Company may exclude up to four (4) managers or members.

Request an exemption from workers’ compensation coverage ...

    https://www.mass.gov/how-to/request-an-exemption-from-workers-compensation-coverage
    Corporate officers who own at least 25% interest in the corporation can file a Form 153 - Affidavit for Certain Corporate Officers or Directors with the Department of Industrial Accidents (DIA) to request an exemption from workers compensation coverage. All eligible corporate officers must sign the Form 153, to exempt themselves

Exemptions

    https://www.tn.gov/workforce/injuries-at-work/employers/employers/who-must-carry-insurance/exemptions.html
    Corporate officers are afforded the right to exempt themselves from a workers’ compensation policy, but are NOT excluded from the count of employees unless they are not paid or compensated.

Workers’ Compensation Law Election to Exclude Executive ...

    https://www.dfs.ny.gov/insurance/ogco2000/rg009291.htm
    An executive officer is not entitled to be covered under the employers’ liability insurance portion of a Workers’ Compensation and Employers’ Liability policy after electing to be excluded from the compensation insurance contract pursuant to N.Y. Work. Comp. Law § 54 (6) (d) (McKinney 1994).

State of New York WORKERS' COMPENSATION BOARD

    http://www.wcb.ny.gov/content/main/forms/c105_51.pdf
    NOTICE OF ELECTION OF A CORPORATION WHICH IS REQUIRED TO HAVE COVERAGE FOR ITSEMPLOYEES UNDER THE NEW YORK STATE WORKERS' COMPENSATION LAW TO EXCLUDE THESOLE SHAREHOLDER-OFFICER OR ONE OF THE TWO OR BOTH EXECUTIVEOFFICERS-SHAREHOLDERS OF THE CORPORATION FROM SUCH COVERAGE To: (Print name and …File Size: 40KB

EXCLUSION OF WORKERS’ COMPENSATION COVERAGE

    http://www.dph.illinois.gov/sites/default/files/forms/workers-comp-opt-out-042616.pdf
    The following ownership types must complete this form if they wish to opt out of the Workers’ Compensation Requirement: Corporations with no employees other than the four main corporate officers (president, vice president, secretary & treasurer), must complete this form (Part A Only), signed by each of those four main corporate officers.File Size: 19KB

Exemptions - myfloridacfo.com

    https://myfloridacfo.com/Division/WC/Employer/Exemptions/default.htm
    The purpose of filing an exemption is for an officer of a corporation or member of a limited liability company to exclude themselves from the workers' compensation laws. Upon issuance of a Certificate of Election to be Exempt, the officer or member is not an employee and may not recover workers' compensation benefits.

California Exclusion Rules - Policyholder Center

    https://www.icwgroup.com/pc/payments/ca-exclusion-rules/
    SB 189 allows exclusion of the owners listed below with signed waivers: Corporate officers and members of board of directors who owns at least 10% of the issued and outstanding stock; and is covered by a health insurance policy or health care service plan.

IL Officer Exclusion Form - Don R. Jensen & Company

    http://www.donrjensen.com/wp-content/uploads/2014/08/IL-Officer-Exclusion-Form.pdf
    The undersigned sole proprietor, partner(s), member(s) or corporate officer(s) of the above referenced business do hereby reject coverage under the Illinois Workers Compensation Act and the Workers Compensation policy. Type or print each name and title under signature.

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