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Workers comp waiver form pdf indiana

Workmans comp waiver indiana 2025

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The document is an application form for a Worker’s Compensation Clearance Certificate from the Indiana Department of Revenue, specifically for independent contractors in the construction trades. It outlines the requirements and definitions for independent contractor status, including exemptions from worker's compensation coverage. The form requires personal information, residency verification, and payment of a non-refundable fee. It also explains the certification process and the implications of being classified as an independent contractor versus an employee.

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Click ‘Get Form’ to open the workmans comp waiver Indiana in the editor.
Begin by entering your name and business name in the designated fields. Ensure that you type or print clearly for accurate processing.
Fill in your specified trade, address, email, and telephone number. This information is crucial for identification and communication purposes.
Indicate whether you are an Indiana resident by checking the appropriate box. If not, provide your state of residence.
Select the applicable exemption category: independent contractor, sole proprietor, or partner. Complete any additional required fields based on your selection.
If you have employees, indicate this by checking 'Yes' and provide their names and SSNs/TINs/FIDs as necessary.
Sign and date the application at the bottom to certify that all information provided is accurate.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a workers comp lien waiver?

One of the ways a workers comp lawyer can assist you if you have both a workers comp claim and third-party injury case is to request a lien waiver from the employer or their insurance company so that the lien isnt taken from the personal injury settlement.

Which of the following are excluded from workers compensation coverage?

Independent contractors, sole proprietors, business partners, or LLC members in a firm with no employees dont typically need workers compensation.

What is a workers comp waiver?

Workers comp waivers can come from a client This is a standard legal protection that helps your clients manage their costs. Rather than paying for the cost of your coverage themselves, they make you pay for it. But in some contracts, youll find language that states you can waive your workers comp requirements.

Am I exempt from workers compensation?

Workers who are legally considered employees are covered, while workers who are considered independent contractors are not. Generally speaking, independent contractors in Indiana do not have any workers comp coverage or any right to acquire workers compensation benefits.

Who is exempt from workers comp in Indiana?

Exemptions Under Indiana Workers Compensation Laws Sole proprietors, partners and LLC members. Corporate officers. Independent contractors. Licensed real estate agents.

workers comp waiver indiana

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Are you required to have workers comp in Indiana?

Sole Proprietors and Partners: Owners of unincorporated businesses (sole proprietors and partners) generally are not covered by this insurance unless they elect coverage. Casual Employees: Employees hired for a short period to perform a non-recurring task may not be covered.

What is the major problem with workers compensation waivers of subrogation?

With this endorsement on the policy, the company cannot attempt to recover payments it made to an injured worker from the company listed on the endorsement, even if that company was responsible for the injury. Consequently, the loss impacts the employers experience modification, probably increasing future premiums.