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Application for Elective Coverage (F213-042-000). Application for Elective Coverage (F213-042-000) 2026
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- Click ‘Get Form’ to open the Application for Elective Coverage in the editor.
- Begin by selecting your business entity type: Sole Proprietor, Partner, For Profit Corporation, or LLC. Ensure you understand the requirements for each category as outlined in the form.
- Fill in your business name, contact name, address, UBI, account ID, and phone number. This information is crucial for identification and processing.
- In the section for exempt corporate officers or members, list each individual’s name, position, duties, social security number, date of birth, and percentage of ownership. Ensure all electing members sign where indicated.
- Review all entered information carefully to ensure accuracy before submitting. Once completed, save your document and follow the instructions to mail it to the appropriate department.
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How do I get workers comp insurance in Washington state?
Washington workers compensation coverage is only available through the state fund. This means it cant be bought through a private insurer.
How is Washington workers comp calculated?
Hourly employees Only actual hours worked are used when determining the WC calculation. Vacation, sick, holiday pay and so on, should not be counted, even if its paid leave. The formula for WC calculations is: rate x hours worked. 80 hours are worked during the pay period.
Who is exempt from WA workers comp?
Workers Comp Exemptions in Washington Business owners, partners, members and officers are generally excluded from workers comp coverage in Washington. The state has limits on the number of owners that can be excluded and the level of control required in order to be considered an owner.
How long can you stay on workers compensation in WA?
You can continue receiving workers compensation income payments in Western Australia as long as you remain unable to work due to your injury.
How does workers compensation work in Washington state?
Employers purchase coverage through the Department of Labor Industries (LI). LI manages all claims and pays benefits out of an insurance pool called the Washington State Fund. The fund is financed by premiums paid by employers and employees, not by general revenue taxes.
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How much does workers comp pay in Washington state?
In such cases, the Washington State Department of Labor and Industries (LI) will reimburse you for lost time and wages typically between 60-75% of the workers earnings prior to the injury or disease up to a maximum cap.
Related links
Use this form to elect coverage for certain employments excluded from mandatory coverage as described in the Industrial Insurance laws of Washington, RCW 51.12.Read more
To add this coverage, the department must receive a completed application for elective coverage of excluded employments form F213-112-000 from the entity