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Click ‘Get Form’ to open the workers comp exemption form in the editor.
Begin by entering the name and trade name of the independent contractor at the top of the form. Ensure accuracy as this information is crucial for identification.
Fill in the type of work being performed, along with the Social Security or Federal Employer Identification Number. This section verifies the contractor's status.
Provide both addresses and phone numbers for the independent contractor and policyholder. This establishes clear communication channels.
Initial where applicable next to each criterion listed to confirm that both parties agree on the independent contractor's status according to Colorado law.
Both parties must sign and have their signatures notarized. Ensure you follow all instructions carefully to avoid delays in processing.
Make copies of the completed form for your records before sending the notarized original to Pinnacol Assurance at the specified address.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (56 Votes)
2006	4.3 Satisfied (116 Votes)
2005	4.2 Satisfied (63 Votes)

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What does a workers comp exemption do?

Being workers comp exempt means an employee doesnt have coverage for workers compensation insurance. If a worker has an exemption, they wont get benefits to help them recover from a work-related injury or illness. So, they or their employer will have to pay out of pocket for: Medical bills.

Why do I need a workers comp exemption?

Most states require businesses with employees to carry workers compensation insurance. But you may be able to apply for a workers comp exemption for certain types of workers, like independent contractors. This means you dont have to provide workers comp to cover that worker if they get hurt or sick from their job.

Is workers compensation mandatory in Utah?

The law does contain some limited exemptions. Domestic employees; most real estate salespersons; uncompensated officers and directors of certain non- profit organizations; and public officials are specifically exempted. Most volunteer workers are not entitled to benefits.

Who is exempt from workers comp in Arizona?

(a) (Quick Option) - Access the online application at .wcb.ny.gov. Click the WC/DB Exemption button and then click Request for WC/DB Exemption (Form CE-200). Complete the on-line application, then print, sign and submit the certificate with your application.

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