A Workers Compensation Waiver is utilized when eligible individuals, such as corporate officers, LLC members, or independent contractors, choose to opt out of workers' compensation coverage. This document is particularly relevant in jurisdictions where state law permits such waivers. The waiver must explicitly state the individual's voluntary decision to forgo coverage, acknowledge understanding of the rights being waived, and meet state-specific requirements for validity. Some states require filing with the workers' compensation board, while others mandate specific language or notarization. The document typically includes details about alternative insurance coverage, if applicable, and must comply with both state and federal labor laws.
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1. Parties: Identification of employer and employee/contractor including full legal names, addresses, and relevant business/employment details
2. Background: Context of employment relationship, nature of work, and explanation of why the waiver is being executed
3. Definitions: Key terms used in the waiver including 'Workers Compensation', 'Waiver', 'Coverage Period', and state-specific terminology
4. Waiver Statement: Express statement of workers' compensation coverage waiver, clearly outlining what rights are being waived
5. Acknowledgment of Rights: Statement acknowledging understanding of rights being waived and voluntary nature of the waiver
6. Duration: Period for which waiver is valid and any conditions affecting the duration
1. Alternative Insurance Coverage: Details of any alternative insurance coverage being provided in lieu of workers' compensation
2. Revocation Terms: Conditions and process for revoking the waiver, if permitted by state law
3. State-Specific Declarations: Additional declarations and statements required by specific state laws
1. Schedule A - Proof of Alternative Insurance: Documentation showing details of alternative insurance coverage, if applicable
2. Schedule B - State Filing Forms: Required state-specific forms that must be filed with relevant authorities
3. Schedule C - Corporate Resolution: For corporate officers, official resolution authorizing the waiver of workers' compensation coverage
Relevant legal definitions
Workers' Compensation Coverage
Waiver
Effective Date
State Workers' Compensation Law
Governing Law
Alternative Insurance Coverage
Employer
Employee
Independent Contractor
Corporate Officer
LLC Member
Work-Related Injury
Occupational Disease
State Workers' Compensation Board
Compensation Benefits
Medical Benefits
Disability Benefits
Notice Period
Revocation
Employment Relationship
Waiver
Effective Date
State Workers' Compensation Law
Governing Law
Alternative Insurance Coverage
Employer
Employee
Independent Contractor
Corporate Officer
LLC Member
Work-Related Injury
Occupational Disease
State Workers' Compensation Board
Compensation Benefits
Medical Benefits
Disability Benefits
Notice Period
Revocation
Employment Relationship
Clauses
Acknowledgment of Rights
Voluntary Waiver
Scope of Waiver
Duration
Revocation Rights
Alternative Insurance
State Law Compliance
Medical Coverage
Liability Release
Notice Requirements
Severability
Governing Law
Amendment
Entire Agreement
Acknowledgment of Understanding
Representation of Capacity
Filing Requirements
Benefit Exclusion
Termination
Execution
Voluntary Waiver
Scope of Waiver
Duration
Revocation Rights
Alternative Insurance
State Law Compliance
Medical Coverage
Liability Release
Notice Requirements
Severability
Governing Law
Amendment
Entire Agreement
Acknowledgment of Understanding
Representation of Capacity
Filing Requirements
Benefit Exclusion
Termination
Execution
Relevant Industries
Relevant Teams
Relevant Roles
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