Get Illinois Workers' Compensation Coverage Rejection Form

The Illinois Workers' Compensation Coverage Rejection Form is essential for corporate officers, sole proprietors, partners, or members of an LLC who wish to waive their rights to workers' compensation coverage. This guide provides clear, step-by-step instructions on how to complete the form efficiently online.

Follow the steps to complete the form with ease.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the form, locate the section requiring you to check off your status as a corporate officer, sole proprietor, partner, or member of an LLC. It's essential to select the appropriate option to proceed.
3. Proceed to the 'Waiver of Rights Under the Illinois Workers' Compensation Act' section. Here, you will need to confirm that you are waiving your rights for coverage against accidental injuries, including death, that arise from your employment.
4. In the box provided, ensure you check the option labeled 'I elect not to be covered under the Illinois Workers’ Compensation Act.' This indicates your decision to waive coverage.
5. Next, fill in your business name, your name, and your title. This information identifies you and your business for this rejection form.
6. You must then enter your policy number. Ensure that the policy number is accurate as it is critical for processing the form.
7. Finally, provide your signature and the date. This action finalizes your rejection of the coverage and confirms your understanding of the implications.
8. After completing the form, you can save your changes, download it for your records, print a copy for submission, or share it as needed.

Complete your documents online today for a streamlined experience.