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Missouri Affidavit of Exemption For Workers Compensation Insurance

State:
Missouri
Control #:
MO-SKU-2153
Format:
PDF
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Affidavit of Exemption For Workers Compensation Insurance

The Missouri Affidavit of Exemption For Workers Compensation Insurance is a document that employers must file with the Missouri Department of Labor and Industrial Relations to exempt any business that only employs themselves and/or their spouse from having to purchase workers’ compensation insurance. There are two types of Missouri Affidavit of Exemption For Workers Compensation Insurance: 1) Sole Proprietor Affidavit of Exemption; and 2) Spouse of Sole Proprietor Affidavit of Exemption. The Sole Proprietor Affidavit of Exemption must be completed by the sole proprietor and must include the name, address, and Social Security number of the sole proprietor. The Spouse of Sole Proprietor Affidavit of Exemption must be completed by the spouse of the sole proprietor and must include the name, address, and Social Security number of the spouse. Both affidavits must be signed and notarized before they can be submitted to the Missouri Department of Labor and Industrial Relations. Upon approval, the employer is exempt from purchasing workers’ compensation insurance and from paying the related premiums.

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FAQ

A waiver of subrogation means that a business and their insurance company is foregoing all rights to file suit, or seek damages, from another business.

Workers' compensation is a state-mandated, "no-fault" insurance system that pays benefits to workers injured on the job to cover medical care, part of lost wages and permanent disability. In return, employers receive immunity from civil lawsuits by employees over such workplace injuries.

WC Waiver of Subrogation The employer's WC policy pays statutory benefits to the injured worker regardless of negligence on the part of the employer or any outside party. If the employee's injury has resulted from an outside party's negligence, the insurer has the right to seek recovery from that party.

Waivers of Subrogation: Not allowed and are against public policy in Missouri for an employer in the construction group of code classifications.

In the state of Missouri you are required to carry workers' compensation insurance if you have five or more employees, unless you are in the construction industry, then you must carry workers' compensation insurance if you have one or more employees.

An employer who knowingly fails to insure its workers' compensation liabilities is guilty of a class A misdemeanor and may be liable to the state of Missouri for a penalty of up to three times the annual premium or up to fifty thousand dollars, whichever amount is greater. A subsequent violation is a class E felony.

Railroad, postal, and maritime workers are covered under federal laws and not by Missouri Workers' Compensation Laws.

More info

The following ownership types must complete this form if they wish to opt out of the. Once notarized, this BP-1 form serves as an exemption for both workers' compensation and disability benefits insurance coverage.I am an independent contractor, not an employee of the contractor, and I do not want workers' compensation insurance. 5. I have not filed a notice to withdraw the exemption for my corporation with the Missouri Division of. Workers' Compensation. 4. Their right of exemption per c. 152, §1(4), and we have no employees. Workers' Compensation Act. Affidavit. 152, §1(4), and we have no employees. You must either obtain workers' compensation coverage for yourself or complete a form indicating you wish to reject that coverage.

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Missouri Affidavit of Exemption For Workers Compensation Insurance