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Workers Comp Exclusion Form
"Need a Workers Comp Exclusion Form for our UK-based software development contractors who have their own professional insurance coverage, to be effective from March 1, 2025, ensuring compliance with English law while acknowledging their independent status."
1. Employee Information: Personal and employment details of the worker including name, address, employment status, and role
2. Scope of Exclusion: Detailed specification of which workers compensation coverage elements are being excluded
3. Acknowledgment of Rights: Worker's explicit confirmation of understanding their rights and the implications of the exclusion
4. Legal Compliance Statement: Confirmation that the exclusion complies with relevant legislation including the Employers' Liability Act 1969
5. Signature Block: Space for dated signatures from the employee, employer, and any required witnesses
1. Alternative Coverage Details: Section detailing any alternative insurance arrangements or coverage being provided in lieu of standard workers compensation
2. Time Limitation: Section specifying the duration of the exclusion if it is temporary or fixed-term
3. Special Circumstances: Description of specific situations or conditions that warrant this exclusion
1. Schedule A - Proof of Alternative Coverage: Documentation and details of alternative insurance arrangements if applicable
2. Schedule B - Risk Assessment: Detailed assessment of workplace risks relevant to the exclusion and mitigation measures
3. Appendix 1 - Statutory Rights Summary: Comprehensive summary of worker's statutory rights that remain in effect despite the exclusion
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