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Workers Comp Exclusion Form

Workers Comp Exclusion Form for the United Kingdom

Workers Comp Exclusion Form Template for England and Wales

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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."

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What is a Workers Comp Exclusion Form?

The Workers Comp Exclusion Form is utilized in situations where statutory exemptions permit the exclusion of certain workers from standard compensation coverage under English and Welsh law. This document becomes necessary when alternative arrangements are made or when specific statutory exemptions apply. The form must carefully balance the employer's right to implement exclusions with the worker's statutory protections under the Employers' Liability (Compulsory Insurance) Act 1969 and related legislation. It serves as a formal record of the agreement and understanding between all parties regarding the modification of standard workers compensation coverage.

What sections should be included in a Workers Comp Exclusion Form?

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

What sections are optional to include in a Workers Comp Exclusion Form?

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

What schedules should be included in a Workers Comp Exclusion Form?

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

Authors

Alex Denne

Head of Growth (Open Source Law) @ ¶¶Òõ¶ÌÊÓƵ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co
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Industries

Health and Safety at Work etc. Act 1974: Primary legislation governing workplace safety and health in the UK that sets out the fundamental structure and authority for workplace health and safety regulation

Employers' Liability (Compulsory Insurance) Act 1969: Key legislation that makes it mandatory for employers to maintain insurance to cover workplace injuries and illnesses

Employers' Liability (Compulsory Insurance) Regulations 1998: Detailed regulations specifying the requirements for employers' liability insurance, including coverage levels and documentation requirements

Social Security (Recovery of Benefits) Act 1997: Legislation governing how social security benefits can be recovered in relation to workplace injury claims

Insurance Act 2015: Modern legislation governing insurance contracts and disclosure requirements that must be considered in any insurance-related documentation

HSE Guidance: Regulatory guidance from the Health and Safety Executive that provides practical interpretation of health and safety legislation

FCA Regulations: Financial Conduct Authority regulations governing insurance products and their documentation

Mandatory Insurance Requirements: Legal requirement for minimum coverage levels and specific risks that must be insured against

Statutory Exemptions: Specific circumstances under which employers may be exempt from certain insurance requirements

Scope of Exclusion Requirements: Legal requirements for clearly defining and documenting any exclusions from workers' compensation coverage

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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