Workers Comp Exclusion Form for the United Kingdom
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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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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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