A Workers Comp Waiver is utilized when an independent contractor or certain eligible workers choose to opt out of workers' compensation coverage. This document is particularly important in industries with high contractor utilization, such as construction or professional services. The waiver must carefully comply with state-specific requirements, as some U.S. states prohibit such waivers or impose strict conditions on their use. The document typically includes acknowledgment of rights being waived, alternative insurance arrangements if applicable, and specific state-mandated disclosures.
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1. Parties: Identification of employer and worker/contractor including full legal names, addresses, and relevant registration numbers
2. Background: Context of employment relationship, nature of work, and reason for workers' compensation waiver
3. Definitions: Key terms used in the waiver including 'Workers' Compensation Benefits', 'Waiver Period', and state-specific terminology
4. Waiver Statement: Express waiver of workers' compensation benefits, clearly stating the rights being waived and the voluntary nature of the waiver
5. Acknowledgment of Rights: Worker's explicit acknowledgment of the rights being waived and confirmation of understanding the implications
6. Duration: Specific period for which the waiver is valid, including start date and any termination conditions
1. Alternative Insurance: Details of alternative insurance coverage provided by the employer, including policy numbers and coverage limits
2. State-Specific Disclosures: Additional disclosures and statements required by specific state laws regarding workers' compensation waivers
3. Revocation Rights: Terms and conditions under which the worker may revoke the waiver, including notice requirements and procedures
1. Schedule A - Proof of Alternative Insurance: Documentation of alternative insurance coverage including policy details and certificates
2. Schedule B - State-Required Forms: Copies of any state-mandated forms or certificates required for valid workers' compensation waivers
3. Schedule C - Independent Contractor Agreement: Copy of the underlying independent contractor agreement if the waiver relates to contractor status
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