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Available Programs:

 Carrier Risk Tolerance:

Pay As You Go Workers' Compensation

N/A  Monopolistic State.

Direct Bill Work Comp

N/A  Monopolistic State.

Pay As You Go General Liability

Contractor and service risks acceptable:  low, medium, and high.

Commercial Packages- 12 Equal Installs

Non-construction risks only.

Workers Compensation Information:

 Owners Wages for Workers' Compensation

Individuals and Partners

LLC Members

Corporate Officers: Corporations

 General Liability Information:

 Owners Wages for General Liability:

Individuals and Partners

Corporate Officers & LLC Members

WY Resources & Links:

 WY Workers Compensation Forms:

State of Wyoming

http://wyoming.gov/

Department of Employment

http://wydoe.state.wy.us/

Cheyenne Business Center
1510 East Pershing Boulevard
Cheyenne, Wyoming 82002
(307) 777-7672, Fax: (307) 777-5805
Cindy Pomeroy, Director, (307) 777-5960

CPOMER@state.wy.us
 

Charles Rando, Administrator, (307) 777-6370 CRANDO@state.wy.us

Workers’ Safety and Compensation Division

http://wydoe.state.wy.us/doe.asp?ID=9

Cheyenne Business Center
1510 East Pershing Boulevard
Cheyenne, Wyoming 82002
(307) 777-7159, Fax: (307) 777-5524.
    

To Report an Injury: (800) 870-8883 or (307) 777-7441

Fax: (307) 777-6552.
To Report Fraud: (888) 996-9226 or (307) 777-6552,

Fax: (307) 777-3581. 
    

Gary Child, Administrator, (307) 777-7159, Fax: (307) 777-5524 GCHILD@state.wy.us

Acord 130 Form

Certificate Request Form

ERM-14 Form

Order Loss Runs (Example)

NCCI Mod Authorization

* Information contained herein is based on the most accurate data as of the time of posting.  Please check with you states Division of Workers' Compensation Insurance for the most up to date information and to verify accuracy.