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Here is a list of all the forms, applications, and manuals related to Workers' Compensation Insurance in the state of Alaska. We strive to keep this up to date and accurate.
As with all information we provide please verify the accuracy of this information with the Alaska Division of Workers' Compensation.
If you have any questions about where to find or how to fill out one of these or any other form, please feel free to call one of our Workers' Compensation Expert's at 888-611-7467.
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AK Acord 130 Workers' Compensation Application.
The standard Acord 130 application form for workers' comp coverage in Alaska.
Alaska First Report of Injury Form.
AK First Report of Injury Form. Employers should complete this form and send to their insurance company each time an injury occurs.
Alaska Petition for Executive Officer Waiver
Owners and Officers of corporations should complete this form to exclude themselves from a work comp policy.
Alaska Application for Exemption for Workers' Compensation Insurance
Complete this form if you are a sole-proprietor, partnership with no employees or an sole officer of a corporation and would like to be exempt from coverage.
Employer's Notice of Insurance
This form is to notify employees of insurance coverage and carrier.
Alaska Workers' Compensation Claim Form
Complete this form to file an official workers' compensation claim with the Alaska Department of Labor and Workforce Development.
Notice of Possible Claim Against the Second Injury Fund
Use this form to apply for a claim against the Second Injury Fund for injuries that have caused further damage to a pre-existing condition.
Facts for Injured Workers In Alaska
Information about workers' compensation in Alaska for workers and employers.
Each state has its own laws and requirements regarding when and how employers are allowed to opt-out of coverage under their workers' compensation policy. Some states make it easier than others because they don't require anything to be filed. Other states require special inclusion or exclusion affidavit documentation. Failure to comply often causes employers to have to pay premium on themselves even when they wanted to be excluded form coverage.
A waiver of subrogation means that a business and their insurance company is foregoing all rights to file suit, or seek damages, from another business. This is common in the construction industry as builders attempt to protect their company from negligence. A workers' comp waiver of subrogation does not prevent an injured employee from filing a lawsuit for damages. This coverage typically add about $100 to the cost of a work comp policy.
A Certificate of Insurance is a document that serves as evidence of insurance or proof of coverage. Certificates indicate your current coverages and policy limits. Insurance Agencies issue on an insured's behalf and they often list a third party as a certificate holder. This means they should be notified if a policy cancels prior to expiration. Requests for any special wording should be carefully checked against the policy language before being added to a certificate as they can create legal issues with coverage.
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State Resources for Alaska
Alaska Division of Workers' Compensation
Post Office Box 25512Juneau, Alaska 99802-5512907-465-2790 labor.state.ak.us/wc/home.htm
National Council on Compensation Insurance (NCCI)
901 Peninsula Corporate CircleBoca Raton, FL 33487-1362800-622-4123 www.ncci.com/
Workers' compensation insurance is required by law for Alaska employers.
Alaska forms and applications such as owners inclusion or exclusion forms are sometimes updated by the state. Contact us if you need help or can't find the workers' compensation form your need for Alaska.
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