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At Workers Compensation Shop.com, we provide free access to most of the forms relating to Minnesota Workers' Compensation Insurance. We strive to keep these forms up to date and accurate. It is always a good idea to check with the state website to ensure you are using the most up to date form. We want to be your resource for Workers' Comp Forms, application, rates and quotes
If you have any questions about any of these forms, feel free to contact a Workers Comp Specialist at 888-611-7467. Our agents specialize in work comp and they know the process inside and out.
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MN Acord 130 Workers' Compensation Application
The standard Acord 130 application form for workers comp coverage in Minnesota.
Minnesota First Report of Injury Form
MN First Report of Injury Form. Employers should complete this form and send to their insurance company each time an injury occurs.
Minnesota Application for Exclusion of Officers and Stockholders
Owners and officers of corporations should complete this form to exclude themselves from a work comp policy.
Minnesota Application for Election/Rejection of Coverage
Owners and officers of corporations should complete this form to elect or exclude themselves and/or their family from a work comp policy.
Minnesota Application for Exemption for Workers' Compensation Insurance
Complete this form if you are an independent contractor and would like to be exempt from coverage.
Minnesota Certificate of Compliance
Required form to verify workers' compensation insurance.
Facts for Injured Workers In Minnesota
Information about workers compensation in Minnesota for 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 Minnesota
Minnesota Workers' Compensation Insurers Association, Inc.
7701 France Ave. South, Suite 450 Minneapolis, MN 55435-3200952-897-1737 http://www.mwcia.org/
Minnesota Labor and Industry
Workers Compensation Division443 Lafayette RoadSt. Paul, MN 551551-800-342-5354 http://www.dli.mn.gov/wc/contact.asp
Workers compensation insurance is required by law for Minnesota employers.
Minnesota 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 Minnesota.
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