We help business owners navigate Nebraska workers' comp rules.

We offer free access to the most common forms needed relating to Nebraska Workers' Compensation Insurance. We strive to keep these forms up to date and accurate.

As with all the information we provide about state workers' comp rules please verify the accuracy of this information with the Nebraska Department Of Insurance.

If you have questions about any of these forms feel free to contact one of our Work Comp Experts at 888-611-7467. If you are ready you can start a quote online today.

Nebraska Workers' Compensation Insurance Forms

Nebraska Acord 130 Workers' Compensation Application

The standard Acord 130 application form for workers' comp coverage in Nebraska.

Nebraska First Report of Injury Form

Nebraska First Report of Injury Form. Employers should complete this form and send to their insurance company each time an injury occurs

Nebraska Application for Election and Exclusion of Officers and Stockholders

Owners and Officers of corporations should complete this form to include or exclude themselves from a work comp policy.

Nebraska Application for Inclusion Form

Sole proprietors, partners, and spouses of corporate officers should complete this form to include themselves on a work comp policy.

Nebraska New Farm Employee Exemption Form

Complete this form if you are a new farm employee and are not covered by the Nebraska Workers' Compensation Act.

Rights and Obligations Information

Information about workers' compensation in Nebraska for workers and employers.

Workers' Comp Exemption

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.

Waiver of Subrogation

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.

Certificate of Insurance

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 Nebraska

Nebraska Department Of Insurance

Terminal Building
941 O Street, Suite 400
Lincoln, NE 68508-3639
http://www.doi.nebraska.gov/

Nebraska Workers' Compensation Court

P.O. Box 98908
Lincoln NE 68509-8908
800-599-5155
http://www.wcc.ne.gov/

Workers' compensation insurance is required by law for Nebraska employers.

Nebraska 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 Nebraska.

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We've developed Target Programs with key insurance companies that provide bigger discounts and more credits.

Visit NCCI for more resources and information about workers' compensation class codes. Visit United States Department of Labor for more information about government agencies managing workers compensation insurance rates.

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