We help business owners navigate multi-state coverage.

Please feel free to download and utilize our North Dakota forms and documents from our free forms library. We do our best to keep our forms and documents library updated with the most recent guides and applications for your convenience.

North Dakota Workforce Safety & Insurance (WSI) is a monopolistic state fund.  It is part of a state controlled workers' compensation plan.  The state does not allow private insurance carriers to provide policy coverage in this state.

Independent contractors may be able to opt out of workers' compensation if they do not have employees working for them. The state requires contractors to complete an Independent Contractor Verification Application for approval.

North Dakota Workers' Compensation Forms

North-Dakota Acord 130 Workers' Compensation Application

The standard Acord 130 application form for workers' comp coverage in North-Dakota.

North Dakota First Report of Injury Form

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

First Report of Injury Form Instructions

Instructions for filing the First Report of Injury Form properly.

North-Dakota Application for Exclusion of Officers and Stockholders

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

Employers Guide to Workers' Compensation

Information about workers' compensation in North-Dakota for employers.

Facts for Injured Workers In North-Dakota

Information about workers' compensation in North-Dakota for injured workers.

Preferred Worker Registration Form

Complete this form to apply for membership in the Preferred Worker Program..

Preferred Worker Employer Registration Form

Complete this form to apply for membership in the Preferred Worker Program..

Preferred Worker Program Brochure

Information about the Preferred Workers Program to assist injured workers return to work.

Reducing Workers' Compensation Costs

This document contains tip for Employers to help reduce workers' compensation costs.

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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Pay As You Go Work Comp

Improve your business cash flow with our Agency Pay As You Go Workers' Comp plans. Available through most of our insurance companies.

Pay ASs You Go

State Resources for North Dakota

Workforce Safety & Insurance

1600 East Century Ave Ste 1
PO Box 5585
Bismarck, MD 58506-5585
800-777-5033
WSI

North Dakota Department Of Insurance

600 East Boulevard Avenue
Bismarck, ND 58505-0320
800-247-0560
ND Insurance Department

Workers' compensation insurance is required by law for North Dakota employers.

North Dakota 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 North Dakota.

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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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