We help Washington business owners buy out of state coverage.

Washington employers and business owners can download and use these forms and documents from our free forms library.  We make every effort to keep our forms and guides updated with the most recent versions for your convenience.

Washington Department of Labor and Industries 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 and therefore we do not offer any forms at the present time.

We are happy to help your business find other states workers compensation insurance quotes if you work out of state or hire employees in other states.

Washington Workers' Comp Insurance Forms

Washington Acord 130 Workers Compensation Application

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

Washington 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.

Washington Application for Exclusion of Officers and Stockholders

Owners and Officers of corporations should complete this form to exclude themselves from a workers' compensation policy.

Washington Application for Self Insurance

Complete this form if you wish to apply for the right to self insure your company.

Washington File Fast Handouts

This is a brochure outlining the File Fast online claims reporting.

Washington File Fast Poster

This is a poster outlining the File Fast online claims reporting.

File Information Contract

Contract covering secure access to the Labor and Industry computer database and application.

Washington Guide to Industrial Insurance Benefits

This is a brief guide to workers' compensation insurance.

Washington Help for Injured Workers

This contains helpful information for injured employees.

Home Modification for Workers with Catastrophic Injuries

This document is an overview of what modifications are covered by the Department of Labor and Industry for catastrophically injured workers.

WA Notice to Employees

This document is a brief overview of workers' compensation for employees.

Preferred Worker Program Pamphlet

This is a n overview of the Washington Preferred Worker Program.

Residential Care Services for Injured Workers

Complete this form to assess the level of residential assisted care is required for the injured employee.

Safety for Teen Workers

Information about safety for teen workers in regards to operating power lawn and yard-care equipment.

Filing Information

Form containing the required filing information.

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 Washington

Washington Department of Labor and Industries

PO Box 4400
Olympia, WA 98504-4000
360-902-5798
WA Dept. of Labor and Industries

Washington Board of Industrial Insurance Appeals

2430 Chandler Court SW
PO Box 42401
Olympia, WA 98504-2401
360-753-6823
Board of Industrial Insurance Appeals

Workers compensation insurance is required by law for all Washington employers.

Washington insurance forms and workers comp 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 Washington.

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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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