Workers Comp Certificate Checklist

Business: ________________ Trade: ________________ Work state: ________________ Contract type: ________________ Client or general contractor: ________________ Job: ________________ Certificate due date: ________________ Waiver of subrogation requested: ________________

Use this checklist to prepare a workers compensation certificate of insurance request for this job. A certificate shows evidence of coverage. It does not create coverage or change the policy.

• Workers compensation policy declarations page, if coverage is already in force.
• Current workers compensation certificate of insurance, if one has already been issued for this policy term.
• The contract insurance exhibit or certificate instructions from ________________.
• Certificate holder name, mailing address, and project name exactly as the contract lists them.
• Required policy limits for employers liability, if the contract lists them.
• Waiver of subrogation wording, if the contract requires a workers compensation waiver.
• State exemption, rejection, or owner exclusion paperwork for ________________, if you have no employees and the client accepts that instead of a certificate.
• Written confirmation from ________________ if an exemption or rejection document will be accepted for this job.

• Confirm whether the contract requires workers compensation statutory coverage for employees.
• Confirm whether the contract requires employers liability limits, and copy the exact limit wording into the certificate request.
• Confirm whether a waiver of subrogation is required. Ask for this endorsement only when the contract requires it.
• Confirm whether the contract asks to include owners, officers, members, or sole proprietors under the workers compensation policy.
• Confirm whether the contract accepts a state exemption, rejection, or owner exclusion document when ________________ has no employees.
• If helpers or subcontractors will work on the job, check the ________________ rule before relying on a no-employee exemption.
• If the contract wording is unclear, request written clarification from ________________ before the job start date.

• Send the certificate request instructions and contract insurance exhibit before ________________.
• Ask the insurance contact to confirm whether the policy includes the owner, sole proprietor, officer, or member as required by ________________ law or the contract.
• If a waiver of subrogation is required, ask whether the carrier can add it before work starts and whether a charge applies.
• Review the certificate after it is issued. Check business name, policy dates, workers compensation coverage, employers liability limits, and certificate holder details.
• Send the final certificate or accepted exemption document to ________________ and keep a copy with the job file.

For ________________, do not assume a 1099 tax form proves exemption from workers compensation rules. State rules may treat a worker as an employee based on control, construction rules, owner status, employees, helpers, or subcontractors. If ________________ has no employees, check whether ________________ offers an exemption, rejection, or owner exclusion document and whether ________________ will accept it for ________________.