Exclusion Forms

[Mkilroy]

I'm a independent agent, and I do a lot of work with commercial accounts. I am looking for advice or templates on Work Comp and Endorsement exclusion forms that I can have the client sign off on, showing they KNOWINGLY refused coverage of WC and specific endorsements. I feel this would be beneficial to have in avoiding disputes/arguments with clients down the road.

Any ideas?

 

[MrGolf]

I don't know about a lot of other states but depending on your states laws the WC should be pretty black and white for you. In Kentucky, where I do most of my work, officers of a corporation are automatically included in WC unless otherwise elected. If they reject WC that has to be filed with the Commonwealth of Kentucky in a Form 4 Rejection. Members of an LLC are automatically excluded unless they file the paperwork to be included. Solves most all your problems on the Workers Comp end.

Again, other states may differ. Check with your states Department of Workers Comp Claims for the details.

 

[Milkman1265]

same, for NY there is an officer exclusion form, or they will be auto included.

 

[blue_wynd]

I think you guys are missing the OP's question. He is asking if your agency has paper forms that goes through coverage for the insured and have them sign off on it if they decided not get those coverage. If a E & O claim happens, you show them the paper of them not wanting the coverage after you recommended it.

 

[Milkman1265]

Only thing I have close is those pia checklist.

I just make notes of coverages he declined and have a general statement that he understands the coverage applied for including the endorsements or exclusions.

For WC, the state form should work.

Checklist has pros and con's.

 

[Mkilroy]

Thanks everyone for the information.

 

[BigIVU]

Some E&O carriers have lots of sample documents for this.