Rejection of Coverage (Form 16A) - ONLINE

The Rejection of Coverage form may be filed by an executive officer or their agent should the officer elect to exclude himself or herself from coverage under the Act. An executive officer means (i) president, vice-president, secretary, treasurer or other officer, elected or appointed in accordance with the charter and bylaws of a corporation and (ii) the manager elected or appointed in accordance with the articles of organization or operating agreement of a limited liability company. It does not include persons with the title of director, LLC member or chairman. An officer may exclude himself or herself from coverage for injury or death by accident, but not for occupational disease. A Rejection of Coverage filing is commonly performed in order to reduce the insurance premium on the business workers’ compensation insurance policy.

Instructions: