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Here is a list of all the forms, applications, and manuals related to Workers' Compensation Insurance in the state of New Hampshire. We strive to keep this up to date.
As with all information we provide, please verify the accuracy of these forms with the New Hampshire Department of Labor.
If you have any questions about where to find or how to fill out one of these or any other form, please feel free to call one of our Workers' Compensation Experts at 888-611-7467.
NH Acord 130 Workers' Compensation Application.
The standard Acord 130 application form for workers' comp coverage in New Hampshire.
New Hampshire First Report of Injury Form.
NH First Report of Injury Form. Employers should complete this form and send to their insurance company each time an injury occurs.
New Hampshire Application for Exclusion of Officers and Stockholders
Owners and Officers of corporations should complete this form to exclude themselves from a work comp policy.
New Hampshire Application for Exemption for Workers' Compensation Insurance
Complete this form if you are a sole-proprietor, partnership with no employees or an sole officer of a corporation and would like to be exempt from coverage.
Employer's Guide to Workers' Compensation
Information about workers' compensation in New-Hampshire for employers.
Workers' Compensation Forms
IA collection of workers' compensation forms and instruction to assist in proper filing of forms.
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.
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.
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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 New Hampshire
NH Department of Labor
Workers' Compensation Division 95 Pleasant StreetConcord, NH 03301603-271-2042 www.nh.gov/
National Council on Compensation Insurance (NCCI)
901 Peninsula Corporate CircleBoca Raton, FL 33487-1362800-622-4123 www.ncci.com/
Workers' compensation insurance is required by law for New Hampshire employers.
New Hampshire 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 New Hampshire.
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