Please use the Notice of Election to Be Exempt system to electronically submit an exemption application and payment, if required, to the Division of Workers' Compensation. The link is here:
Once received, the Division has 30 days to review your application to determine if it meets the eligibility requirements for the issuance of an exemption. The Division will either:
Issue a Certificate of Election to be Exempt. The Certificate of Election to be Exempt will be mailed to the address shown on the application.
Notify you by mail that your application is incomplete and what information is needed to complete the application.
Deny the exemption - If the Notice of Election to be Exempt is denied, the applicant must submit a new Notice of Election to be Exempt and, if the applicant is engaged in the construction industry, another $50.00 fee is required.
The Division reviews and processes exemption applications in the order they are received. Exemption information will be reflected on the Proof of Coverage Database the day following the issuance of the exemption.
Exemptions are effective on the date they are issued by the Division.
Certificates of Election to be Exempt shall apply only to the corporate officer named on the Notice of Election to be Exempt and apply only within the scope of the business or trade listed on the Notice of Election to be Exempt.
An exemption is subject to revocation if the person named on the certificate no longer meets any of the requirements to be eligible for an exemption. To voluntarily revoke an exemption, complete a Revocation of Election to be Exempt