Inclusion and exclusion forms made easy.

Find the correct form for your state and business type.

Owner/Officer Inclusion and Exclusion Forms

Choose the state and company type to access the appropriate form. Once you’ve completed the appropriate form, please send it to subs@pieinsurance.com.

Pie's general form

If you're looking for our Pie workers' compensation rejection/inclusion/exclusion form, look no further!

Pie general INCL/EXCL form

What you need to know

What are owner and officer inclusions and exclusions?

In most states, owners and officers are automatically covered by their workers’ comp policy but can elect to be excluded from coverage. When an owner or officer decides they would like to be excluded, we typically need an exclusion form. Each state has its own exclusion form requirements, so your request to be excluded is effective the date Pie receives the form.

Why are officer inclusions and exclusions important?

Your election of being included or excluded will determine your eligibility for coverage benefits in the event you are injured at work. You should speak with your insurance agent about which coverage is right for you.

State requirements

Inclusion and exclusion requirements vary by state. Some states may even include or exclude you from the policy by default. Insurance providers, like Pie, follow the inclusion and exclusion guidelines defined by each state unless we have a signed election form on the policy. In addition, some states have regulations on individuals that cannot elect to be exempted from workers’ compensation coverage. Find your state and business type in the tool above to see your default treatment.