Iowa Code 87.22 – Exclusion from workers’ compensation or employers’ liability coverage — corporate officers, proprietors, limited liability company members, limited liability partners, and partners
Terms Used In Iowa Code 87.22
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- following: when used by way of reference to a chapter or other part of a statute mean the next preceding or next following chapter or other part. See Iowa Code 4.1
- person: means individual, corporation, limited liability company, government or governmental subdivision or agency, business trust, estate, trust, partnership or association, or any other legal entity. See Iowa Code 4.1
- state: when applied to the different parts of the United States, includes the District of Columbia and the territories, and the words "United States" may include the said district and territories. See Iowa Code 4.1
- week: means seven consecutive days. See Iowa Code 4.1
I understand that by signing this statement I reject the coverage of chapters 85, 85A, and 85B of the Code of Iowa relating to workers’ compensation. I understand that my rejection of the coverage of chapters 85, 85A, and 85B is not a waiver of any rights or remedies available to me or to others on my behalf in a civil action related to personal injuries sustained by me arising out of and in the course of my employment with the corporation. I also understand that by signing this statement and checking alternative (1) below I reject employers’ liability coverage for bodily injuries or death sustained by me arising out of and in the course of my employment with the corporation. [Check either alternative (1) or (2):] (1) I reject the employers’ liability coverage. (2) I decline to reject the employers’ liability coverage. Signed Corporate Office Date City, County, State of Residence Witness ……………………………………………………………………..Witness …………………………………………………………………….. I also understand that the signing of this statement and checking of alternative (1) below by an authorized agent of the corporation rejects for the corporation employers’ liability coverage for bodily injuries or death sustained by me arising out of and in the course of my employment with the corporation. [Check either alternative (1) or (2):] (1) The corporation rejects the employers’ liability coverage. (2) The corporation declines to reject the employers’ liability coverage. Signed Relationship to Corporation Date City, County, State of Residence Witness ……………………………………………………………………..Witness ……………………………………………………………………..
I acknowledge that I am a proprietor, limited liability company member, limited liability partner, or partner and that I am not required to be covered by the workers’ compensation law of this state pursuant to section 85.1A. I understand that by signing this statement I am not electing the coverage of chapters 85, 85A, and 85B of the Code of Iowa relating to workers’ compensation. I understand that my nonelection of the coverage of chapters 85, 85A, and 85B is not a waiver of any rights or remedies available to me or to others on my behalf in a civil action related to personal injuries sustained by me arising out of and in the course of my employment with the employer. I also understand that by signing this statement and checking alternative (1) below I am not electing employers’ liability coverage for bodily injuries or death sustained by me arising out of and in the course of my employment with the employer. [Check either alternative (1) or (2):] (1) I am not electing the employers’ liability coverage. (2) I am electing the employers’ liability coverage by purchasing valid workers’ compensation insurance specifically including me. Signed Employer’s Office Date City, County, State of Residence Witness ……………………………………………………………………..Witness …………………………………………………………………….. I also understand that the signing of this statement and checking of alternative (1) below by an authorized agent of the employer is a nonelection for the employer of the employers’ liability coverage for bodily injuries or death sustained by me arising out of and in the course of my employment with the employer. [Check either alternative (1) or (2):] (1) The employer does not elect the employers’ liability coverage. (2) The employer elects the employers’ liability coverage by purchasing valid workers’ compensation insurance specifically including me. Signed Relationship to Employer Date City, County, State of Residence Witness ……………………………………………………………………..Witness ……………………………………………………………………..