87.22 - CORPORATE OFFICER EXCLUSION FROM WORKERS' COMPENSATION OR EMPLOYERS' LIABILITY COVERAGE.
87.22 CORPORATE OFFICER EXCLUSION FROM WORKERS'
COMPENSATION OR EMPLOYERS' LIABILITY COVERAGE.
1. The president, vice president, secretary, and treasurer of a
corporation other than a family farm corporation, but not to exceed
four officers per corporation, may exclude themselves from workers'
compensation coverage under chapters 85, 85A, and 85B by knowingly
and voluntarily rejecting workers' compensation coverage by signing,
and attaching to the workers' compensation or employers' liability
policy a written rejection, or if such a policy is not issued, by
signing a written rejection which is witnessed by two disinterested
individuals who are not, formally or informally, affiliated with the
corporation and which is filed by the corporation with the workers'
compensation commissioner.
2. The written rejection shall be in substantially the following
form:
"REJECTION OF WORKERS' COMPENSATION OR EMPLOYERS' LIABILITY COVERAGE
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 .........."
3. The rejection of workers' compensation coverage is not
enforceable if it is required as a condition of employment.
4. A corporate officer who signs a written rejection filed with
the workers' compensation commissioner may terminate the rejection by
signing a written notice of termination which is witnessed by two
disinterested individuals, who are not, formally or informally,
affiliated with the corporation and which is filed by the corporation
with the workers' compensation commissioner. Section History: Recent Form
83 Acts, ch 36, § 5, 7, 8; 97 Acts, ch 186, § 1; 98 Acts, ch 1061,
§ 11; 2008 Acts, ch 1031, §28
Referred to in § 85.1, 517.6