FUBA Workers' Comp Waiver Instructions and Details
This file provides important guidelines for requesting blanket and specific waiver endorsements for workers' compensation policies. Get step-by-step instructions for filling out the necessary forms and learn about the associated fees. Ideal for policyholders looking to streamline their waiver requests.
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How do I fill this out?
To begin filling out this form, first gather all required information, including your policy details and the name of the entity for specific waivers. Carefully complete the ACORD Monthly Change Sheet, ensuring accuracy in each section. Lastly, ensure you have the necessary payment information ready to expedite your request.
How to fill out the FUBA Workers' Comp Waiver Instructions and Details?
1
Gather all necessary policy information.
2
Complete the ACORD Monthly Change Sheet accurately.
3
Indicate the type of waiver requested in the 'Remarks' section.
4
Provide payment information to process your request.
5
Submit the completed form to the Policy Services Department.
Who needs the FUBA Workers' Comp Waiver Instructions and Details?
1
Contractors who wish to waive subrogation rights for clients.
2
Businesses entering contracts requiring waiver endorsements.
3
Policyholders needing specific waivers for unique clients.
4
Companies utilizing payroll services to handle insurance payments.
5
Insurance agents seeking to assist clients with submission.
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What are the instructions for submitting this form?
To submit this form, email the completed ACORD Monthly Change Sheet to policyinfo@fubaworks.com. Alternatively, you can send it via fax at 888-871-7474 or mail it to Post Office Box 1303, Tallahassee, FL 32302. Make sure to include all necessary information to prevent processing delays.
What are the important dates for this form in 2024 and 2025?
Ensure your requests are submitted timely, especially around April 20, 2024, and April 20, 2025, as these dates affect the waiver terms. Policies written prior to these dates have different charge structures. Always check your renewal dates to avoid gaps in coverage.
What is the purpose of this form?
The purpose of this form is to provide policyholders with a structured approach to request waiver endorsements. By completing the necessary documentation, entities can effectively waive subrogation rights, ensuring compliance with contractual obligations. This process is crucial for protecting policyholders' interests and maintaining smooth business operations.
Tell me about this form and its components and fields line-by-line.
- 1. Policyholder Name: The name of the individual or business holding the policy.
- 2. Entity Name: Name of the entity requiring the waiver.
- 3. Waiver Type: Indicates whether it is a blanket or specific waiver.
- 4. Payment Information: Details for payment, including method and amounts.
- 5. Signature: Area for the policyholder's signature upon completion.
What happens if I fail to submit this form?
Failure to submit this form can result in delays or inability to obtain the necessary waiver endorsements. This could lead to the policyholder being held liable for subrogation claims, impacting their financial responsibilities.
- Liability Issues: Without a waiver, contractors may face unnecessary liabilities.
- Financial Penalties: Missing out on timely submissions could incur extra costs.
- Contractual Obligations: Non-compliance with contract terms may lead to legal challenges.
How do I know when to use this form?
- 1. Contractual Agreements: Use this form when entering into contracts that stipulate a need for waiver endorsements.
- 2. Policy Renewals: Completion during policy renewals can ensure continued waiver coverage.
- 3. Client Requirements: When clients demand waiver endorsements for risk mitigation.
Frequently Asked Questions
How do I request a waiver endorsement?
To request a waiver, complete the ACORD Monthly Change Sheet and submit it to our Policy Services Department.
What fees are associated with waiver endorsements?
A blanket waiver costs $400 upfront or 2% of premium, while a specific waiver costs $200.
Can I edit the PDF before submitting?
Yes, you can edit the PDF using PrintFriendly's editing tools to fill out the necessary information.
How do I pay for a waiver endorsement?
Payment can be made via check or electronic funds transfer, depending on your setup.
What if my policy has expired?
We cannot issue a waiver for expired policies; ensure your policy is active.
Can I submit the form via email?
Yes, email the completed form to policyinfo@fubaworks.com.
What information do I need to fill out?
Gather your policy details, the entity’s name for specific waivers, and payment information.
Are blanket waivers renewable?
Yes, blanket waivers will automatically renew with your policy.
How will I know if my waiver is approved?
Once processed, you will receive confirmation from our Policy Services Department.
Is there a version of the ACORD form I should use?
Use the ACORD Monthly Change Sheet 175-FL (rev. 3/97) for submissions.
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