Insurance Coverage Exemption Form

An Insurance Coverage Exemption Form is a document used by a policyholder to request an exemption or waiver from certain types of coverage that may be required by law or contract. The form typically requires the policyholder to provide information about their specific circumstances and reasons for seeking the exemption, as well as to acknowledge the risks and limitations of forgoing coverage. Insurance coverage exemption forms are often used in the context of workers’ compensation or other mandatory insurance programs.