The Iowa Division of Workers' Compensation (DWC) is no longer accepting the paper version of Form 14-0175, Nonelection of Workers' Compensation or Employers' Liability Coverage.
This online form must be used to make a nonelection of coverage under Iowa Code section 87.22 when the employer has not been issued a workers' compensation or employers' liability policy.
To file the form:
- Provide all requested information.
- The proprietor, limited liability company member, limited liability partner, or partner and authorized representative of the employer must sign the form by selecting the "Signed" in front of two disinterested witnesses, who have no formal or informal affiliation with the employer.
- You must click the "Submit" button to file the completed and signed form with DWC.
After you complete, sign, and submit the form, you will receive a verification email at the address(es) provided with the information you provided on the form to verify your submission of the form.
The information you provided will also be shown on the public list of persons who have made a nonelection of coverage.
For resources relating to nonelections of coverage, click here.