Independent Contractor Status Form

Confirms that a person is an independent consultant as defined under the Workers' Comp Act.

Created for: Pinnacol policyholders and their HR managers

• Is required to be notarized and returned to Pinnacol Assurance
• Confirms that a person is an independent consultant as defined under the Workers' Comp Act
• Ensures that the independent contractor understands he/she will not be entitled to any workers' comp benefits in the event of an injury

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COVID-19 policy update

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