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You Are Here: Businesses Workers' CompensationWC Assessment Fund
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Workers' Compensation Assessment Fund
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You may need the free Adobe PDF Reader for some of the forms. If you don't have Adobe Reader, click here to download.
- What is the Workers' Compensation Assessment Fund?
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The workers’ compensation administration fund was created to provide the funds necessary to administer Vermont’s Workers’ Compensation Program.
The fund consists of contributions from employers, based on the Workers’ Compensation Assessment Rate.
The stautory reference for the Workers' Compensation Administration Fund is available at the following link: http://www.leg.state.vt.us/statutes/fullsection.cfm?Title=21&Chapter=009&Section=00711
- Current Workers' Compensation Assessment Rates:
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Insurance Companies:
- Starting July 1, 2011 the assessment rate is 1.75%.
- July 1, 2010 the assessment rate was 1.425%.
- Insurer's Quarterly Assessment Form Submission Instructions (in PDF Format)
Workers' Compensation Assessment Fund Historical Rates
INSURERS
Insurer's Quarterly Assessment Form
- For the period October 31, 2012 to July 31, 2013 Download in Adobe 9 Fill In Format
- For the period October 31, 2011 to July 31, 2012 Download in Adobe 9 Fill In Format
- For the period October 31, 2010 to July 31, 2011 Download in Microsoft Word
- For the period October 31, 2010 to July 31, 2011 Download in Adobe 9 Fill In Format
- For the period October 31, 2009 to July 31, 2010 Download in Microsoft Word
- For the period October 31, 2009 to July 31, 2010 Download in Adobe 9 Fill In Format
- After July 1, 2008 Download in Microsoft Word
- After July 1, 2008 Download in Adobe PDF Format
- After July 1, 2008 Download in Adobe 9 Fill In format
- Between July 1, 2007 and June 30, 2008 Download in Microsoft Word
- Between July 1, 2007 and June 30, 2008 Download in Adobe PDF Format
- Between July 1, 2007 and June 30, 2008 Download in Adobe 9 Fill In format
Insurer's Reconciliation Statement
For information contact Tami Furry at tami.furry@state.vt.us or 802-828-4117.
SELF-INSURERS
All self-insured employers must be approved by the Department. Please see Rule 25 for information.
Approved Self-Insured Employers
Form 30 - Application for Self Insurance
Bond Form for Self-Insured Employers
Assumption and Guarantee Form
Download Assumption & Guarantee Form in PDF format
Download Assumption & Guarantee Form in Word format
Self-Insurer's Report
For information contact J. Stephen Monahan at stephen.monahan@state.vt.us
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