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You Are Here: Businesses Workers' Compensation WC 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?
- Current Workers' Compensation Assessment Rates:
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Insurance Companies: Prior to July 1, 2007 .4% of the direct calendar year premiums for workers’ compensation insurance. After July 1, 2007 .42% of the direct calendar year premiums for workers' compensation insurance. On July 1, 2008 the assessment rate changed to .81%. On July 1, 2009 the assessment rate changed to .96%
- Insurer's Quarterly Assessment Form Submission Instructions (in PDF Format)
Workers' Compensation Assessment Fund Historical Rates
INSURERS
Insurer's Quarterly Assessment Form
- Prior to July 1, 2007 Download in Microsoft Word
- Prior to July 1, 2007 Download in Adobe PDF Format
- Prior to July 1, 2007 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
- 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
- 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
Insurer's Reconciliation Statement
For information contact Steven Nutter at steven.nutter@state.vt.us or 802-828-4110
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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