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Independent Contractor Status Form

Policy and claims

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

Created for: Pinnacol policyholders and their HR managers

This form:

  • 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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