• Pay Your Policy
Call 952-930-3661
Maverick Risk Partners
  • Home
  • Insurance Options
    • Personal Insurance
      • Auto Insurance
      • Teen Driver Insurance
      • Motorcycle Insurance
      • Boat Insurance
      • RV Insurance
      • Home Insurance
      • Renters Insurance
      • Personal Umbrella Insurance
      • Condo Insurance
      • Rental & Vacation VRBO Insurance
      • Flood Insurance
      • Electric Bicycle Insurance in Minnesota
      • Landlord Protection Insurance in Minnesota
    • Business Insurance
      • Business Owners Insurance (BOP)
      • Commercial Property Insurance
      • Commercial Umbrella Insurance
      • General Liability Insurance
      • Commercial Auto
      • Professional Liability Insurance
      • Cyber Liability Insurance
      • Workers Compensation
      • Employee Practices Liability Insurance (EPLI)
      • Directors & Officers Insurance
      • Flood Insurance
      • Specialty Business Insurance Products
    • Hospitality Insurance
      • Restaurant Insurance
      • Liquor Liability Insurance
      • Business Income & Extra Expense
      • Contamination & Food Spoilage
      • Crime & Dishonest Employee
      • Equipment Breakdown Coverage
    • Benefits Insurance
      • Life Insurance
      • Disability Insurance
      • Health Insurance
      • Long Term Care Insurance
    • Specialty Insurance
      • Pet Health Insurance
      • Travel Insurance
      • Wedding Insurance
  • Contact Us
    • Claims and Payments
    • Pay Your Policy
    • Accessibility Statement
    • Careers
  • About Us
    • Community Involvment
    • Minnesota Insurance Group
    • Aspen Agency
  • Blog
  • Quote
  • Client Portal
  • Click to open the search input field Click to open the search input field Search
  • Menu Menu

Worker’s Compensation Renewal Survey

You are here: Home1 / Worker’s Compensation Renewal Survey

Workers Compensation Renewal Survey

"*" indicates required fields

Basic Contact Information

We will also send a copy of your responses to this e-mail.

Workers Compensation

Do you have any employees who RESIDE in the states of North Dakota, Ohio, Washington, or Wyoming? These states are Monopolistic and will not honor workers comp from other states.*
Do you have separate state-issued workers compensation for these employees?*
Do you have any employees who RESIDE in the state of New York?*
Do you have any employees who physically travel to or do any work while physically in the state of New York?*
Do you have any employees who reside in any states OTHER THAN ND, WA, OH, WY, NY, or the state your company is domiciled in?*
Have there been any changes in your employees’ job roles or the nature of the work they perform?*
Are you employing any seasonal, temporary workers, or leased employees?*
Do you use any subcontractors or pay anyone with a 1099?*
Have you secured certificates of insurance from all of your subcontractors showing at least the same workers’ compensation insurance limits as you carry for your audit?
Do you require copies of certificates from all subs before they begin working?
Do you have updated safety measures, employee training programs, or injury prevention protocols in place?*
Do you want to discuss coverage options for claims made by employees related to discrimination (such as age, gender, religion, disability accommodations), harassment, employee hiring/supervision/termination negligence, retaliation, discipline, privacy, or wage & hour violation allegations?*
Owner Exclusion Notice: For companies with 11 or fewer full-time equivalent employees, owners are automatically excluded from workers comp coverage in the state of Minnesota unless they have signed an election form to be included and paid the additional premium for owner payroll.
Audit Reminder: Your workers’ compensation policy is based upon an estimated payroll. You will receive the audit request after your policy renews. Completing your audit is required by the carrier. A non-compliant audit can result in significant (sometimes doubling) the workers’ compensation premium and termination of the coverage.
Please acknowledge that you have read the notices above*

Our Mission

Our mission is simply stated, yet earnest. We provide families and business owners peace of mind by safeguarding their assets through risk management expertise. Our proven process ensures you understand your risk tolerance while feeling informed, educated, and protected.

How Can We Help?

Please do not include any sensitive personal information like your social security number here.

Wayzata

1907 Wayzata Blvd Ste 210,
Wayzata, MN 55391

Call or Text

952-930-3661

Hours

Mon. – Thurs.: 8:00 am – 4:30 pm
Friday 8:00 am – 2:00 pm

Coon Rapids

8960 Springbrook Drive, Suite 100
Coon Rapids, MN 55433

Call or Text

763-755-7000

Hours

Mon. – Thurs.: 8:00 am – 4:30 pm
Friday 8:00 am – 2:00 pm

© Copyright - Maverick Risk Partners
Website Design by Tosten Marketing
  • Link to LinkedIn
  • Link to Instagram
  • Link to Facebook
Scroll to top Scroll to top Scroll to top