FORMS: MWCARP Applications

Certificates of Insurance

Insurance agencies are not authorized to issue a Certificate of Insurance on behalf of the
MWCARP in Minnesota. This activity is not in compliance with the operation of the MWCARP.
On page 4 of the Application for Workers' Compensation Insurance, number 7, under
Application Rules and Procedures, it states
: "Agents are not agents of the Assigned Risk Plan
and cannot issue certificates of insurance or bind coverage".
Your agency should request any Certificate that is needed for policies written through the MWCARP
from the servicing carrier to whom the coverage has been assigned. These Certificates must be
issued by the servicing carrier.


Methods of applying for coverage:

ONLINE APPLICATION:

Register to use MWCARP online (OAR).
Complete and submit an online Assigned Risk application.
Payment options available using OAR:

· Electronic Check from the Employer's bank account
· Electronic Check from the Agency (see below)
· Visa
· Master Card
Apply Online Now

PAPER APPLICATION:

Download, complete and mail the paper application with one of the following payment options:

· Bank Draft
· Money Order
· Agency Check (see below)
· Employers Check

Agent Checks
Payment submitted with an application should be made by the insured to the Assigned Risk Plan.
If payment is made by an agent, the agent understands that it will be soley responsibile for
reimbursement from the insured, and will have no right to cancel the policy for nonpayment by the insured, unless cancellation is agreed to by the insured. All premium refunds are issued to the insured.


04-01-2017 ASSIGNED RISK PLAN PAPER APPLICATION

04-01-2017 MWCARP PAPER APPLICATION

ASSIGNED RISK PLAN PAPER APPLICATION

MWCARP PAPER APPLICATION ASSISTANCE

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