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Workers Compensation Exemption Form Template for New Zealand

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Key Requirements PROMPT example:

Workers Compensation Exemption Form

"I need a Workers Compensation Exemption Form for our software development team relocating to our Singapore office from March 2025, ensuring coverage for 12 employees who will be working remotely from both Singapore and New Zealand."

What is a Workers Compensation Exemption Form?

The Workers Compensation Exemption Form serves as a crucial legal instrument within New Zealand's accident compensation system. While New Zealand operates under a universal no-fault accident compensation scheme through ACC, there are specific circumstances where alternative arrangements may be necessary or preferred. This document is typically used when employees are working internationally, engaged in specialized industries, or covered by alternative comprehensive insurance schemes. The form must comply with the Accident Compensation Act 2001 and related legislation, requiring detailed information about the parties involved, the basis for exemption, and alternative compensation arrangements. It's essential for establishing clear legal parameters when deviating from the standard ACC coverage and protecting both employer and employee interests.

What sections should be included in a Workers Compensation Exemption Form?

1. Worker Details: Full legal name, contact information, and identification details of the worker seeking exemption

2. Employer Details: Full legal name, business registration number, and contact information of the employer

3. Work Arrangement: Description of the specific work arrangement, including role, duties, and employment status

4. Basis for Exemption: Clear statement of the grounds under which the exemption is being sought, with reference to relevant legislation

5. Acknowledgment of Effects: Explicit statement acknowledging understanding that this exemption may affect accident compensation coverage

6. Duration of Exemption: Specific timeframe for which the exemption is being sought or will be valid

7. Declaration: Formal declaration by both parties confirming the accuracy of information provided

What sections are optional to include in a Workers Compensation Exemption Form?

1. Alternative Insurance Arrangements: Details of any private insurance or alternative compensation arrangements, required when the worker has separate coverage

2. Special Conditions: Any specific conditions or requirements attached to the exemption, used when there are particular circumstances to note

3. Overseas Work Details: Information about work conducted outside New Zealand, required for international work arrangements

4. Previous Claims History: Details of any previous ACC claims or workplace incidents, included when relevant to the exemption application

What schedules should be included in a Workers Compensation Exemption Form?

1. Schedule A - Risk Assessment: Detailed assessment of workplace risks and mitigation strategies relevant to the exemption

2. Schedule B - Supporting Documentation: List and copies of all required supporting documents (e.g., insurance certificates, medical certificates)

3. Appendix 1 - Relevant Legislative Excerpts: Key excerpts from relevant legislation supporting the exemption application

4. Appendix 2 - ACC Guidelines: Applicable ACC guidelines and policies relating to exemptions

Authors

Alex Denne

Head of Growth (Open Source Law) @ Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions





























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Relevant Industries

International Business

Maritime Industry

Aviation

Professional Sports

Entertainment Industry

Technology and Software

Professional Services

Construction

Mining and Resources

Healthcare

Education (particularly international exchanges)

Relevant Teams

Human Resources

Legal

Risk Management

Compliance

Global Mobility

Health and Safety

Employee Relations

Insurance Administration

International Operations

Executive Leadership

Relevant Roles

Human Resources Manager

Compensation and Benefits Specialist

Risk Management Officer

International Assignment Manager

Legal Counsel

Compliance Officer

Health and Safety Manager

HR Director

Chief Human Resources Officer

Employment Relations Manager

Global Mobility Specialist

Workplace Safety Coordinator

Insurance Coordinator

Employee Relations Specialist

Industries





Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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