Vt. Stat. Ann. tit. 21, § 690 (2026)

§ 690. Certificate, form; copy of policy

(a) An employer subject to the provisions of this chapter who has workers’ compensation insurance coverage pursuant to section 687 or 689 of this title shall file with the Commissioner a certificate of the insurance in a form prescribed by the Commissioner. The certificate shall include the policy number, effective date, date of expiration, operations covered, and such other information the Commissioner requests. The certificate shall be signed by a duly authorized representative of the insurance or guarantee company that issued the insurance coverage. Upon request, the insurance or guarantee company shall file with the Commissioner a copy of the contract or policy of insurance issued.

(b)(1) In addition to any other authority provided to the Commissioner pursuant to this chapter, the Commissioner may issue a written request to an employer subject to the provisions of this chapter to provide a workers’ compensation compliance statement on a form provided by the Commissioner. For the purposes of this subsection, an employer includes subcontractors and independent contractors. The form shall require all the following information sorted by job site:

(A) The number of employees employed during the entire current workers’ compensation policy term or the previous year if no policy was in effect or partially in effect prior to the request and the effective dates of the term of any policies in effect.

(B) The total number of hours for which compensation was paid.

(C) A list of all subcontractors and 1099 workers and their function on the job site for the period in question.

(D) The name of the workers’ compensation insurance carrier, the policy number, and the agent, if any.

(E) As an attachment, the insurance policy declaration pages, including how much payroll the policy is covering and a designation of the hours that provide the basis of the appropriate National Council on Compensation Insurance classification code.

(2) Any employer who fails to comply with this subsection or falsifies information on the compliance statement may be assessed an administrative penalty of not more than $5,000.00 for each week during which the noncompliance or falsification occurred and any costs and attorney’s fees required to enforce this subsection. The Commissioner may also seek injunctive relief in Washington Superior Court.

(3) A compliance statement shall be a public record, and the Commissioner shall provide a copy of a compliance statement to any person on request. An insurance company provided with a compliance statement may investigate the information in the statement. Based on evidence that an employer is not in compliance with this chapter, the Commissioner shall request a compliance statement or an amended compliance statement from the employer, investigate further, and take appropriate enforcement action.

(4) In the event the Commissioner receives a request for an employer to provide a compliance statement but finds no evidence of noncompliance with this chapter, the Commissioner shall provide timely notification of the findings to the requesting party. (Amended 2007, No. 57, § 1; 2009, No. 54, § 80, eff. June 1, 2009.)