Understanding the Florida Workers' Compensation Exemption Form (FA)

What Is the Florida Workers' Compensation Exemption Form (FA)?

The Florida Workers' Compensation Exemption Form, often referenced as Form FA, is the official document employers use to claim exemption from the state's mandatory workers' compensation insurance coverage. It applies when a business meets specific criteria—such as having fewer than three employees or being a sole proprietor—allowing the employer to opt out of coverage while remaining compliant with Florida law.

Who Must File the Exemption Form?

Not every employer qualifies. Florida statutes define three primary categories that may be exempt:

• Businesses with fewer than three employees (including the owner) who are not required to carry workers' compensation.
• Sole proprietors, partners, and corporate officers who are not covered by the policy.
• Employers whose workforce consists exclusively of certain agricultural workers, as defined by state law.

If your organization falls outside these groups, you must obtain workers' compensation insurance or self‑insure.

Key Requirements for a Valid Exemption

To be accepted, the exemption form must include accurate, verifiable information:

• Employer's legal name and FEIN.
• Exact count of employees (including full‑time, part‑time, and seasonal workers).
• Declaration that the employer is not required to carry workers' compensation under Florida Statute 440.01.
• Signature of an authorized representative and the date of filing.

Step‑by‑Step Guide to Completing Form FA

1. Gather Required Data

Collect your business's Federal Employer Identification Number (FEIN), payroll records, and a current employee roster. Verify that the employee count truly meets the exemption threshold.

2. Access the Official Form

The form is available on the Florida Department of Financial Services (DFS) website. Download the PDF titled "Workers' Compensation Exemption – Form FA."

3. Fill Out the Form

Enter the employer's name exactly as it appears on tax filings, the FEIN, and the address of the principal place of business. In the employee count section, write the total number of employees, confirming it is fewer than three.

4. Sign and Date

The authorized officer—usually the owner or a corporate officer—must sign and date the form. Unsigned forms are automatically rejected.

5. Submit the Form

Submit the completed form to the Florida DFS either electronically through the online portal or by mail to the address listed on the form. Retain a copy for your records.

Where to Submit the Form

Submission options:

• Online: Use the DFS "eFile" system for immediate acknowledgment.
• Mail: Send to Workers' Compensation Division, 500 South Monroe Street, Tallahassee, FL 32301.

Consequences of Filing an Incorrect or False Exemption

Providing inaccurate information can result in severe penalties, including:

• Fines up to $5,000 per violation.
• Mandatory retroactive workers' compensation coverage.
• Potential civil liability for employee injuries.

DFS may also conduct audits to verify exemption claims.

Frequently Asked Questions

Q: Can I file the exemption form for a single calendar year and then re‑apply?A: Yes, exemptions are reviewed annually. You must submit a new Form FA each year you wish to remain exempt.

Q: What if my employee count increases mid‑year?A: You must obtain workers' compensation coverage immediately once you exceed the exemption threshold.

Q: Are there any industries automatically exempt?A: No industry is automatically exempt; the exemption is based solely on employee count and ownership status.

Comparison: Exemption vs. Standard Coverage

Resources and Further Reading

For the most current forms and detailed statutory language, consult the Florida Department of Financial Services:

• DFS Workers' Compensation Exemption Form FA – official download
• Florida Statutes § 440.01 – Workers' Compensation Overview
• DFS FAQ – "Do I Need Workers' Compensation?"