Orange County NC Website
Browse       Search
Name: <br />From: <br />Subject: <br />To Whom It May Concern <br />Alabama Self Insured Worker's Comp Fund <br />P.0. Box 59509, Birmingham, AL 35259 <br />Phone: 1-888-515-1530 or 205-868-6900 <br />Fax: 205-868-6909 <br />Email Address: ChristinaT@ASIWCF.org <br />Visit our Website at www.ASIWCF.org <br />Waiver of Subrogation <br />(/\0 I Alabama 1-\-:J Self-Insured <br />worker's compensation fund <br />�.rwdbyfh&�Ccur.dt';JI� <br />As a Self -Insured Workers' Compensation Fund in Alabama we are not able to issue a Workers' <br />Compensation policy and thus are not able to offer any of the Workers' Compensation <br />endorsements. Below is the wording for Waivers of Subrogation requests, approved by our <br />attorney, which can be added to a Certificate of Insurance issued by your office. <br />The Alabama Self-Insured Worker's Compensation Fund waives the right to bring an action <br />against Certificate Holder to enforce any right of subrogation, which may arise from Alabama <br />Self-Insured Worker's Compensation Fund's payment of workers compensation benefits. This <br />waiver does not affect (1) the right of an employee of Member to bring an action for damages, <br />or (2) Alabama Self-Insured Worker's Compensation Fund's right to intervene in such action to <br />protect any interest in any proceeds of any such action. This waiver shall apply only if and to <br />the extent required by Certificate Holder. <br />Please let us know if you have any questions. <br />Thank you, <br />Underwriting <br />Alabama Self-Insured Worker's Compensation Fund <br />Docusign Envelope ID: 0A3F1D3D-B676-8864-82F4-0CBECDBE83E5