Workers Compensation

Long Island

Workers' Compensation is insurance paid by companies to provide benefits to employees who become ill or injured on the job. Through this program, workers are provided with benefits and medical care, and employers have the assurance that they will not be sued by the employee. Please be advised that, as a 1099 Independent Provider, you are NOT covered under Achieve Beyond Workers’ Compensation Insurance Coverage. Because of this, we strongly encourage you to purchase coverage in case of an accident or injury on the job. If you do not currently hold Worker’s Compensation Insurance and need an agent referral feel free to contact Achieve Beyond's current broker:

Michael Vitulli
Senior Vice President, Risk Strategies Company
160 Federal St, Boston, MA 02110
Office: (617) 330-5726
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If you choose not to purchase this coverage, you MUST complete this online waiver form below:

This is a Hold Harmless Agreement by and between [“Contractor”] and Achieve Beyond [“Agency”]. In consideration of the Agency not receiving a certificate of Workers’ Compensation coverage, Contractor agrees to indemnify and hold the Agency harmless from any losses and/or litigation expenses sustained because of any Workers’ Compensation claim or suit arising from injury, occupational disease, or death.

Worker's Compensation Refusal Form LI
I work (or have worked) in the following office(s): (Select all that apply)




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