The full name of the Additional Insured as shown in the. Insurance Exhibit should be entered here.A workers' comp waiver of subrogation is a document that states that you are waiving your right for your insurer to seek compensation from a third party. How do i fill out a workmans' compensation waiver and subrogation form for the state of california?? Subrogation in a workers' compensation case occurs when another party can secure a portion of your workers' compensation benefits. If the employee brings a third-party action, the employee must serve a copy of the complaint on the employer and file proof of service of same. Example: Jack drives a delivery truck and is involved in an auto accident that is the fault of Chris. If the employee brings a third-party action, the employee must serve a copy of the complaint on the employer and file proof of service of same. Injured worker filling out paperwork. The employer can assert a lien or intervene in the third party matter to protect its right of recovery.
