Any corporate officers who own at least 25% interest in the corporation may exercise their right to exempt themselves from the provisions of the Massachusetts Workers' Compensation Act (M.G.L. ch. 152) .

Such an exemption DOES NOT apply to employees of such a corporation who are not corporate officers. Those employees must be covered by a valid workers' compensation policy at all times.

If the corporation named on this form employs no persons other than the eligible corporate officer(s) or director(s) who have exercised their right of exemption by signing the Form 153, said corporation may legally operate without a workers' compensation coverage. However, the corporation may not employ any person other than those corporate officers or directors who have exercised their right of exemption by signing the Form153. Should the corporation hire additional employees, workers' compensation coverage must be obtained for those employees

In order for a corporation and its officers to exercise this right of exemption, all eligible corporate officers must sign the Form 153 Affidavit of Exemption For Certain Corporate Officers, electing either to exempt themselves, or not exempt themselves.

The completed Form 153 must be submitted to the Department of Industrial Accidents, Office of Investigations for the exemption under M.G.L. c. 152, § 1(4) to be invoked.

On the front of the Form 153 companies should put the Massachusetts address that they are doing business at, not the address of the out-of-state corporate HQ.

Once the Form 153 is received and processed by the Office of Investigations those corporate officers will then be deemed to have invoked the statutory exemption.

The policies and procedures surrounding the exemption of a corporate officer or director are governed by 452 C.M.R. 8.06 et. seq.
If your corporation is submitting this form in response to a notice or Stop Work Order (SWO) from the DIA Office of Investigations, please write the Investigation ID Number or Stop Work Order Number on that correspondence in the space provided in upper right hand corner of the front of this form.

Print Form 153 - Affidavit of Exemption for Certain Corporate Officers pdf format of f153.pdf

WCRIB Circular Letter 1902 - For more information on the implementation of the new regulations, read this notice from the MA Workers' Compensation Rating and Inspection Bureau. 10/30/2002

WCRIB Circular Letter 1906 - For more information on the implementation of the new regulations, read this notice from the MA Workers' Compensation Rating and Inspection Bureau. 11/7/2003