Policy cancellation agreement

Review our Policy Cancellation Agreement before submitting your request.


As stipulated in your policy, advance written notice is required for all cancellation requests; the completion and return of this form serves as your advanced written request to cancel. We will cancel your policy per the rules and regulations of your state. Please note that failure to provide all the information requested above may result in a delay or inability to process your cancellation request.

A short rate penalty may apply to all cancellations. You must complete a premium audit for all workers’ compensation policies (end of term or cancelled) to determine refund due or premium payment owed. Please refer to policy declarations for the most updated information.

Our estimate turnaround time for processing a cancellation request is up to 72 business hours. Once your cancellation has been processed, you will receive an e-mail confirming the policy has been canceled and removed from recurring automatic payments.