COVID19 Impact Assistance

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Midwestern’s concern for the health and safety of our entire nation impacted by the COVID-19 is a top priority. Our sympathy goes out to anyone directly affected by this virus. We know the virus has indirectly affected everyone in this country and that many are not only worried about their health, but also their economic situation. Midwestern understands this has impacted many of our insureds and wishes to work with you to keep your workers’ compensation policy active so when the crisis passes you may resume your business without additional burden.

If your workers’ compensation policy has canceled, or if you have received a notice of cancellation and need assistance reinstating your coverage, please complete this form. Additionally if you are not on a monthly-reporting payment plan and the COVID-19 crisis makes it necessary to adjust your payroll, please complete this form.

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Amount of payroll: For the month in question, list state, class code and payroll for each state and classification code on your policy. Click "add another response" to create as many entries as necessary.
State / Class Code /Payroll

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Present and Future Payments