The Maryland Exclusion Form allows officers or members of certain business entities to opt out of workers' compensation insurance coverage. By filing this form with the Workers’ Compensation Commission, individuals can formally declare their intention to be exempt from such coverage. To initiate this process, it is essential to complete the form, submit it to the Commission, and notify the company's insurer.
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In Maryland, business owners and certain key members have the option to opt out of workers' compensation insurance coverage, a decision that can significantly impact their business operations. This choice is formalized through the Maryland Exclusion Form, which must be filed with the Workers’ Compensation Commission. The form is designed for officers or members of specific business entities, such as close corporations, general corporations, farm corporations, professional corporations, and limited liability companies. To initiate this process, individuals must complete the form, providing essential information such as the company's name, address, and type, along with details about the insurance provider. It's crucial for those electing exclusion to sign the document, submit it to the Commission, and notify their insurance company. Each signatory affirms the accuracy of the information provided, emphasizing the importance of honesty in this legal declaration. By understanding the nuances of the Maryland Exclusion Form, business leaders can make informed decisions that align with their operational needs and risk management strategies.
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WORKERS’ COMPENSATION COMMISSION
EXCLUSION FORM
INSTRUCTIONS: Pursuant to Labor & Employment Article §9-206, Annotated Code of Maryland, officers or members of certain business entities may elect to be exempt from workers' compensation insurance coverage by filing this Exclusion Form with the Commission. To exercise this option, the officer or member making the election must sign this document, submit the form to the Workers’ Compensation Commission, a copy to the insurer of the company/corporation, and keep a copy for your files.
Company Name: ______________________________________________________________________
Address: ____________________________________________________________________________
City: _____________________
State: ___________
ZIP _______________________
Type of Company:
___ Close Corporation
___ General Corporation
___ Farm Corporation
___ Professional Corporation
___ Limited Liability Company
Insurance Company Name: _____________________________________________________________
Date Insurance Company Notified:_________________
Typed Name and Title of the Officer
% of
Personal
or Member Electing Exclusion
Ownership
Signature
____________________________________
________
___________________
NOTE: By signing this Exclusion Form, each officer or member affirms under the penalties of perjury that the information contained in this form is true and correct as to that officer or member, to the best of the officer’s or member’s knowledge, information, and belief.
10 East Baltimore Street Baltimore, Maryland 21202-1641
Form IC-16 (09/2019)
Here are 10 common misconceptions about the Maryland Exclusion Form related to workers' compensation:
Filling out the Maryland Exclusion form can be straightforward, but many people make common mistakes that can lead to complications. One frequent error is failing to provide complete information about the company. It's essential to fill in all required fields, including the company name, address, and type of company. Incomplete information can delay the processing of the form or result in a rejection.
Another mistake often seen is not notifying the insurance company promptly. The form requires that you inform your insurer about the exclusion. If you neglect to do this, it can create confusion regarding your coverage status. Always ensure that the date you notify the insurance company is clearly noted on the form.
Many individuals overlook the importance of signatures. Each officer or member electing exclusion must sign the form. If signatures are missing, the form will not be considered valid. This step is crucial, as it confirms that all parties understand and agree to the exclusion.
Additionally, some people forget to keep a copy of the form for their records. Retaining a copy is vital for your own documentation and can be helpful if questions arise in the future. Without a copy, you may find it challenging to prove that the exclusion was filed.
Finally, failing to understand the implications of signing the form can lead to serious issues. By signing, you affirm that the information is accurate and truthful. Misrepresenting any details can lead to penalties. Take the time to review everything carefully before submitting the form to avoid potential legal troubles down the line.
Filling out and using the Maryland Exclusion form requires careful attention to detail. Here are some key takeaways to keep in mind:
The Maryland Exclusion Form is an essential document for certain business entities seeking to opt out of workers' compensation insurance coverage. However, several other forms and documents often accompany this form to ensure compliance and clarity in the process. Below is a list of relevant documents that may be required or beneficial to have on hand.
Having these documents readily available can facilitate a smoother process when filing the Maryland Exclusion Form. It is advisable to ensure all information is accurate and up-to-date to avoid any complications in the future.
The Maryland Exclusion Form shares similarities with the "Certificate of Exemption" commonly used in various states. This document allows certain business owners to opt out of specific regulatory requirements, such as workers' compensation insurance. Just like the Maryland Exclusion Form, the Certificate of Exemption requires the business owner to provide personal information and details about the business. Both documents must be filed with the appropriate state authority, ensuring that the business complies with local laws while also protecting the owner's rights to opt out of certain coverage.
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Another document akin to the Maryland Exclusion Form is the "Sole Proprietor Exemption Form." This form is designed for sole proprietors who wish to exclude themselves from workers' compensation coverage. Similar to the Maryland Exclusion Form, it requires the individual to affirm their status and intention to opt out. Both documents emphasize the need for the individual to understand the implications of their decision, ensuring they are fully aware of the risks involved in not having coverage.
The "Business Entity Election Form" is also comparable to the Maryland Exclusion Form. This form allows members of certain business entities, like LLCs or partnerships, to elect not to carry workers' compensation insurance. Like the Maryland Exclusion Form, it requires signatures from the members or officers and must be submitted to the appropriate regulatory body. Both forms aim to clarify the responsibilities and rights of business owners, providing them with the option to manage their insurance needs according to their specific circumstances.
The "Workers' Compensation Waiver" serves a similar purpose to the Maryland Exclusion Form by allowing certain individuals, such as independent contractors, to waive their rights to workers' compensation benefits. This waiver must be signed and submitted to the relevant authority, just like the Maryland Exclusion Form. Both documents require the signatory to acknowledge their understanding of the risks associated with waiving coverage, ensuring they are making an informed choice.
Lastly, the "Employer's Notice of Exclusion" is another document that resembles the Maryland Exclusion Form. This notice is filed by employers who wish to inform the state that certain employees are not covered under their workers' compensation policy. Similar to the Maryland Exclusion Form, it requires detailed information about the business and the employees being excluded. Both documents aim to maintain transparency between the employer and the regulatory body, ensuring that all parties are aware of who is covered under the insurance policy.