What is the Maryland Exclusion Form?
The Maryland Exclusion Form is a document that allows certain business officers or members to opt out of workers' compensation insurance coverage. This option is available under Maryland law, specifically Labor & Employment Article §9-206. By filing this form, individuals can formally declare their intention to exclude themselves from coverage.
Who is eligible to use the Maryland Exclusion Form?
Eligibility primarily includes officers or members of specific business entities such as close corporations, general corporations, farm corporations, professional corporations, and limited liability companies. Each individual must meet the criteria outlined in the law to make this election.
What steps must be taken to complete the form?
To complete the Maryland Exclusion Form, an eligible officer or member must fill out the necessary information, including the company name, address, and type of company. After signing the form, it must be submitted to the Workers’ Compensation Commission, a copy sent to the company’s insurer, and another copy kept for personal records.
What happens after I submit the form?
Once the form is submitted, the Workers’ Compensation Commission will process it. It’s essential to ensure that all information is accurate, as any discrepancies could delay the exclusion. The insurer will also need to be notified to update their records accordingly.
Is there a deadline for submitting the Maryland Exclusion Form?
There is no specific deadline mentioned in the instructions for submitting the form. However, it’s advisable to submit it as soon as the decision to exclude is made to ensure that there is no lapse in coverage or confusion regarding insurance obligations.
What are the consequences of not filing the form?
If the Maryland Exclusion Form is not filed, the officer or member will remain covered under the company’s workers' compensation insurance. This means that if an injury occurs, they may not be able to claim the exclusion benefits and could be subject to the terms of the insurance policy.
Can I revoke my exclusion after filing the form?
Yes, an individual can revoke their exclusion. However, the process for revocation may involve additional steps and should be communicated clearly to both the Workers’ Compensation Commission and the insurance provider. It’s best to consult the Commission for specific guidance on how to proceed.
What does it mean to affirm under penalties of perjury?
By signing the Maryland Exclusion Form, the officer or member is affirming that all information provided is true and correct to the best of their knowledge. Doing so under penalties of perjury means that providing false information could lead to legal consequences, including potential fines or other penalties.
Is there a fee associated with filing the Maryland Exclusion Form?
The instructions do not mention any fees for filing the Maryland Exclusion Form. However, it’s always a good idea to check with the Workers’ Compensation Commission for any updates or changes regarding fees or filing requirements.
Where can I find more information about the Maryland Exclusion Form?
For more information, you can visit the Maryland Workers’ Compensation Commission website or contact their office directly. They provide resources and assistance to help navigate the process and answer any additional questions you may have.