Homepage Fill Out Your Maryland Exclusion Template

Dos and Don'ts

When filling out the Maryland Exclusion form, it's essential to be thorough and accurate. Here’s a list of things you should and shouldn't do to ensure a smooth process.

  • Do read the instructions carefully before starting.
  • Do provide complete and accurate information about your company.
  • Do sign the form where indicated.
  • Do keep a copy of the completed form for your records.
  • Do submit the form to both the Workers’ Compensation Commission and your insurance company.
  • Don't leave any required fields blank.
  • Don't submit the form without checking for errors.
  • Don't forget to notify your insurance company of the exclusion.
  • Don't assume that verbal communication is sufficient; always provide written documentation.

Misconceptions

Understanding the Maryland Exclusion Form is essential for business owners and officers who wish to opt out of workers' compensation insurance. However, several misconceptions can lead to confusion. Here are five common misunderstandings:

  • Only large corporations can use the Exclusion Form. This is not true. Any eligible business entity, regardless of size, can file the form if they meet the criteria outlined in the law.
  • Filing the form means you are no longer responsible for workplace injuries. This misconception is misleading. While the form allows certain officers or members to opt out of coverage, it does not eliminate the employer's responsibility for ensuring a safe work environment.
  • The Exclusion Form is only for specific types of businesses. In reality, various business structures, including close corporations, general corporations, and limited liability companies, can utilize this form as long as they meet the requirements.
  • You can submit the form at any time without consequences. This is incorrect. There are deadlines for filing the Exclusion Form, and failure to submit it in a timely manner may result in automatic coverage under workers' compensation insurance.
  • Once you file the Exclusion Form, you cannot change your mind. While it is a significant decision, it is possible to revoke the exclusion. However, this process must be followed according to the regulations set forth by the Workers' Compensation Commission.

Being informed about these misconceptions can help ensure that business owners make the best decisions for their companies and comply with Maryland's regulations.

Key takeaways

Filling out and using the Maryland Exclusion Form is a significant step for certain business officers or members who wish to opt out of workers' compensation insurance. Here are key takeaways to consider:

  • Eligibility: Only officers or members of specific business entities, such as close corporations, general corporations, farm corporations, professional corporations, and limited liability companies, can file this form.
  • Intent to Exclude: The form allows eligible individuals to formally elect to be exempt from workers' compensation coverage.
  • Submission Requirements: To complete the process, the signed form must be submitted to the Workers’ Compensation Commission and a copy sent to the company’s insurer.
  • Record Keeping: It is essential for the officer or member to keep a copy of the submitted form for personal records.
  • Signature Requirement: Each officer or member must sign the form, affirming that the information provided is accurate to the best of their knowledge.
  • Legal Affirmation: By signing, individuals affirm under penalties of perjury that the details in the form are true and correct.
  • Notification of Insurer: The date when the insurance company is notified must also be documented on the form.

Understanding these key points can help ensure a smooth process when opting out of workers' compensation coverage in Maryland.

Guidelines on Utilizing Maryland Exclusion

Filling out the Maryland Exclusion form is a straightforward process that allows certain business officers or members to opt out of workers' compensation insurance coverage. After completing the form, it must be submitted to the Workers’ Compensation Commission, sent to the company’s insurer, and a copy should be retained for personal records. Follow these steps to ensure everything is filled out correctly.

  1. Obtain the Form: Make sure you have the Maryland Exclusion form ready for completion.
  2. Fill in Company Name: Write the official name of your business in the designated space.
  3. Enter Address: Provide the complete address of your company, including city, state, and ZIP code.
  4. Select Company Type: Check the box that corresponds to your type of company: Close Corporation, General Corporation, Farm Corporation, Professional Corporation, or Limited Liability Company.
  5. Insurance Company Name: Write the name of the insurance company that provides coverage for your business.
  6. Date Insurance Company Notified: Indicate the date you notified your insurance company about the exclusion.
  7. Typed Name and Title: Provide the typed name and title of the officer or member electing exclusion.
  8. Signature: Each officer or member must sign the form in the designated area, affirming the accuracy of the information.
  9. Retain a Copy: Keep a copy of the completed form for your records.
  10. Submit the Form: Send the completed form to the Workers’ Compensation Commission and a copy to your insurer.

Form Preview Example

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)

Common mistakes

  1. Neglecting to Provide Complete Information: One of the most common mistakes individuals make is failing to fill out all required fields. The form requires specific details such as the company name, address, and type of business entity. Omitting any of this information can lead to delays or even rejection of the form.

  2. Not Signing the Form: Another frequent error is forgetting to sign the Exclusion Form. The signature is crucial as it verifies that the officer or member is making the election knowingly and willingly. Without a signature, the form is incomplete and cannot be processed.

  3. Failing to Notify the Insurance Company: It is essential to notify the insurance company about the exclusion. Many people overlook this step, which can result in complications later. A copy of the form should be submitted to the insurer, ensuring that they are aware of the decision to opt-out of coverage.

  4. Not Keeping a Copy for Personal Records: After submitting the form, it is vital to retain a copy for personal records. Some individuals forget this step, which can lead to confusion or disputes in the future. Keeping a personal copy ensures that you have proof of your election should any questions arise later.

Learn More on This Form

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.