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Inclusion Form for Sole Proprietors and Partners Election C15R 9 Election Pursuant Listed Laws, Version September 2019-2026

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Any sole proprietor or partner electing to be a covered employee must complete and sign this document. IMPORTANT Submit this form to the Workers Compensation Commission a copy to the insurer and keep a copy for your records. Unless otherwise agreed this election will be effective upon the date of receipt of this form by the MD Workers Compensation Commission. DATE INSURANCE COMPANY WAS NOTIFIED CURRENT DATE NAME OF INSURANCE COMPANY COMPANY NAME ADDRESS CITY ZIP STATE Name and Title of Person...

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What is the Maryland Workers Compensation Exclusion Form?

The Maryland Workers Compensation Exclusion Form, also known as the IC-15R, is a legal document that allows sole proprietors and partners to opt out of workers' compensation coverage. This form is essential for business owners who wish to exclude themselves from the protections offered under Maryland's workers' compensation laws. By completing this form, individuals can formally declare their intention not to participate in the workers' compensation system, which can affect their liability and insurance obligations.

Steps to Complete the Maryland Workers Compensation Exclusion Form

Completing the Maryland Workers Compensation Exclusion Form involves several key steps:

  1. Gather Required Information: Collect all necessary personal and business information, including your business name, address, and the nature of your work.
  2. Access the Form: Obtain the IC-15R form from the appropriate state agency or download it from a reliable source.
  3. Fill Out the Form: Carefully complete all sections of the form, ensuring that all information is accurate and legible.
  4. Sign and Date: Sign and date the form to validate your request for exclusion.
  5. Submit the Form: Submit the completed form to the Maryland Workers' Compensation Commission via mail or in person, as per the guidelines provided.

Legal Use of the Maryland Workers Compensation Exclusion Form

The Maryland Workers Compensation Exclusion Form is legally binding once it is properly completed and submitted. It is important for business owners to understand that opting out of workers' compensation coverage can have significant legal implications. By filing this form, individuals acknowledge that they are waiving their rights to benefits under the workers' compensation system. Therefore, it is advisable to consult with a legal expert or insurance professional before making this decision.

Eligibility Criteria for the Maryland Workers Compensation Exclusion Form

To be eligible for the Maryland Workers Compensation Exclusion Form, applicants must meet specific criteria:

  • The applicant must be a sole proprietor or partner in a business.
  • The business must be registered and operating within the state of Maryland.
  • The applicant must not have any employees covered under the workers' compensation policy.

Required Documents for the Maryland Workers Compensation Exclusion Form

When completing the Maryland Workers Compensation Exclusion Form, certain documents may be required to support your application:

  • Proof of business registration in Maryland.
  • Identification documents, such as a driver's license or state ID.
  • Any prior workers' compensation insurance policies, if applicable.

Form Submission Methods

The Maryland Workers Compensation Exclusion Form can be submitted through various methods:

  • By Mail: Send the completed form to the Maryland Workers' Compensation Commission at the designated address.
  • In-Person: Deliver the form directly to the commission's office during business hours.

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MD C-15R 20194.8 Satisfied (1533 Votes)
MD C-15R 20154.8 Satisfied (3887 Votes)
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