Workers compensation exclusion 2026

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4.9 out of 5

43 votes

The document is an Exclusion Form from the Maryland Workers' Compensation Commission, allowing officers or members of certain business entities to opt out of workers' compensation insurance coverage by filing this form. It requires the completion of company details, type of company, and signatures from the officers or members electing exclusion, affirming the accuracy of the information provided.

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Click ‘Get Form’ to open the workers compensation exclusion form in the editor.
Begin by entering your company name and address in the designated fields. Ensure that all information is accurate for proper processing.
Select the type of company from the options provided: Close Corporation, General Corporation, Professional Corporation, Farm Corporation, or Limited Liability Company.
Fill in the insurance company name and the date you notified them about this exclusion. This is crucial for compliance.
For each officer or member electing exclusion, provide their typed name, title, percentage of ownership, and personal signature in the respective fields.
Review all entries for accuracy. Once confirmed, submit the original form to the Workers’ Compensation Commission and keep copies for your records.

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Versions	Form popularity	Fillable & printable
2011	4.9 Satisfied (43 Votes)

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