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For businesses in Michigan seeking workers' compensation insurance, the Michigan F 6 Form serves as a vital application document. This comprehensive form, outlined by the Michigan Workers' Compensation Placement Facility, requires detailed information about the applicant business, including employer details, insurance record, and specifics regarding the nature of the business and premium calculation. Located in Livonia, the placement facility emphasizes the importance of submitting a thoroughly completed application to avoid delays in coverage, which is essential for businesses to comply with state regulations and protect their employees. It is crucial that the form be typed or legibly printed in ink, with coverage only being considered from the day following the receipt of the application. Various sections delve into prior insurance coverage, any business name changes, business principal details, and the need for an accurate estimate of annual premiums. Moreover, the application touches on the employer's agreement to maintain accurate payroll records, comply with safety laws, and meet premium payment obligations. Highlighting the sensitivity and specificity required when filling out this form, it also provides guidance on handling subcontractor information to ensure appropriate classification and premium calculation. The Michigan F 6 Form is a key step for businesses in securing workers' compensation insurance through the Michigan Workers' Compensation Placement Facility, facilitating compliance and contributing to the welfare of employees.

Preview - Michigan F 6 Form

MICHIGAN APPLICATION FOR WORKERS’ COMPENSATION INSURANCE

MICHIGAN WORKERS’ COMPENSATION PLACEMENT FACILITY

MAIL: P.O. Box 3337, Livonia, MI 48151-3337

EXPRESS MAIL AND VISITORS: 17197 N. Laurel Park Dr., Suite 311, Livonia, MI 48152-2686

734-462-9600

IMPORTANT: Instructions for completing this application can be found in the Michigan Workers’ Compensation Placement Facility’s Information and Procedures Handbook. This handbook is available from the Michigan Worker’s Compensation Placement Facility or at www.caom.com.

This application must be typed or legibly printed in ink. Under no circumstance will coverage be bound sooner than 12:01 AM the day following receipt by MWCPF. Missing or incomplete information may delay the binding of coverage.

I. GENERAL INFORMATION

 

 

EFFECTIVE 12:01 AM (DATE)

 

 

 

 

 

 

 

 

 

(To be completed by the Facility) _________________

1.

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF EMPLOYER

 

 

 

 

 

 

 

2. _____-________________________________

 

__(________)_______________________

 

 

FEDERAL EMPLOYERS IDENTIFICATION NUMBER

 

PHONE NUMBER

 

 

3.

 

 

 

 

 

 

 

 

 

 

 

MAILING ADDRESS

 

(STREET)

(CITY)

(STATE)

(ZIP)

4.

 

 

 

 

 

 

 

 

 

 

 

 

PRINCIPAL LOCATION

 

(STREET)

(CITY)

(STATE)

(ZIP)

5.

 

 

 

 

 

 

 

 

 

 

 

OTHER MICHIGAN LOCATIONS

(STREET)

(CITY)

(STATE)

(ZIP)

6.

 

 

 

 

 

 

 

 

 

 

PAYROLL OFFICE ADDRESS

(STREET)

(CITY)

(STATE)

(ZIP)

 

6a. Total number of employees

 

 

 

 

 

 

 

 

 

 

 

 

7.

 

 

LEGAL STATUS

__ Sole Proprietor* __ Partnership

__ Corporation

__ Non-Profit Corp __ Limited Partnership

 

 

 

 

__ LLC

 

__ LLP

__ Trust

__ Other (explain) _____________________

*A sole proprietor is not eligible for workers’ compensation benefits

*A sole proprietor with no employees working for a distinct entity is an employee of that entity. Supply a list of entities for which work is performed.

8. Are there operations in states other than Michigan?

__ No __ Yes;

If yes complete the following

 

 

 

 

 

(If uninsured indicate under Insurance Carrier)

 

 

 

STATE

LOCATION

INSURANCE CARRIER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

II. INSURANCE RECORD

 

 

 

 

 

 

 

1. Has there been previous workers’ compensation insurance coverage in Michigan?

 

 

 

__

No; If no, complete

__ New business

__ Self Insured

__ Other (explain) ____________________________

__

Yes;

If yes, provide insurance record – three previous years

 

 

 

 

 

 

 

If previously self-insured, give name of self-insured employer or group fund if different from the above named insured.

 

STATE

INSURANCE CARRIER

POLICY NUMBER

POLICY PERIOD

PREMIUM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F-6 (1-04) page 1 of 5

MICHIGAN APPLICATION FOR WORKERS’ COMPENSATION INSURANCE

II. INSURANCE RECORD (CONTINUED)

2.

Has there been a name change during the past five years?

__

No

__

Yes; If yes, give previous name and date of change and

 

complete an ERM form. _________________________________________________________________________________

3.

Was this an existing business purchased by the insured?

__

No

__

Yes; If yes, give previous name, date of purchase and

 

complete an ERM form. _________________________________________________________________________________

4.

Do owner(s) own a majority interest in any other business?

__

No

__

Yes; If yes, give the complete legal name of the other

 

entity(s) and complete an ERM form. _______________________________________________________________________

5.Do you (applicant) have a workers’ compensation insurance policy in force?

__ No __ Yes; If yes, indicate expiration or cancellation date: _________________________________________

6.Are you in debt to any insurance company for any unpaid premium for worker’s compensation?

__ No __ Yes; If yes, explain: ___________________________________________________________________

7. Is the employer in bankruptcy? __ No

__ Yes; If yes, attach a copy of the bankruptcy order.

III.BUSINESS PRINCIPALS

1.List below the name and title of all officers, general partners, members of limited liability company or spouse of sole proprietor. Indicate duties and approximate annual salaries for each person. If eligible persons are to be excluded check the space below. The appropriate completed exclusion form must accompany this application. (See information and Procedures handbook for exclusion eligibility.)

2.Indicate percentage of ownership for each person listed. If 100% of ownership is not shown, complete and submit an ERM form with this application.

 

 

 

 

 

PERCENTAGE

 

APPROXIMATE

NAME

TITLE

EXCLUDE

OWNED

DUTIES

ANNUAL SALARY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. If eligible persons are excluded, is the appropriate exclusion form attached? __ No __ Yes

If not excluded, have payrolls for officers, partners, LLC members or spouse been included in determining the estimated annual premium? __ No __ Yes

IV. NATURE OF BUSINESS AND PREMIUM COMPUTATION

1.Explain nature of business. Completely describe all operations at each location. (Do not use manual phraseology for description.) If more than one legal entity is to be insured indicate each named entity’s operation.

2.If you use subcontractors in your business, ask your agent to tell you about the rules for audits for money paid to the subcontractors. The employee/employer relationship will be governed by the elements of rule Nine F part 3 and part 5 in the Facility Basic Manual and the Information and Procedures Handbook.

F-6 (1-04) page 2 of 5

MICHIGAN APPLICATION FOR WORKERS’ COMPENSATION INSURANCE

IV. NATURE OF BUSINESS AND PREMIUM COMPUTATION (CONTINUED)

3. Are employees leased? __ No __ Yes If yes, provide name and address of leasing company. ________________________

4.Employee leasing firms and temporary contractors must furnish a client list. Include a brief job description for each client.

5.Calculation of Estimated Annual Premium: Assign a classification code to each individual operation. (Attach additional sheet if necessary.) IF PAYROLL LEVELS DIFFER FROM THE MOST RECENT AUDIT OR PREVIOUS POLICY, CONFIRM APPLICATION PAYROLL LEVELS WITH SOCIAL SECURITY FORM 941, TAX FORM SCHEDULE C (BOTH SIDES), CURRENT PAYROLL SCHEDULE, OR M.E.S.C. REPORT.

TOTAL PAYROLL BASIS

Describe by location the duties

Class

Number of

Total

 

 

of employees

Code

Employees

Payroll

Rate

Premium

 

 

 

 

 

 

 

 

Total Premium

 

 

Experience Modification

 

 

Standard Premium

 

 

Less Premium Discount

 

 

Expense Constant

DEPOSIT PREMIUM

 

Rate Plan _____ Surcharge

1. DEPOSIT REQUIRED:

Terrorism Premium (total payroll/100 x .01)

Under $1,000

100%

Total Estimated Annual Premium

 

 

Percentage of annual estimated premium to

$1,000 to $2,500

50%

determine Deposit Premium

Over $2,500

25%

Deposit Premium

The balance of the Total Estimated Annual Premium is to be paid according to a deferred payment plan established by the servicing carrier.

2.PREMIUM PAYMENT

Enclose CASHIER’S CHECK, CERTIFIED CHECK, MONEY ORDER, AGENCY CHECK OR FINANCE COMPANY CHECK for premium payment. Coverage will not be bound without one of the above.

ENCLOSED IS CHECK NUMBER _______________________ MADE PAYABLE TO THE MICHIGAN WORKERS’ COMPENSATION

PLACEMENT FACILITY (MWCPF) IN THE AMOUNT OF $ __________________.

Is the premium Financed? __ No __ Yes; If yes, attach a signed copy of the agreement.

F-6 (1-04) page 3 of 5

MICHIGAN APPLICATION FOR WORKERS’ COMPENSATION INSURANCE

VI. EMPLOYER’S AGREEMENT

The employer must:

1.Maintain a complete record of all payroll transactions in such form as the insurance company may reasonably require. Such record will be available to the company at the designated address.

2.Comply substantially with all laws, orders, rules and regulations in force and effect made by the public authorities relating to the welfare, health and safety of employees.

3.Comply with all reasonable recommendations made by the insurance company relating to the welfare, health and safety of employees.

The undersigned employer certifies that:

1.The employer has read and understands the application and has truthfully answered all questions.

2.The undersigned employer hereby applies for assigned risk workers’ compensation insurance in Michigan and expressly represents that such insurance is being sought in good faith and that the employer is making such application with knowledge that the employer is unable to procure workers’ compensation insurance through ordinary methods.

3.The employer understands that by making application to the Michigan Workers’ Compensation Placement Facility, his Business Name, City, Risk I.D. Number, Premium, Expiration Date, Class Code, Experience Modification, and any Assigned Risk Surcharge will be published quarterly in the Michigan Workers’ Compensation Placement Facility Depopulation Report, issued to any interested party, in an effort to depopulate the Assigned Risk Plan.

4.Any person who knowingly provides false or misleading information on this application for workers’ compensation insurance may be subject to criminal prosecution.

___________________________________________________________________________________________________________

Print or type Employer Name and Title

Date

* Signature (Corporate Officer, General Partner)

 

 

(Individual Proprietor, Member or Manager of LLC)

*If a person other than those listed has signed this application attach a copy of the power of attorney or other legal document assigning authority for signature.

VII. NON-STATUTORY COVERAGE

The Facility provides federal coverage as an adjunct to State Act Coverage. If you have admiralty (Jones Act) exposure and insure such in a Facility policy, the fact that you also have a Protection and Indemnity policy on vessels does not negate the Facility coverage and premium is due.

VIII. AGENCY AND PRODUCER

___________________________________________

AGENCY FEDERAL IDENTIFICATION NUMBER

Agency ___________________________________________________________________________(______)_______________

NamePhone Number

Address ___________________________________________________________________________(______)_______________

StreetCityState Zip Fax Number

Producer _________________________________________________________________________________________________

Name (Print or Type)

Signature

Date

Agency contact person

 

 

 

(if other than producer)

_____________________________________

E-Mail __________________________________

NOTE:

IF THE APPLICATION IS NOT COMPLETELY FILLED OUT AN EFFECTIVE DATE WILL NOT BE GIVEN

F-6 (1-04) page 4 of 5

MICHIGAN APPLICATION FOR WORKERS’ COMPENSATION INSURANCE

SUBCONTRACTOR STATEMENT

Criteria used to determine subcontractor status vary from situation to situation. Refer to Rule IX. F. SUBCONTRACTORS in the Basic Manual for Workers’ Compensation and Employers Liability Insurance (1997 Edition). At a minimum (additional information may be required), the following information must be supplied at audit on each subcontractor who is a sole proprietor with no employees (claiming to be an independent contractor) you use during the course of a given policy period:

1.A written statement that the sole proprietor has no one working for him/her.

2.A copy of printed business material (advertisement, certificate of general liability insurance, filed dba or assumed name document, business card, etc.) used by the subcontractor in the operation of his/her business.

3.A list of other entities the sole proprietor has worked for in the past 6 months.

In the case of over-the-road, long-haul truck drivers, subcontractors who are sole proprietors must provide:

1.A written statement that the sole proprietor has no one working for him/her.

2.A written statement that the sole proprietor owns his/her own vehicle (tractor and/or trailer).

In all cases where the subcontractor is a sole proprietor with employees, a partnership, corporation, LLC or other entity, a valid certificate of workers compensation insurance or a properly filed BWC 337 (if the entity is qualified) form must be provided. Failure to provide this information on subcontractors will result in additional premium being charged at audit.

IT MUST BE UNDERSTOOD BY INDIVIDUALS USING THIS DOCUMENT TO DECLARE THEIR INDEPENDENT CONTRACTOR STATUS: THEY ARE NOT ELIGIBLE FOR WORKERS COMPENSATION BENEFITS PROVIDED BY POLICIES WRITTEN TO PROTECT ENTITIES THEY WORK FOR. ALSO, MEETING THE REQUIREMENTS OF THIS DOCUMENT IS NOT AN ATTEMPT TO EVADE THE WORKERS’ COMPENSATION LAWS OF THE STATE OF MICHIGAN, NOR IS IT GIVING UP THE RIGHT TO WORKERS COMPENSATION COVERAGE; IT IS A STATEMENT OF FACT IN SUPPORT OF DECLARING INDEPENDENT CONTRACTOR STATUS IN CONJUNCTION WITH SECTION 418.161(N) OF THE STATE OF MICHIGAN, WORKERS’ DISABILITY COMPENSATION ACT, PUBLIC ACT 317 OF 1969.

Employer Name and Title

Date

* Signature (Corporate Officer, General Partner

Type or Print

 

(Individual Proprietor, Member or Manager of LLC)

*If a person other than those listed has signed this application, attach a copy of the power of attorney or other legal document assigning authority for signature.

THIS SUBCONTRACTOR STATEMENT IS PART OF THE APPLICATION AND MUST BE SIGNED AND SUBMITTED WITH THE APPLICATION.

06-06

Revised 06-06

F-6 (1-04) page 5 of 5

Click for Michigan F 6 PDF Form

Form Characteristics

Fact Number Fact Name Description
1 Form Purpose The Michigan F-6 form is used for applying for workers' compensation insurance through the Michigan Workers' Compensation Placement Facility.
2 Contact Information The form provides both a mailing and a physical address for the Michigan Workers' Compensation Placement Facility, as well as a contact telephone number.
3 Application Requirement Applications must be either typed or legibly printed in ink, ensuring clarity and legibility of the information provided.
4 Coverage Binding Details Coverage will not be bound sooner than 12:01 AM the day following the receipt of the application by the Michigan Workers' Compensation Placement Facility. Moreover, missing or incomplete information may delay the binding of coverage.
5 Legal Status and Eligibility A distinction is made regarding the eligibility of sole proprietors for workers’ compensation benefits, emphasizing that those without employees working for a distinct entity are considered employees of that entity.
6 Previous Insurance Record Requirement If there has been previous workers’ compensation insurance coverage in Michigan, the form requests a detailed insurance record for the three previous years.
7 Governing Law The form is governed by and must be submitted in accordance with the Workers' Disability Compensation Act, Public Act 317 of 1969, as applicable to the State of Michigan.

Guidelines on Utilizing Michigan F 6

Filling out the Michigan F-6 form is a detailed process meant for businesses to apply for Workers' Compensation Insurance, managed by the Michigan Workers’ Compensation Placement Facility. This document plays a critical role in ensuring that businesses provide statutory benefits to their employees in case of work-related injuries or diseases. Duly completing and submitting this form is necessary for legality and compliance, and ensures that businesses can fulfill their obligations to protect their workers.

To correctly complete the form, follow these steps:

  1. Begin by obtaining the Information and Procedures Handbook either from the Michigan Worker’s Compensation Placement Facility or their website at www.caom.com for detailed instructions.
  2. Type or legibly print all information in ink to ensure clarity.
  3. Under Section I. GENERAL INFORMATION, enter the effective date, employer details including name and federal employer identification number, and contact information.
  4. Fill out the mailing address, principal location of the business, any other Michigan locations, and the payroll office address.
  5. Indicate the total number of employees and select the legal status of the business entity.
  6. Answer if the operations are conducted in states other than Michigan and provide details if so.
  7. In Section II. INSURANCE RECORD, detail any previous workers’ compensation coverage, highlight any business name changes, indicate if the business was purchased, and disclose any other owned businesses.
  8. Provide information regarding current insurance policies, any existing uninsured debts, and the bankruptcy status of the employer.
  9. Under Section III. BUSINESS PRINCIPALS, list names, titles, duties, and ownership percentages of key personnel, indicating whether there are exclusions.
  10. In Section IV. NATURE OF BUSINESS AND PREMIUM COMPUTATION, describe your business operations in depth, disclose the use of subcontractors or leased employees, and complete the premium calculation table with appropriate classification codes and payroll information.
  11. For Section VI. EMPLOYER’S AGREEMENT, carefully read and ensure understanding of the obligations outlined, then print the employer name and title, sign, and date the form.
  12. If opting for non-statutory coverage (Section VII), ensure thorough understanding and compliance with the requirements for federal coverage.
  13. Complete the AGENCY AND PRODUCER section with the agency’s details, including the federal identification number, and the producer’s name, signature, and date.
  14. Ensure to review and fill out the SUBCONTRACTOR STATEMENT if applicable, providing all required information and documentation to avoid any potential audit issues or additional premium charges.
  15. Lastly, verify that all sections are completely filled out. Incomplete applications may result in a delay or inability to assign an effective coverage date. Attach a cashier’s check, certified check, money order, agency check, or finance company check for the premium payment to the application.

Once completed, mail the form and any accompanying documents or payments to the address specified for either standard mail or express mail and visitors as listed on the form. Ensuring accuracy and completeness in filling out this form is important for timely processing and securing the necessary workers' compensation insurance coverage.

Crucial Points on This Form

What is the purpose of the Michigan F6 form?

The Michigan F6 form is an application for workers’ compensation insurance. Businesses in Michigan use it to apply for workers' compensation coverage through the Michigan Workers' Compensation Placement Facility (MWCPF). This insurance helps cover medical expenses and lost wages for employees injured on the job. Completing this form is a step employers take to comply with state laws requiring workers' compensation insurance.

How can an employer complete the Michigan F6 form?

The form must be typed or legibly printed in ink. Employers need to provide detailed information about their business, including general information such as the name and address of the employer, payroll office address, total number of employees, and legal status of the company. Additionally, details regarding the nature of the business, insurance record, and premium computation must be furnished. Following completion, the form requires a signature from the employer, certifying the accuracy and truthfulness of the information provided. The completed form should then be mailed to the MWCPF or submitted as directed in the form's instructions.

What information is required if an employer has operations in states other than Michigan?

If an employer operates in states other than Michigan, the form requires specifying each state where operations are conducted. For each location outside Michigan, the employer must provide the state, location of the operations, and the insurance carrier, if any, covering those operations. If there is no insurance coverage for a particular state, this should be clearly indicated on the form. This information helps the MWCPF understand the full scope of the employer's operations and ensure proper workers' compensation coverage.

What happens if the application is not completely filled out?

An incomplete Michigan F6 form will result in an inability to assign an effective date for the insurance coverage. This means that coverage cannot be bound, and the employer will not have the workers' compensation insurance required by law until all missing or incomplete information is provided, and the form is resubmitted. It is crucial for employers to thoroughly review the application before submission to ensure all required fields are filled out and all necessary documentation is attached.

Common mistakes

Filling out the Michigan F 6 form is a critical step for businesses seeking workers' compensation insurance. While it seems straightforward, a surprising number of errors can occur. One common mistake is not ensuring that all information is typeset or legibly handwritten. Clarity is essential to prevent misunderstandings or processing delays.

Another area where people often err is in providing incomplete or inaccurate general information about their employer. The name of the employer, federal employer identification number, and contact information must match official records precisely. Discrepancies here can lead to significant issues down the line, including coverage delays.

Omitting details about other Michigan locations or payroll offices is yet another mistake. The MWCPF requires comprehensive details about all locations to accurately assess the insurance risk and needs. Furthermore, inaccurately reporting the legal status of the business, such as misclassifying a sole proprietorship or corporation, can affect eligibility and the terms of coverage.

Not fully disclosing operations in states other than Michigan can also be problematic. The form explicitly asks for this information, and failure to provide it can result in incomplete or incorrect coverage. This mistake is often made by businesses that underestimate the importance of disclosing their full operational footprint.

When it comes to the insurance record section, some applicants fail to mention previous workers' compensation coverage or neglect to provide a complete insurance record for the past three years. This oversight can hinder the underwriting process, leading to delays in obtaining coverage.

Similarly, failing to report a name change or the purchase of an existing business can complicate the background check process, as the insurance history may not align with the current business name or owner. Include all relevant historical details to ensure a smooth application process.

An often-overlooked part of the form is the section regarding business principals. All designated officers or partners must be listed, along with their duties and salaries. Excluding this information, or failing to attach the appropriate exclusion forms when applicable, can lead to an inaccurate assessment of the business’s insurance needs.

Regarding the nature of business and premium computation section, a frequent error is not providing a detailed enough description of business operations or misclassifying the operations, which can lead to improper coverage. Details matter greatly here.

Under the premium payment section, not including the required deposit or submitting payment via an unacceptable method can stall the application process. It’s crucial to follow the payment instructions carefully to ensure timely processing.

Finally, errors or omissions in the subcontractor statement, when applicable, can lead to audit issues and additional premium charges. This document must be filled out correctly and completely to reflect the true nature of subcontractor relationships and maintain compliance with Michigan workers' compensation laws.

Documents used along the form

When applying for workers' compensation insurance in Michigan using the Michigan F-6 form, several other documents and forms may also be necessary to ensure a comprehensive and compliant application process. These additional documents play a vital role in providing detailed information about your business operations, ownership details, and compliance with state regulations, thus facilitating a smoother processing of your insurance application.

  • ERM (Entity Relationship Management) Form: This form is required if there have been any name changes, business purchases, or if the owner owns a majority interest in another business. It helps in identifying all entities related to the main business for insurance purposes.
  • Bankruptcy Order Copy: If the employer is in bankruptcy, a copy of the bankruptcy order must be attached. This document is crucial for the insurance provider to assess the financial stability and risk factor associated with the business.
  • Exclusion Forms: These forms are necessary for excluding certain officers or partners from the policy, detailing who will not be covered by the workers’ compensation insurance under the policy being applied for.
  • Subcontractor Statement: A vital document for businesses that use subcontractors, clarifying the status of these subcontractors and their eligibility or lack thereof for compensation under the employer’s policy.
  • Social Security Form 941 or Tax Form Schedule C: These forms are used to confirm payroll levels, providing a snapshot of the business’s financial obligations and operational scale.
  • Current Payroll Schedule or M.E.S.C. Report: Similar to the above, these documents offer detailed insights into the business’s payroll details, which are essential for premium calculation.
  • Power of Attorney or Other Legal Document Assigning Signature Authority: If the application is signed by someone other than a corporate officer, general partner, individual proprietor, member, or manager of LLC, this document is needed to verify the authority of the person signing the application.

Together, these documents complement the Michigan F-6 form, providing a full picture of the business’s operations, legal standing, and financial health. Accurate and complete submissions of these forms can expedite the approval process and ensure that the business obtains workers’ compensation insurance coverage that meets all statutory requirements and adequately protects both the employer and its employees.

Similar forms

  • General Liability Insurance Application: Similar to the Michigan F 6 form, this type of application collects detailed information about the business seeking insurance, including general information, insurance history, nature of business operations, and coverage specifics. Both forms are essential in assessing risk and determining the appropriate premium.

  • Commercial Auto Insurance Application: Like the F 6 form, commercial auto insurance applications require detailed business and operational information, including previous insurance coverage and vehicle details. The primary focus is on assessing the risk associated with vehicle operations instead of workers' compensation.

  • Property Insurance Application for Businesses: This application collects extensive information about the property to be insured, similar to how the F 6 form gathers details about the business's operations and locations. The objective is to evaluate the risk and establish the insurance premium.

  • Professional Liability Insurance Application: Professional liability applications and the Michigan F 6 form share the need for detailed business information, including history, services provided, and operational data. Both are used to evaluate the risk profile and determine coverage terms.

  • Directors and Officers Liability Insurance Application: This document, like the F 6 form, requires detailed information about the organization's executives and their roles, operational details, and past insurance history. It focuses on risks related to management decisions and practices.

  • Employment Practices Liability Insurance (EPLI) Application: EPLI applications and the F 6 form both assess risk associated with personnel, including past insurance coverage and claims. The focus for EPLI is on employment-related issues, whereas the F 6 form concentrates on workers' compensation.

  • Health Insurance Application for Small Businesses: While focusing on health coverage for employees, this type of application also requires detailed employer information, similar to the F 6 form. Both forms assess eligibility and risk to determine the terms of insurance.

  • Disability Insurance Application for Businesses: This application gathers similar types of information as the F 6 form, focusing on the business and its operations. The primary difference is the focus on disability coverage for employees instead of workers' compensation.

  • Product Liability Insurance Application: Similar to the F 6 form, this application requires details about the business's operations, particularly regarding the products manufactured or sold. Both types of applications are used to assess risk and determine insurance needs.

  • Umbrella Insurance Policy Application for Businesses: Umbrella policies, which provide extra liability coverage over other policies, require comprehensive business information like the F 6 form. Both applications are crucial in understanding the full scope of the business's operations and potential risks.

Dos and Don'ts

When completing the Michigan F-6 form for Workers’ Compensation Insurance, there are certain practices you should follow to ensure the process is smooth and free from common errors. Below is a list of things you should and shouldn't do:

Things You Should Do:

  • Ensure all information is complete and accurate. Review each section of the form thoroughly to provide accurate details about your business and insurance needs. Missing or incorrect information can delay the processing of your application.
  • Use legible handwriting if filling out by hand or type your responses. This makes the form easier to review and process, leading to fewer mistakes and delays.
  • Provide detailed business operations descriptions. Clearly describe the nature of your business and the duties of employees at each location to ensure proper coverage and premium calculations.
  • Include all relevant documents and information. This includes previous insurance records, information on business principals, and any necessary additional forms such as the ERM form or subcontractor statements, where applicable.
  • Review the premium payment requirements. Understand the deposit required and ensure you enclose the appropriate form of payment with your application to avoid delays in binding coverage.
  • Sign and date the application appropriately. Ensure that the individual authorized to apply for insurance on behalf of the business signs and dates the form to confirm the accuracy of the information provided.

Things You Shouldn't Do:

  • Don’t leave sections incomplete. Failing to fill out any part of the application can result in delays or denial of coverage.
  • Avoid guessing on details such as payroll or employee numbers. Use accurate data to prevent issues during the audit process.
  • Do not use vague descriptions of your business operations. Ambiguity in describing your business operations can lead to incorrect classification and premium issues.
  • Do not withhold information about previous coverage. Complete honesty about your insurance history is necessary for accurate assessment and premium calculation.
  • Do not forget to include payment with your application. Coverage will not be bound without the necessary premium payment.
  • Avoid submitting the form without checking for errors. Review the entire application for completeness and accuracy before submission to ensure a smooth process.

Misconceptions

When it comes to understanding the complexities of applying for workers' compensation insurance in Michigan, especially through the Michigan F 6 form, many misconceptions can lead businesses astray. Here's a look at some common myths and the truths behind them:

  • Myth 1: The Michigan F 6 form is only for new businesses without prior workers' compensation coverage.

    In reality, both new businesses and those with previous or existing workers' compensation coverage in Michigan use this form to apply through the Michigan Workers’ Compensation Placement Facility, indicating their insurance history where applicable.

  • Myth 2: Sole proprietors cannot apply for workers' compensation insurance using the Michigan F 6 form.

    This is a misconception; while it's true that a sole proprietor is not eligible for workers’ compensation benefits under their own policy, they can still apply for coverage for their employees, if any, using this form.

  • Myth 3: You can bind coverage immediately upon submission of the F 6 form.

    Actually, coverage cannot be bound sooner than 12:01 AM the day following receipt by the Michigan Workers’ Compensation Placement Facility, emphasizing the importance of timely submission.

  • Myth 4: All businesses, regardless of legal status, fill out the form the same way.

    Different sections of the form must be completed based on the business's legal status—such as sole proprietorship, partnership, corporation, etc.—to accurately reflect the business structure and insurance needs.

  • Myth 5: The F 6 form automatically includes federal coverage.

    While the Facility provides federal coverage as an adjunct to State Act Coverage, businesses must specify their need for such coverage, particularly if they have exposures like admiralty (Jones Act).

  • Myth 6: The premium payment amount is negotiable after submission of the F 6 form.

    The premium calculation is based on payroll and must adhere to the rates and rules set forth by the Facility. The deposit required and the balance of the Total Estimated Annual Premium must be paid according to established guidelines, not on a negotiable basis.

  • Myth 7: Information about business principals is optional.

    Listing the names, titles, and percentage of ownership of business principals is a mandatory section that must be filled out completely, providing transparency and aiding in the proper assessment of the application.

  • Myth 8: Only Michigan operations need to be disclosed on the form.

    If a business operates in states other than Michigan, this information must be disclosed along with the respective workers’ compensation insurance carriers to ensure complete coverage and compliance with laws.

  • Myth 9: The employer's agreement is a formality and doesn't require careful attention.

    The employer's agreement section reinforces the employer's responsibilities towards maintaining a safe workplace, complying with laws, and keeping accurate payroll records. Signing it acknowledges these duties and the truthfulness of the application, which carries legal significance.

Understanding the facts behind these misconceptions about the Michigan F 6 form can streamline the process of acquiring workers' compensation insurance, ensuring businesses comply with state laws while providing protection for their employees.

Key takeaways

Filling out the Michigan F 6 form, which is an application for workers’ compensation insurance, requires attention to detail and thoroughness. To ensure accuracy and compliance, here are key takeaways to consider:

  • The application should be either typed or legibly printed in ink to avoid any misunderstandings or delays.
  • Be aware that coverage cannot be bound earlier than 12:01 AM the day after the Michigan Workers’ Compensation Placement Facility (MWCPF) receives the form.
  • Sourcing the Michigan Workers’ Compensation Placement Facility's Information and Procedures Handbook can provide valuable instructions for completing the form and is available online or through MWCPF.
  • Every section of the form should be completed in full; missing or incomplete information may delay the process of binding coverage.
  • It’s important to list all operations not only in Michigan, but also in any other states to ensure adequate coverage.
  • Previous workers’ compensation insurance coverage details, including policy numbers and the insurance carriers' names for the past three years, if applicable, must be provided.
  • Legal status of the employer must be clearly indicated, taking note that sole proprietors are not eligible for workers’ compensation benefits unless they have employees and those employees are working for a distinct entity. If that is the case, a list of entities for which work is performed has to be included.
  • If the applicant has had any operations in states other than Michigan or has any leased employees, that information must be included.
  • An estimated premium calculation is required, supported by appropriate documentation such as payroll records, tax forms, or M.E.S.C. reports. This helps determine the deposit premium necessary.
  • Identifying information for the business principals, including duties and annual salaries, ownership percentage, and specifying if any eligible persons are to be excluded from coverage (with the appropriate exclusion form attached), is mandatory.
  • The signature of the employer certifies understanding and truthful completion of the application. Providing false or misleading information could result in criminal prosecution.

Getting workers’ compensation insurance through the Michigan F 6 form is a structured process that requires careful attention to detail and full disclosure of the employer's operations. Making sure all the required sections are accurately completed can help avoid potential delays in obtaining coverage.

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