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The Michigan Workers Independent Contractor Worksheet serves as a crucial tool in the assessment of independent contractor status within the state’s workers’ compensation framework. This form is designed specifically for sole proprietors without employees who seek to be recognized as independent contractors. Beginning July 1, 2009, the previous practice of accepting a Certificate of Insurance alone will no longer suffice in the residual market; thus, the completion of this worksheet is essential for determining an individual’s eligibility for independent contractor status. The form requests detailed information, including the nature of the work performed, any employees or subcontractors hired, and existing liability coverage. It also requires the independent contractor to substantiate their claim of independence by documenting other clients or contractors they have engaged with over the past year. Importantly, the worksheet serves not only as a self-declaration but may also invite verification by a company representative, emphasizing the need for accuracy and completeness in documentation. Failure to properly fill out the worksheet could result in continued exposure to audit liabilities. Through its structured inquiries and emphasis on declaration, the worksheet provides a mechanism that protects both workers and policyholders while clarifying the status of independent contractors in Michigan.

Michigan Workers Independent Contractor Worksheet Example

MICHIGAN WORKERS’ COMPENSATION PLACEMENT FACILITY

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

(734) 462-9600 Fax (734) 462-9721

Internet WEB Site: www.caom.com E-Mail: caom@caom.com

October 3, 2008

CIRCULAR LETTER #222

MICHIGAN WORKERS’ COMPENSATION PLACEMENT FACILITY (MWCPF)

INDEPENDENT CONTRACTOR WORKSHEET

It has been an accepted practice in the residual market to consider a sole proprietor without employees as an independent contractor, if a Certificate of Insurance (COI) for the individual is presented. Effective July, 1, 2009, this practice will cease in the residual market (on new and renewal policies as of that date). In order for a sole proprietor without employees to be considered for independent contractor status, the MWCPF Independent Contractor Worksheet must be completely filled out and supplied to the entity undergoing a workers compensation audit.

Attached is a copy of the worksheet. As indicated on the worksheet, additional information may be requested to determine independent contractor status.

Sincerely,

Gary L. Thompson

MICHIGAN WORKERS’ COMPENSATION PLACEMENT FACILITY

INDEPENDENT CONTRACTOR WORKSHEET

TO BE COMPLETED BY THE INDEPENDENT CONTRACTOR

Policyholder Name form is being filled out for:

Subcontractor Name:

Doing Business As (DBA):

 

 

If DBA is filed, attach a copy.

 

1. I operate as a :

Sole Proprietor

Partnership

Corporation

Limited Liability Company

Note: If indicating

Partnership, Corporation or Limited Liability Company, a Certificate of Workers’

Compensation Insurance or a properly filed Form BWC-337 must be submitted.

 

2.The type of work I perform can be described as:

3.I hire employees or casual laborers to complete work for the named policyholder:

Yes

 

Number hired (Attach Certificate of Workers’ Compensation Insurance)

No

Form 1040 SCHEDULE C (Profit or Loss from Business) may be provided as verification.

4. I hire subcontractors to complete work for the named policyholder: Yes No If yes, additional information may be required.

5. I have General Liability coverage: Yes No

If yes, a Certificate of General Liability Insurance is required.

6.To validate my standing as an independent contractor, I state that I do not exclusively depend upon the payments of the named policyholder and have worked for the following general contractors or clients during the past twelve months.

NAME

CITY

TELEPHONE

1.

2.

3.

I acknowledge that as a sole proprietor, I am by law not covered by or subject to the Workers’ Disability Compensation Act.

I certify the above represents a true and complete statement of my status as an Independent Contractor. I understand a company representative may verify this statement at any time. If requested, I agree to provide documentation to verify my status as a sole proprietor.

Signed:

 

 

 

 

Date:

 

 

 

(Independent Contractor)

Phone Number:

 

Email Address :

 

(Required)

This form is utilized as a test of the above individual’s independent status. By completing this form, it does not automatically remove the above individual’s exposure from the audit of the policy period in question. Additional information may be required. If independent status is proven, the exposure will not be charged.

ICW08

Form Characteristics

Fact Name Description
Purpose of the Worksheet This form is used to determine the independent contractor status of sole proprietors without employees for workers’ compensation purposes.
Governing Law The guidelines for this form are in accordance with the Michigan Workers’ Disability Compensation Act.
Certificate of Insurance Requirement To qualify, sole proprietors must present a Certificate of Insurance, with additional documents required for certain business structures like partnerships or corporations.
Effective Date of Changes As of July 1, 2009, a new policy requires the completion of this form to establish independent contractor status in the residual market.
Verification Process Upon completion, the submitted information can be verified by a company representative, and additional documentation might be requested at any time.

Guidelines on Utilizing Michigan Workers Independent Contractor Worksheet

Once the Michigan Workers Independent Contractor Worksheet is filled out, it should be submitted to the appropriate entity for review during a workers' compensation audit. Here’s how to properly complete the form:

  1. Enter the Policyholder Name: Fill in the name of the policyholder for whom you are completing the form.
  2. Subcontractor Name: Provide your name as the subcontractor.
  3. Doing Business As (DBA): If you operate under a DBA, include that name and attach a copy of the DBA filing.
  4. Business Structure: Check the appropriate box indicating your business type (Sole Proprietor, Partnership, Corporation, Limited Liability Company).
  5. Type of Work: Describe the type of work you perform in the provided space.
  6. Employees: Indicate if you hire employees or casual laborers for the policyholder. If yes, note the number hired and attach a Certificate of Workers’ Compensation Insurance.
  7. Subcontractors: State whether you hire subcontractors for the policyholder. If yes, be aware that additional information may be needed.
  8. General Liability Coverage: Mark yes or no to show if you have General Liability coverage. If yes, attach the Certificate of General Liability Insurance.
  9. Validation of Independent Status: List general contractors or clients you have worked with in the past twelve months. Include name, city, and telephone number for each.
  10. Acknowledge Legal Status: Read and acknowledge that as a sole proprietor, you are not covered under the Workers’ Disability Compensation Act.
  11. Signature: Sign and date the form, and provide your phone number and email address.

What You Should Know About This Form

What is the Michigan Workers Independent Contractor Worksheet used for?

The Michigan Workers Independent Contractor Worksheet is a form that helps determine whether a sole proprietor without employees qualifies as an independent contractor for workers' compensation purposes. As of July 1, 2009, for individuals to be considered independent contractors, they must complete this worksheet and provide it during a workers' compensation audit. This ensures that the proper classification can be verified for insurance purposes.

Who needs to fill out the worksheet?

The worksheet must be completed by sole proprietors who do not have employees and wish to be recognized as independent contractors. This applies not only to individuals working alone but also to those who hire subcontractors or casual labor for jobs. It is important that all sections of the form are filled in accurately to ensure proper evaluation of independent status.

What information is required on the worksheet?

The worksheet requires several pieces of information including the policyholder's name, the independent contractor's name and DBA (if applicable), the type of business entity they operate as (sole proprietor, partnership, corporation, or LLC), and details about their work history for the past twelve months. They also need to indicate if they hire employees or subcontractors, provide insurance certificates when applicable, and affirm that they do not solely depend on the named policyholder for income.

What if I do not provide the worksheet or complete it accurately?

If the worksheet is not completed or submitted correctly, the individual may remain categorized as an employee rather than an independent contractor. This could result in a lack of insurance coverage or possible charges against the policyholder's workers' compensation policy. Additionally, incomplete information may lead to further requests from the auditing entity, which can delay the process.

Common mistakes

Filling out the Michigan Workers Independent Contractor Worksheet can be straightforward, but many people make mistakes that can complicate their status as independent contractors. One common error is not providing accurate information about their business structure. Indicating the wrong type of business—such as marking "Sole Proprietor" when it should be "LLC" or "Corporation"—can lead to misclassification. This mistake can affect coverage and lead to complications during audits.

Another frequent issue is failing to attach necessary documentation. For instance, if a subcontractor states that they hire employees, they must submit a Certificate of Workers' Compensation Insurance. Not including this certificate can delay the processing of their application or result in a denial of their independent contractor status. Always double-check that all required documents are attached before submitting the form.

Moreover, many applicants underestimate the importance of detailing their work history. The worksheet asks for a list of general contractors or clients they've worked with in the past year. Omitting this information or providing vague descriptions can raise red flags during the audit process. Providing clear, specific, and thorough information can help ensure a smoother verification process.

Finally, some individuals overlook the importance of clarity in their statements about their work. The form requires a clear declaration that they do not depend exclusively on the named policyholder for income. Failing to articulate this adequately can lead to further inquiries and complications. Being precise and honest in these declarations is crucial to maintain independent contractor status.

Documents used along the form

The Michigan Workers Independent Contractor Worksheet form is a critical document for determining the status of a sole proprietor as an independent contractor in the state of Michigan. However, several other documents often accompany this form to provide additional context and verification. Understanding these supplementary documents is important for ensuring compliance with workers' compensation regulations. Below is a list of commonly used forms that may be required in conjunction with the Independent Contractor Worksheet.

  • Certificate of Insurance (COI): This document verifies that a contractor has active insurance coverage. It is essential for demonstrating that the contractor has protection against potential liabilities and is particularly important if they are hiring subcontractors.
  • Form BWC-337: This is used to report business structure and insurance information for entities such as partnerships, corporations, or limited liability companies (LLCs). Submitting this form may be necessary for those who do not operate as sole proprietors.
  • General Liability Insurance Certificate: This certificate verifies that the contractor holds general liability insurance. It provides an extra layer of protection and assurance for the policyholder regarding the contractor's financial stability in case of accidents or damages.
  • Form 1040 Schedule C: This form is part of individual income tax returns and reports profit or loss from a business. It is a useful document for independent contractors to demonstrate their income-generating activities and can aid in assessing their independent status.
  • Payroll Records: Maintained by the contractor, these records can help substantiate claims of independence by detailing the number of hired employees and payments made. They serve as verification of employment and payment practices.
  • Contracts or Agreements: Any written agreements between the contractor and the policyholder outlining the scope of work can provide evidence of the contractor's independent status and business relationship with the policyholder.

Collectively, these documents help clarify a contractor's independent status and ensure compliance with Michigan's workers' compensation regulations. Having this information readily available can facilitate smoother audits and greater peace of mind for all parties involved.

Similar forms

The Michigan Workers Independent Contractor Worksheet form is similar to several other documents used to establish independent contractor status. Each has its own specific purpose but shares common elements related to verifying work status and insurance requirements. Here are four comparable documents:

  • Form BWC-337: This Ohio Bureau of Workers' Compensation form is used for contractors to verify their independent contractor status. Like the Michigan Worksheet, it requires information about the contractor’s business structure and insurance coverage, helping to clarify employment status in the context of workers’ compensation.
  • IRS Form 1099-MISC: This form is issued by businesses to report payments made to independent contractors. Similar to the Michigan Worksheet, it serves to confirm that the recipient is classified as a contractor, not an employee, thereby influencing tax responsibilities and liabilities.
  • Certificate of Insurance (COI): A COI provides proof of insurance coverage for independent contractors. Both the Michigan Worksheet and the COI emphasize the importance of insurance documentation to validate the contractor's work status and protect against liability claims.
  • W-9 Form: The IRS Form W-9 is used to provide taxpayer information for independent contractors. This form is essential in establishing that the contractor is not an employee and aligns with the Michigan Worksheet by confirming the independent role of the contractor in a business relationship.

Dos and Don'ts

When filling out the Michigan Workers Independent Contractor Worksheet form, it is essential to adhere to certain practices to enhance accuracy and compliance. Below is a list of dos and don’ts that can help ensure effective completion of the form.

  • Do accurately fill in the policyholder name for whom the form is being completed.
  • Do include a copy of the DBA if applicable.
  • Do provide the necessary documentation, such as a Certificate of Workers’ Compensation Insurance, if required.
  • Do state the type of work performed clearly to avoid ambiguity.
  • Don't leave any sections blank; incomplete information can delay verification.
  • Don't assume that providing a Certificate of Insurance alone is sufficient for independent contractor status.

By following these guidelines, individuals can ensure a smoother process when submitting the Michigan Workers Independent Contractor Worksheet form.

Misconceptions

  • Independent contractors don’t need to fill out this worksheet. Many believe that filling out the Michigan Independent Contractor Worksheet is optional. This is incorrect. It is mandatory for sole proprietors without employees to complete the worksheet to be considered for independent contractor status.
  • All sole proprietors are automatically independent contractors. Another common misconception is that all sole proprietors qualify as independent contractors. This is not true. Only those who complete the worksheet can be evaluated for independent status.
  • A Certificate of Insurance guarantees independent contractor status. Some think that simply presenting a Certificate of Insurance means they are independent contractors. This belief is misleading. The completed worksheet is necessary for assessment, regardless of the insurance documentation.
  • You can ignore employee information if you don’t hire anyone. It's a mistake to think that employee information is irrelevant. The worksheet still requires accurate disclosure. If you do not hire employees or casual laborers, you must still indicate that clearly on the form.
  • Filling out the worksheet guarantees you won’t face an audit. Many assume that completing the worksheet protects them from audits. This assumption is incorrect. The worksheet does not eliminate exposure from policy audits; it only provides information for evaluation.
  • Independent contractor status is determined solely by the worksheet. Some believe the worksheet alone will decide their independent status. In reality, additional documentation and information may be required to substantiate claims of independent contractor status.
  • You won’t be asked for further documentation. A frequent misconception is that the worksheet is the final step. However, if the information provided raises questions, you may be asked to supply additional documentation to verify your status.
  • Only new policies require the worksheet. There’s a misunderstanding that only new policies need the worksheet. In fact, both new and renewal policies must include this worksheet for assessment of independent contractor status.
  • You can complete the worksheet without a DBA attachment. Some individuals think they can complete the worksheet without attaching proof of their Doing Business As (DBA) name if applicable. This is inaccurate. If a DBA is filed, attaching a copy is necessary.

Key takeaways

Filling out and using the Michigan Workers Independent Contractor Worksheet form requires attention to detail. Here are five key takeaways to ensure the process is understood and implemented correctly:

  1. Complete All Sections: Ensure that the form is entirely filled out. Missing information can lead to delays or misunderstandings regarding independent contractor status.
  2. Documentation is Crucial: Certain documents, such as a Certificate of Workers’ Compensation Insurance or a Certificate of General Liability Insurance, are necessary depending on your business structure and coverage. Be prepared to attach these documents.
  3. Independent Contractor Status Verification: The form serves to verify independent contractor status but does not automatically exempt you from any audits related to the policy period. Expect possible follow-up requests for additional information.
  4. Multiple Clients: You must declare any work done for other clients within the last year. This demonstrates that you do not solely rely on the policyholder for income, which is an essential criterion for independent contractor status.
  5. Legal Acknowledgment: As a sole proprietor, acknowledge that you are not covered under the Workers’ Disability Compensation Act. Your signature certifies that the information provided is accurate and complete.

Being thorough and organized during this process can significantly enhance your experience with the Michigan Workers’ Compensation Placement Facility.