Homepage Blank Michigan Workers Independent Contractor Worksheet Form
Outline

The Michigan Workers Independent Contractor Worksheet is an essential document for sole proprietors seeking to establish their status as independent contractors in the state. This form is particularly important as it outlines the necessary information required to assess whether an individual qualifies for independent contractor status under the Michigan Workers’ Compensation Placement Facility guidelines. Beginning July 1, 2009, the acceptance of a Certificate of Insurance alone will no longer suffice; instead, the worksheet must be completed in full and submitted during a workers' compensation audit. It requires details such as the contractor's business structure, type of work performed, and whether they hire employees or subcontractors. Additionally, proof of general liability insurance may be needed, along with a list of previous clients to demonstrate independent work. By signing this form, contractors acknowledge their legal standing and the fact that they are not covered by the Workers’ Disability Compensation Act. This worksheet serves as a critical tool for both contractors and policyholders, ensuring compliance and clarity in worker classification.

Sample - Michigan Workers Independent Contractor Worksheet Form

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: [email protected]

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 Information

Fact Name Description
Purpose The Michigan Workers Independent Contractor Worksheet is used to determine if a sole proprietor without employees qualifies as an independent contractor.
Effective Date This form became essential for independent contractor status as of July 1, 2009, impacting new and renewal policies.
Governing Law The form is governed by the Workers’ Disability Compensation Act of Michigan.
Required Information Contractors must provide detailed information about their business structure, work performed, and any employees or subcontractors hired.
Insurance Certificates A Certificate of Workers’ Compensation Insurance is required if the contractor hires employees or if the business structure is a partnership, corporation, or LLC.
Verification Process Completing the form does not guarantee independent status; additional documentation may be requested to verify claims.
General Liability Contractors must indicate whether they have General Liability coverage and provide a Certificate of General Liability Insurance if applicable.
Audit Exposure Filling out this form does not automatically exempt an individual from the audit of the policy period; exposure may still be charged unless independent status is proven.

Detailed Guide for Filling Out Michigan Workers Independent Contractor Worksheet

Filling out the Michigan Workers Independent Contractor Worksheet is a straightforward process. This form is essential for sole proprietors without employees who wish to be considered independent contractors. Once completed, the form must be submitted to the entity undergoing a workers' compensation audit. Below are the steps to fill out the form correctly.

  1. Begin by entering the Policyholder Name for whom the form is being filled out.
  2. Next, provide the Subcontractor Name.
  3. If applicable, include the Doing Business As (DBA) name. If a DBA is filed, attach a copy of the documentation.
  4. Select your business type by checking the appropriate box: Sole Proprietor, Partnership, Corporation, or Limited Liability Company.
  5. If you selected Partnership, Corporation, or Limited Liability Company, attach a Certificate of Workers’ Compensation Insurance or a properly filed Form BWC-337.
  6. Describe the type of work you perform in the provided space.
  7. Indicate whether you hire employees or casual laborers to complete work for the named policyholder by selecting Yes or No. If yes, provide the number hired and attach a Certificate of Workers’ Compensation Insurance.
  8. Next, indicate whether you hire subcontractors to complete work for the named policyholder by selecting Yes or No. If yes, be aware that additional information may be required.
  9. State whether you have General Liability coverage by selecting Yes or No. If yes, attach a Certificate of General Liability Insurance.
  10. List the general contractors or clients you have worked for in the past twelve months, including their name, city, and telephone number for three entries.
  11. Acknowledge that as a sole proprietor, you are not covered by the Workers’ Disability Compensation Act.
  12. Sign and date the form as the Independent Contractor. Provide your phone number and email address (required).

After completing these steps, review the form for accuracy. Ensure that all required attachments are included. Submit the form to the appropriate entity for further processing. Additional information may be requested to verify your independent contractor status.

Obtain Answers on Michigan Workers Independent Contractor Worksheet

  1. What is the purpose of the Michigan Workers Independent Contractor Worksheet?

    The Michigan Workers Independent Contractor Worksheet is designed to help determine the independent contractor status of sole proprietors without employees. This form is essential for compliance with Michigan’s workers' compensation regulations, especially for those who may have previously relied solely on a Certificate of Insurance to establish their status.

  2. Who needs to complete this worksheet?

    This worksheet must be completed by sole proprietors who do not have employees and are seeking to be classified as independent contractors. If you hire employees or subcontractors, additional documentation will be required.

  3. What information is required on the worksheet?

    The worksheet requires several key pieces of information, including:

    • Your name and the name of the policyholder.
    • Your business structure (sole proprietor, partnership, corporation, or LLC).
    • A description of the work you perform.
    • Details about any employees or subcontractors you hire.
    • Proof of general liability insurance, if applicable.
  4. What happens if I do not fill out the worksheet?

    If the worksheet is not completed and submitted, your status as an independent contractor may not be recognized. This can lead to potential complications during a workers' compensation audit, where you could be classified differently, impacting your liability and insurance coverage.

  5. Is there a deadline for submitting the worksheet?

  6. What if I hire subcontractors?

    If you hire subcontractors, you must indicate this on the worksheet. Additional information may be requested to clarify your relationship with these subcontractors and ensure compliance with workers' compensation regulations.

  7. Do I need to provide proof of insurance?

    Yes, if you have general liability coverage, you must provide a Certificate of General Liability Insurance. Additionally, if you hire employees or subcontractors, you will need to provide their Certificates of Workers’ Compensation Insurance as well.

  8. Can I use the worksheet to prove my independent status?

    Completing the worksheet is a step towards proving your status as an independent contractor. However, it does not automatically exempt you from an audit. The information provided may be verified, and additional documentation may be required to substantiate your claims.

  9. What should I do if my status is challenged during an audit?

    If your independent contractor status is challenged during an audit, be prepared to provide additional documentation that verifies your business operations and relationships with clients. Having a complete and accurate worksheet will help support your case.

  10. Where can I obtain the worksheet?

    The worksheet can typically be obtained from the Michigan Workers’ Compensation Placement Facility's website or by contacting them directly via phone or email. It is crucial to use the most current version of the form to ensure compliance with regulations.

Common mistakes

Filling out the Michigan Workers Independent Contractor Worksheet form can be straightforward, but many individuals make common mistakes that can complicate their applications. One frequent error occurs when individuals fail to provide a Certificate of Insurance when required. If you operate as a partnership, corporation, or limited liability company, this certificate is essential. Without it, your status as an independent contractor may be questioned, leading to potential delays in processing your application.

Another mistake involves not fully completing the section that describes the type of work performed. This part is crucial for establishing the nature of your business activities. Vague or incomplete descriptions can lead to misunderstandings and may result in your application being rejected. It is important to be as specific as possible to ensure clarity.

Some individuals mistakenly indicate that they do not hire employees or casual laborers, even when they do. This inconsistency can raise red flags during the review process. If you do hire workers, you must provide the number hired and attach the necessary Certificate of Workers’ Compensation Insurance. Omitting this information can jeopardize your independent contractor status.

Another common error is neglecting to provide information about hiring subcontractors. If you do hire subcontractors, it is imperative to answer "Yes" and be prepared to provide additional information as requested. Failing to disclose this can suggest a lack of transparency, which may negatively impact your standing.

Individuals often overlook the requirement to provide proof of General Liability coverage. If you indicate that you have this coverage, a Certificate of General Liability Insurance must accompany your application. Without this documentation, your application may be deemed incomplete, causing further delays.

Additionally, some applicants do not list their previous clients or general contractors in the required section. This information is vital for demonstrating that you do not solely depend on the named policyholder for income. Listing multiple clients shows that you operate independently, which is a key factor in determining your status.

Another mistake is failing to acknowledge the legal implications of being a sole proprietor. It is essential to understand that, by law, you are not covered by or subject to the Workers’ Disability Compensation Act. This acknowledgment must be included in your submission to avoid any confusion regarding your rights and responsibilities.

Finally, many individuals forget to sign and date the form. This simple oversight can render your application invalid. Always ensure that you have completed all required fields, including your signature, before submitting the worksheet. Attention to detail is crucial in this process.

Documents used along the form

The Michigan Workers Independent Contractor Worksheet form is essential for determining the independent contractor status of sole proprietors without employees. Alongside this form, several other documents may be required to provide additional context or verification. Below is a list of related forms and documents that are often used in conjunction with the Michigan Workers Independent Contractor Worksheet.

  • Certificate of Insurance (COI): This document serves as proof of insurance coverage for the independent contractor. It is essential for verifying that the contractor has the necessary liability coverage.
  • Form BWC-337: This form is used to report workers’ compensation insurance coverage for partnerships, corporations, or limited liability companies. It is necessary for those entities to demonstrate compliance with workers’ compensation requirements.
  • General Liability Insurance Certificate: This certificate confirms that the independent contractor has general liability coverage, which protects against claims of bodily injury or property damage.
  • Form 1040 Schedule C: This tax form details profit or loss from business operations. It can be submitted as verification of the contractor's business activities and income.
  • Client List: A list of clients or general contractors the independent contractor has worked with in the past year. This information helps establish the contractor's independence from the policyholder.
  • Business License: A copy of the contractor's business license may be required to confirm that the individual is legally operating their business.
  • Tax Identification Number (TIN): This number is necessary for tax reporting purposes and may be requested to verify the contractor's business identity.
  • Subcontractor Agreement: If the contractor hires subcontractors, this document outlines the terms of the working relationship and may be required for verification.
  • W-9 Form: This form provides the contractor's taxpayer identification number and certification, which is often needed for tax purposes when working with clients.

Having these documents readily available can facilitate a smoother verification process and help ensure compliance with Michigan's workers' compensation regulations. It is important to gather all necessary paperwork to support your independent contractor status effectively.

Similar forms

The Michigan Workers Independent Contractor Worksheet form serves a specific purpose in determining independent contractor status. Several other documents share similarities with this form, as they also aim to clarify the relationship between workers and employers or contractors. Here are four documents that are comparable:

  • IRS Form 1099-MISC: This form is used to report payments made to independent contractors. Like the Michigan worksheet, it helps define the nature of the working relationship, particularly in distinguishing between employees and independent contractors.
  • W-2 Form: While this form is used for employees, it plays a crucial role in understanding the difference between employees and independent contractors. The Michigan worksheet, in its assessment, relies on similar principles to determine whether a worker qualifies as an independent contractor.
  • Certificate of Insurance (COI): A COI provides proof of insurance coverage for independent contractors. This document is often required alongside the Michigan worksheet to validate a contractor's status and ensure they have the necessary protections in place.
  • Form BWC-337: This form is specifically for businesses in Michigan to report their workers' compensation insurance status. It is required when partnerships, corporations, or limited liability companies are involved, similar to the information requested on the Michigan worksheet.

These documents collectively contribute to a clearer understanding of the independent contractor relationship, ensuring compliance and protection for all parties involved.

Dos and Don'ts

When filling out the Michigan Workers Independent Contractor Worksheet, it’s important to approach the task with care. Here’s a list of things you should and shouldn’t do to ensure your submission is accurate and complete.

  • Do provide accurate information about your business structure, such as whether you operate as a sole proprietor, partnership, corporation, or LLC.
  • Do attach necessary documentation, like a Certificate of Insurance, if you hire employees or subcontractors.
  • Do describe the type of work you perform clearly and concisely to avoid misunderstandings.
  • Do list previous clients or general contractors you’ve worked for in the past twelve months to validate your independent contractor status.
  • Don’t leave any sections of the form blank; incomplete forms can lead to delays or rejection.
  • Don’t assume that submitting the form guarantees independent contractor status; additional verification may be required.

By following these guidelines, you can navigate the form-filling process with confidence and clarity.

Misconceptions

The following are common misconceptions regarding the Michigan Workers Independent Contractor Worksheet form:

  • Misconception 1: Sole proprietors are always considered independent contractors.
  • While sole proprietors can be classified as independent contractors, they must complete the Independent Contractor Worksheet to verify their status, especially after July 1, 2009.

  • Misconception 2: A Certificate of Insurance guarantees independent contractor status.
  • A Certificate of Insurance alone does not guarantee independent contractor status. The worksheet must be filled out completely for proper evaluation.

  • Misconception 3: The form is only necessary for new policies.
  • The worksheet is required for both new and renewal policies as of the specified date.

  • Misconception 4: Providing a Schedule C is optional.
  • Submitting Form 1040 Schedule C is a method to verify independent contractor status and may be necessary if requested.

  • Misconception 5: Independent contractors do not need general liability coverage.
  • If the independent contractor has general liability coverage, a Certificate of General Liability Insurance must be provided.

  • Misconception 6: Completing the form guarantees exemption from audits.
  • Filling out the worksheet does not automatically exempt an individual from audits. Additional verification may still be required.

  • Misconception 7: All subcontractors can be hired without any implications.
  • If subcontractors are hired, additional information may be necessary to assess the independent contractor's status.

  • Misconception 8: The worksheet is a one-time requirement.
  • The worksheet may need to be completed again if circumstances change or if requested by the policyholder.

  • Misconception 9: Sole proprietors are covered under the Workers’ Disability Compensation Act.
  • Sole proprietors are not covered by this Act, as stated in the worksheet. This is an important distinction for understanding their rights and responsibilities.

Key takeaways

Here are key takeaways about filling out and using the Michigan Workers Independent Contractor Worksheet form:

  • Understand the Purpose: The worksheet is used to determine if a sole proprietor without employees qualifies as an independent contractor for workers' compensation purposes.
  • Complete All Sections: Ensure that every section of the worksheet is filled out completely. Incomplete forms may lead to delays or issues during the audit.
  • Provide Necessary Documentation: If applicable, attach required documents such as a Certificate of Workers’ Compensation Insurance or a Certificate of General Liability Insurance.
  • Detail Your Work: Clearly describe the type of work performed. This helps clarify your role and responsibilities.
  • List Other Clients: Include information about other general contractors or clients you have worked with in the past twelve months. This supports your claim of independent status.
  • Be Aware of Changes: Note that effective July 1, 2009, the practice of accepting a Certificate of Insurance alone will no longer suffice for independent contractor status.
  • Verification of Information: Understand that the information provided may be verified by a company representative, and you may need to provide additional documentation if requested.