COMMON REASONS APPLICATIONS ARE DELAYED OR RETURNED

·        Outdated or incorrect Application return

ü      The current application version is F-6(1-04).

ü      Acord produces a Michigan specific application that may be submitted however the universal Acord application is not accepted.

·        Illegible return

ü      Applications should be typed or printed in black or blue ink.

ü      Letters and numbers should be legible.

ü      The application should not be of poor copy quality.  

·        Wrong check return

ü      Acceptable checks are Cashiers’ Check, Certified Check, Money Order, Agency Check or Premium Finance Company check.

·        No check return

ü      Do not send the application without a check.

ü We do not do quotes.  

ü If you need assistance with premium calculation contact our Customer Service Department before sending the app.

·        Check not made payable to MWCPF return

ü      The check must be made payable to Michigan Workers’ Compensation Placement Facility or MWCPF. 

ü      The check may be endorsed to MWCPF.

·        Money Owed to prior Facility carrier return

ü      If the insured owes undisputed premium to any assigned risk carrier the application will be returned, unless a valid payment arrangement has been made.

·        Outstanding audit with prior Facility carrier return

ü      The audit of an expired or cancelled policy must be completed, or scheduled to be done, before coverage can be placed. 

ü      If the insured has not complied with audit requirements of a prior Assigned Risk carrier the application will be returned. 

ü      Payment of an estimated audit does not satisfy the requirement.

·        Current coverage with another carrier return

ü      A copy of the cancellation or lost policy release form is needed.

·        Federal Employers ID Number return

ü      The FEIN for each entity to be insured must be provided. 

ü      A social security number is acceptable for a sole proprietor or an LLC or PLLC that is owned 100% by one person.

ü      If the FEIN has been applied for a copy of the SS-4 form used to apply will be accepted.

·        Insured’s phone number return

ü      The insured’s phone number or cell phone number must be provided.

·        Section II, questions 2, 3, 4, 5, 6 & 7 must be answered return

ü      If you have answered yes to any of the questions additional information must be supplied.

·        ERM-14 not submitted return

ü      If there is more than one entity on the application.

ü      If a name change has occurred.

ü      If the business was purchased by the insured.

ü      If the owner(s) own a majority interest in any other business.

ü      Be sure the ERM includes effective dates of ownership shown and appropriate signatures.

·        Officer titles not provided return

ü      Acceptable titles are President, Vice President, Secretary, Treasurer, CEO, CFO, COO, or Chairman of the Board. 

·        Officer or LLC Member payroll not included return

ü      Active officers or members who are not excluded must have payroll included for premium computation.

ü      Effective 01-01-04 minimum $18,824 – maximum $72,800

ü      Effective 01-01-05 minimum $19,344 – maximum $78,000

·        Exclusion Forms missing or incomplete return

ü      Sole Proprietor – Signature of spouse, parent or child being excluded.

ü      Partnership – Signature of partner(s) being excluded.

ü      Corporation – Title and signature of officer(s) being excluded.  Officers must own at least 10% of the stock to be eligible.  The Certified Board Resolution must also be completed and signed.

ü      LLC – Signature of each member/manager being excluded.  Must be a member and a manager and hold at least 10% interest to be eligible.  The Limited Liability Company Consent must also be completed and signed.

·        Client list not provided return

ü      Employee leasing firms, PEO’s and temporary contractors must furnish a client list.

ü      Include a brief job description for each client.

ü      If there is not a client contract yet, provide a potential list of clients.

·        Payroll verification is needed return

ü      If payroll levels on the application differ from the most recent audit or previous policy verification is required.

ü      Provide social security form 941, tax form schedule C (both sides), current payroll schedule or MESC report.

·        Premium calculation is incorrect or has been amended return

ü      If recalculation of premium causes additional deposit premium the application will be returned.

·        Inadequate deposit amount return

ü      Premium under $1,000 requires 100%

                         $1,000 - $2,500 requires 50%

                               Over $2,500 requires 25%

·        Employer’s signature return

ü      Make sure the application is signed by the employer and their title is provided.

ü      If  the signer is not a corporate officer, partner, sole proprietor, member or manager of LLC, trustee or legal guardian supply the legal document assigning authority for signature.