• Want to confirm a required filing or learn about reporting compliance and requirements?  Contact the Insurance, Compliance & Reporting Division via telephone, (410) 864-5293, outside Baltimore Metro area toll free (800) 492-0479 selecting extension 5293 when prompted or via email: wccinsur@wcc.state.md.us.

• Questions about obtaining workers' compensation insurance?  The Maryland Insurance Administration (MIA) licenses insurers in Maryland to provide workers' compensation insurance services.   The Maryland Injured Workers' Insurance Fund (IWIF) is the Maryland agency that provides workers' compensation insurance services to the Maryland employer.

MD WCC INSURANCE INFORMATION REPORT IC-1 (formerly A-01)

• 2013 Online Annual Insurance Information Report IC-1 (Not Active)
  If you have additional questions, please contact the IC&R Division directly.  Telephone, (410) 864-5293, outside Baltimore Metro area toll free (800) 492-0479 selecting extension 5293 when prompted.  Email: insurance_IC1@wcc.state.md.us.

• Download the Formatta Filler software for Windows/PC to complete the online form.

• Instructions for the 2013 Online Annual Insurance Information Report IC-1 PDF
  2013 Updates/changes, technical information & requirements, instructions, software, tips and tools.

• INSURANCE INFORMATION REPORT Worksheet for IC-1 2013 Fillable - PDF
  This may be used as a worksheet for the online report.

• INSURANCE INFORMATION REPORT WCC Form IC-1 2013 Instruction Manual- PDF
  Detailed information about the report's requirements.

• NOTE: PDF files created by software included with some multifunction scanners create a PDF file that cannot be processed by our system.
  Any attached files available in native MS Office format, such as Excel or Word should be used in lieu of the scanned PDF file.
  Alternatively, you may use another file format, such as JPG or GIF, as output from your scanner to attach to our WebForms.
  If you have resident PC software to create PDF files, such as full Adobe Acrobat or a PDF print driver, you may "reprint" the scanner output via this software to create a compliant file.

  A reliable freeware option is cutePDF http://www.cutepdf.com/products/CutePDF/writer.asp.
  The software installs and behaves like a physical printer to create the PDF file. You may open your scanner-created PDF in Adobe Reader, select Print, select the cutePDF printer and save the output file to your PC. You can then attach the file which will process in our Online Services.

  ---

FORMS FILED WITH THE DIVISION
You may not submit these forms via email or email attachment; the signed original must be mailed to the WCC at the address provided on the form (footer).  Some PDF forms can be completed in Adobe® Reader or you may use the typewriter tool if available in your installed Adobe Reader version.  Forms submitted to WCC must be current and as provided; altered, incomplete, unauthorized or obsolete forms are returned without processing.

• Sole Proprietor's Status as a Covered Employee Form - (WCC 01/2010)

• Inclusion Form  (WCC C-15R, 1/2001)

• Exclusion Form (WCC IC-16, 01/2011)

• Application for Self-Insurance and Instructions (WCC A-05, 2/2009) - 12 pages, approximately 425 KB download

• Self-Insured Employer's Application to Add a Subsidiary (WCC A-05S, 02/2009)

• Parental Guarantee & Board Resolution (WCC A-04, 9/2006)

• Letter of Credit (WCC A-08, 9/2006) - unavailable

• Continuous Surety Bond Form (WCC A-07, 8/2003)

• Memorandum of Understanding (WCC A-09) - unavailable

• Financial Reporting System (FRS)- Selected Data From Audited Financial Statements (7/2003)

RELATED LAWS & REGULATIONS Complete statutes and regulations are available online.

• Certificate of Compliance: Code of Maryland, Labor & Employment Article, Workers' Compensation §9–105

• Covered Employee: Code of Maryland, Labor & Employment Article, Workers' Compensation §9-202

• Site of Employment: Code of Maryland, Labor & Employment Article, Workers' Compensation §9-203

• Corporate or Limited Liability Company Officer: Code of Maryland, Labor & Employment Article, Workers' Compensation §9-206

• Sole Proprietor: Code of Maryland, Labor & Employment Article, Workers' Compensation §9-227

• Governmental Self-insurance Group: Code of Maryland, Labor & Employment Article, Workers' Compensation §9-404

• Self-insurance by Individual Employer: Code of Maryland, Labor & Employment Article, Workers' Compensation §9-405:

• Governmental Group Self-Insurance: COMAR 14.09.02.01 through 14.09.02.08

• Individual Employer Self-Insurer: COMAR 14.09.10.01 through 14.09.10.12

OTHER RELATED MATERIALS AND FORMS     BACK TO TOP OF THIS PAGE 

• Compliance Audit Procedures Guide (Attachment H) -  a reference material for self-insured employers and vendors that provide audit services to the Commission. The guide contains explanations regarding the completion of the IC-1 report as well as sample audit reports.

• The MD WCC Employer's Posting Notice (form C-24) - (Version 11/2007) English/Spanish PDF for printing via Adobe® Reader (325 KB).
  The MD WCC Employers' Posting Notice is 8.5" X 14" and MUST be printed on 8.5" X 14" (legal size) goldenrod or yellow paper.  Laser printer or clear photocopier versions are recommended for printed durability and legibility.  Default resolution for this printing is 600 dpi (dots per inch).  The statutory requirement is "as provided by the MD WCC", hence reduced size or otherwise altered reproductions from the original/default specifications will not constitute statutory compliance.  The Notice is to be posted in a conspicuous location at each worksite and must include the complete employer/insurer information in the lower left corner where indicated.
  

  • EMPLOYER'S POSTING NOTICE, C-24 (fillable and print PDF)

  • EMPLOYER'S POSTING NOTICE, C-24 (print only PDF)

 ADDRESS OR INFORMATION CHANGE

• Insurer Request for Change of Address - (WCC H13R, 9/2008) - fillable

• Insurer Request for Change of Address - (WCC H13R, 9/2008) - print only

• Employer or Self-Insured Employer Request for Change of Address - (WCC H22R, 09/2008) - fillable

• Employer or Self-Insured Employer Request for Change of Address - (WCC H22R, 09/2008) - print only

• Request for Employer Designee to Receive Notice of Employee Claims - (WCC H23R, 06/2009)