Blank 153 Massachusetts Form

Filling out and utilizing the Massachusetts Form 153 can be straightforward when you keep a few key points in mind. Here are some essential takeaways:

• Eligibility Requirements: Only corporate officers or directors who own at least 25% of the corporation's stock can apply for an exemption from workers' compensation coverage. This is a crucial criterion to meet.
• Annual Submission: It's important to submit a copy of this form to your insurance carrier each year, especially before renewing any existing workers' compensation policy. This ensures that your exemption status is recognized and remains valid.
• Employee Coverage: If the corporation employs individuals other than the exempt officers or directors, it must maintain a valid workers' compensation policy for those employees. The exemption applies solely to the signing corporate officers or directors.
• Signature Requirement: All eligible corporate officers must sign the form. Make sure to indicate whether you wish to exercise your right of exemption by checking the appropriate box next to your name.

By keeping these points in mind, you can navigate the process of using Form 153 more effectively. This form serves as an important tool for corporate officers seeking to manage their workers' compensation obligations in Massachusetts.

1. Incomplete Corporate Information: Failing to provide the full name and address of the corporation can lead to processing delays.

2. Missing Signatures: All eligible corporate officers must sign the form. Omitting a signature invalidates the submission.

3. Incorrect Exemption Selection: Not checking the appropriate box to indicate whether the officer wishes to exercise the right of exemption can result in confusion.

4. Exceeding Signature Limit: Including more than four signatures on the form violates the submission rules and may lead to rejection.

5. Failure to Update Changes: Not filing a new Form 153 when there is a change in the status of a corporate officer or director can lead to compliance issues.

6. Ignoring Submission Deadlines: Submitting the form late, especially before the renewal of a workers’ compensation policy, can result in penalties.

7. Neglecting to Provide the Investigation ID Number: If responding to a Stop Work Order, failing to include the Investigation ID Number may complicate the process.

8. Not Understanding Obligations: Officers should fully understand the implications of waiving rights under M.G.L. c. 152. Lack of awareness can lead to unexpected liabilities.

9. Incorrect Form Version: Using an outdated version of Form 153 can lead to non-compliance. Always check for the latest version before submission.

When filling out the 153 Massachusetts form, there are important dos and don'ts to keep in mind. Following these guidelines can help ensure that your submission is correct and complete.

• Do read the instructions carefully before starting the form.
• Do ensure all eligible corporate officers sign the form.
• Do check the appropriate box to indicate whether you wish to exercise your right of exemption.
• Do submit a copy of the form to your insurance carrier annually.
• Do file a new Form 153 if there are any changes in the status of corporate officers or directors.

• Don't leave any sections of the form blank.
• Don't forget to include the corporation's name and address at the top of the form.
• Don't submit the form without ensuring that all signatures are present.
• Don't ignore the requirement for workers’ compensation coverage if you hire additional employees.

By following these guidelines, you can help avoid delays and ensure compliance with Massachusetts regulations.

What is the purpose of Form 153 in Massachusetts?

Form 153 serves as an affidavit of exemption for certain corporate officers or directors from the Massachusetts Workers’ Compensation Act. Specifically, it allows officers or directors who own at least 25% of a corporation's issued and outstanding stock to waive their rights to workers' compensation benefits. By signing this form, these individuals can legally operate without requiring a workers' compensation policy, provided that the corporation does not employ anyone else besides those who have signed the form.

Who is eligible to sign Form 153?

Eligibility to sign Form 153 is limited to corporate officers or directors who own a minimum of 25% of the corporation's issued and outstanding stock. All eligible individuals must sign the form to invoke the exemption. Importantly, there can be no more than four signatures on the form, ensuring that only a small group of key individuals can claim this exemption.

What happens if the corporation hires employees in addition to the exempt officers or directors?

If a corporation that has exempted its officers or directors under Form 153 decides to hire additional employees, it is required by law to obtain a workers’ compensation policy for those employees. The exemption applies solely to the individuals who have signed the form. Therefore, the corporation must ensure compliance with the Massachusetts Workers’ Compensation Act for any non-exempt employees, which includes maintaining valid insurance coverage.

How should Form 153 be submitted, and are there any ongoing obligations?

The completed Form 153 must be submitted to the Department of Industrial Accidents, specifically to the Office of Investigations. Additionally, corporations should submit a copy of this form to their insurance carrier annually, prior to the renewal of any existing policy. If there are any changes in the status of a corporate officer or director, a new Form 153 must be filed with the Department of Industrial Accidents and provided to the insurance carrier to ensure that the exemption remains valid.

Instructions on How to Fill Out 153 Massachusetts

Filling out the Massachusetts Form 153 is an important step for corporate officers or directors who wish to claim an exemption from certain workers' compensation requirements. Ensure that all eligible individuals understand their rights and obligations before completing the form. Following these steps will help you accurately fill out the form and submit it correctly.

1. Begin by entering the name of your corporation and its address in the designated space.
2. In the section labeled "Invest./SWO ID #," write the Investigation ID Number or Stop Work Order Number if applicable.
3. Each officer or director must confirm they hold at least 25% of the issued and outstanding stock by signing their name in the provided signature area.
4. Next to each signature, check the appropriate box to indicate whether the individual wishes to exercise their right of exemption or not.
5. Print the name and title of each signer below their signature.
6. Include the date (in mm/dd/yyyy format) next to each printed name and title.
7. Make sure all eligible corporate officers have signed the form. Remember, there can be no more than four signatures.
8. After completing the form, submit it to the Department of Industrial Accidents at the address listed on the form.
9. Keep a copy of the completed form for your records and provide a copy to your insurance carrier annually, prior to policy renewal.

Once the form is submitted, the Department of Industrial Accidents will review it. If everything is in order, your exemption will be acknowledged, allowing your corporation to operate without the specified workers' compensation coverage, provided there are no additional employees beyond the exempt officers or directors.