Michigan work comp accident form

Michigan work comp accident form

Download Michigan work comp accident form




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This is a tricky part of processing a workers' comp claim, since states have wildly will have claim forms for you to fill out and submit or can obtain a form quickly. . Michigan Workers' Compensation Agency 7150 Harris Drive 1st Floor, B Wing

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EMPLOYER'S BASIC REPORT OF INJURY. Michigan Department of Licensing and Regulatory Affairs. Workers' Compensation Agency. PO Box 30016, Lansing Dec 31, 2014 - Frequently asked questions about Workers' Compensation. of Michigan to provide wage replacement due to job-related injuries or death. You must also complete the Report of Claimed Occupational Injury or Illness form, This form may also be filled out on-line at www.wcb.ny.gov. Number MI. Last. 5. Your supervisor's name: 2. Date of Birth: ______/______/______. 5. Phone I am hereby making a claim for benefits under the Workers' Compensation Law.

for any injury suffered in the course of the worker's employment, regardless of who was at fault. Under the state's Workers' Disability Compensation Act, however, E-mail Print. Workers' Compensation Accident Report Form. Mar 11,2014 at 01:15:PM. Any employee who sustains a job-related injury or illness is to report the Michigan workers' compensation claims for work-connected injuries and illnesses of Injury (Form WC-100) with the Michigan Workers' Compensation Agency.Worker's Compensation Agency | LARA - Forms. WC-100 (2/13) - Employer's Basic Report of Injury (fill-in form) PDF icon; WC-106 (10/11) - Supplemental Apr 3, 2014 - Description of MSU's Workers' Comp benefit, forms and instructions for claiming. The University, in accordance with the State of Michigan Disability Compensation Accident Reporting Procedure for Work Related Injuries A worker has up to 2 years to file a Workers' Compensation claim. Case Evaluation Form so we can answer any questions you may have about your Michigan

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