Get Mi Wc-105b 2012

Filling out the MI WC-105B form is an essential step in providing detailed employer information for a workers' compensation claim. This guide offers a clear and straightforward approach to completing the form online efficiently and accurately.

Follow the steps to complete the MI WC-105B form online.

1. Click the ‘Get Form’ button to access the MI WC-105B. This will open the form in your preferred online editor, allowing you to begin completing the necessary fields.
2. In the first section, provide the employee's name and the last four digits of their social security number. Ensure the date of birth is entered correctly to maintain accuracy.
3. Move to Section 1 – Employer Information. Fill in the full name of the employer, the address of the employee's place of employment, and the corresponding city, state, and ZIP code.
4. In Section 2 – Employment Information, detail the employee's dates of employment, along with their wages for each week over the last 52 weeks prior to the alleged injury or disablement date. If the employee was employed for less than 52 weeks, record all wages for the period employed.
5. Next, specify the fringe benefits received by the employee during their employment, including the employer's costs associated with these benefits as of the alleged injury date and the last day the employee worked.
6. Provide information related to the dates of the alleged injury. Include the employee’s job title(s) and the corresponding dates held, along with a description of all job duties and responsibilities throughout their employment period.
7. Indicate whether the employee’s job was a regular position and describe any necessary licensing, training, or certifications required for their role.
8. Answer whether any job offers were made to the employee post-injury and provide details regarding the offer if applicable. This includes job title, description, hours, pay rate, benefits, and how the offer was conveyed.
9. Confirm if the employment has been terminated, explaining the reasons for either termination or the employee’s departure from the employer.
10. Complete the form with an employer representative's signature, printed name, position, and date. This step is crucial before proceeding to share the form.
11. Finally, save your changes, then download, print, or share the completed MI WC-105B form as required. Ensure copies are exchanged among all involved parties, avoiding submission to the Workers’ Compensation Agency.

Complete your documents online to streamline your workers’ compensation claims process.