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  • Form Wc-117h - State Of Michigan - Mich

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PROVIDER S REPORT OF CLAIM & REQUEST FOR MEDICAL PAYMENT Michigan Department of Licensing and Regulatory Affairs Workers Compensation Agency 1. EMPLOYEE TO COMPLETE THIS SECTION Employee Name.

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Weekly benefits are roughly 80 percent of your after-tax wages. If your employer will not file a claim for you, you may file form WC-117 with the Agency.

Michigan's injured workers and their employers are governed by the Workers' Disability Compensation Act. This Act was first adopted in 1912 and provides compensation to workers who suffer an injury on the job and protects employers' liability.

The going to or coming from work provision of the Act, MCL 418.301(1), provides that a worker going to or coming from their work, while on the employer's premises, and within a reasonable time before and after their working hours, is presumed to be in the course of their employment.

There is a seven-day waiting period for wage loss benefits in Michigan. In other words, your injury or illness must keep you from earning wages for at least seven consecutive days (including weekends and holidays) before you may begin to collect wage loss benefits.

File an exclusion form with the Insurance Compliance Division of the Agency. This division can be reached at 517-284-8922. It is a form provided by the Insurance Compliance Division (WC-337) which is completed by the employer and filed with the Agency.

Michigan Workers' Compensation Coverage For example, if a worker loses a thumb because of their job, they're entitled to 65 weeks of compensation benefits, regardless if they're disabled. Disability benefits for employees that get a temporary or permanent disability from a work-related injury or illness.

When an injury/illness occurs: Immediately notify your supervisor. Seek treatment at an Occupational Health Care Clinic. Submit a Workers' Compensation Claim: Apply Online, or. Print, complete, and fax a State of Michigan Workers' Compensation Claim Form.

Following are the criteria for employers who must carry workers' compensation coverage: All private employers regularly employing 1 or more employees 35 hours or more per week for 13 weeks or longer during the preceding 52 weeks. All private employers regularly employing 3 or more employees at one time.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232