Get Mi Wc-105b 2019-2025
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How to fill out the MI WC-105B online
The MI WC-105B is an essential employer disclosure questionnaire used by the Michigan Department of Labor and Economic Opportunity. Filling it out accurately and completely is crucial for the effective processing of workers' compensation claims.
Follow the steps to efficiently complete the MI WC-105B online.
- Click the ‘Get Form’ button to access the MI WC-105B form in your preferred online platform.
- Begin by entering the employee's name and the last four digits of their Social Security number in the designated fields. This information identifies the individual involved.
- Input the employee's date of birth accurately in the appropriate field.
- Proceed to Section 1, which focuses on employer information. You will need to fill out the full name of the employer, their workplace address, city, state, and ZIP code.
- In Section 2, provide detailed employment information regarding the employee. Include details like dates of employment and the employee’s wages for the 52 weeks preceding the alleged injury or disablement.
- Document any fringe benefits the employee received, including the employer's cost of these benefits during the relevant time frames.
- Attach any necessary records related to the alleged injury, including job title(s), specific job duties, and any relevant job descriptions.
- Indicate whether the employee's job was performed by other non-injured individuals and describe any required licenses, training, or certifications for the employee's position.
- Answer questions regarding any job offers made to the employee after the alleged injury. Provide specific details of the job, including title, description, hours, pay rate, and how the offer was communicated.
- Confirm whether the employee’s employment has been terminated and, if so, provide an explanation.
- Finally, the employer’s representative must sign the form, including their printed or typed name, position, and date of completion.
- After filling out all sections, review the form for accuracy before saving changes, downloading, printing, or sharing the MI WC-105B as required.
Complete your forms online today to ensure an efficient processing of your workers' compensation claims.
In Michigan, businesses are required to carry workers' compensation insurance, and failing to do so can result in significant penalties. Employers may face fines and may be liable for the medical costs and lost wages of injured employees. To avoid these repercussions, it's crucial for businesses to understand their obligations and complete the necessary documentation, such as the MI WC-105B form, to maintain compliance.
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