This is one of the official workers' compensation forms for the state of Michigan
Michigan Application for Reimbursement for Workers' Compensation
State:
Michigan
Control #:
MI-BWC112-WC
Format:
Word;
PDF;
Rich Text
Instant download
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Description
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Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
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FAQ
If you are unable to work due to your injury or disease, you are entitled to benefits to compensate for your lost wages. This is a weekly monetary payment of approximately 80% of your post-tax average weekly wage. However, the weekly benefit cannot exceed a maximum set by law each year, which is $921 for 2019.
Now, worker's compensation insurance has become more than just money for lost wages. Depending on what state you live in, worker's compensation insurance can provide money for lost wages, reimbursement for medical bills, and even life insurance for your dependents if you die on the job.
If your employer does not file a claim for you, you may file form WC-117 with the Agency. If the insurance company or self-insured employer disputes your claim, you may need to submit a form WC-104A, Application for Mediation, or Hearing.
Workers' compensation provides limited reimbursement for medical expenses and lost wages for employees injured at work or who become ill because of work-related conditions.
