Michigan Group Self-Insurer Application (fill-in form)

State:
Michigan
Control #:
MI-WC-402GR
Format:
PDF
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Description

Group Self-Insurer Application (fill-in form) The Michigan Group Self-Insurer Application (fill-in form) is a form used by employers in the state of Michigan to apply for group self-insurance. This type of insurance allows employers to provide their own coverage for workers' compensation and/or liability insurance. The form must be completed and submitted to the Michigan Department of Licensing and Regulatory Affairs (LARA) in order to be approved as a group self-insurer. The form includes sections for information about the employer, the type of coverage being requested, and details about the plan and the coverage offered. There are two versions of the Michigan Group Self-Insurer Application (fill-in form): one for employers applying for workers' compensation coverage and one for employers applying for liability coverage.

The Michigan Group Self-Insurer Application (fill-in form) is a form used by employers in the state of Michigan to apply for group self-insurance. This type of insurance allows employers to provide their own coverage for workers' compensation and/or liability insurance. The form must be completed and submitted to the Michigan Department of Licensing and Regulatory Affairs (LARA) in order to be approved as a group self-insurer. The form includes sections for information about the employer, the type of coverage being requested, and details about the plan and the coverage offered. There are two versions of the Michigan Group Self-Insurer Application (fill-in form): one for employers applying for workers' compensation coverage and one for employers applying for liability coverage.

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Michigan Group Self-Insurer Application (fill-in form)