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Michigan workers' compensation manual

Michigan workers compensation application 2025

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The document is an application form (OCR 104A) for mediation or hearing related to workers' disability compensation in Michigan. It is intended for employees to report injuries, request benefits, and provide necessary personal and employment information. The form requires details about the employee, employer, nature of the injury, dates of employment, and any other benefits received. It also includes sections for medical providers and witnesses. The application must be completed accurately and submitted to the Workers’ Disability Compensation Agency.

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Click ‘Get Form’ to open the Michigan Workers Compensation Application in our platform.
Begin by filling out your personal information in sections 1-13, including your name, social security number, and date of birth. Ensure all details are accurate to avoid delays.
In sections 14-19, provide your employer's information. If known, include the Federal Employer Identification Number (FEIN). Remember, a separate application is required for each employer.
Complete sections 20-24 with your employment dates and wage information. Specify the city and county where the injury occurred and list all relevant dates of injury.
In section 25, describe the nature of your disability and how it occurred. Be clear about the relief you are seeking.
Answer yes or no in sections 26-33 regarding other employment and benefits received during your disability period.
List healthcare providers in section 35 who treated you for injuries related to this claim.
Finally, certify that all information is true by signing at the end of the form. If represented by an attorney, complete their details as well.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (113 Votes)
2019	4.3 Satisfied (56 Votes)
2013	4.3 Satisfied (353 Votes)

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How does workman's compensation work in Michigan?

If you're unable to work at all and are entitled to wage-loss benefits, you'll generally receive 80% of your pre-injury wages (based on the after-tax value of the average weekly wages in the 39 highest-paid weeks out of the 52 weeks before you were injured or became ill).

What is the highest workers comp settlement?

This year, Los Angeles workers' compensation attorney Harry Samarghachian, a partner with Rose Klein & Marias, secured a settlement of $11.3 million for his client who suffered a catastrophic traumatic brain injury. This marked California's largest workers' compensation settlement in history.

How long do I have to file a workers comp claim in Michigan?

The statute states that you should provide notice of injury to the employer within 90 days of the injury. However, you have up to two years from the date of injury, or the date the disability manifests itself, to file a workers' compensation claim.

How much does Workmans Comp pay in Michigan?

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.

How much does Michigan workers compensation pay?

the average of the highest 39 weeks of the last 52 weeks of gross wages prior to injury. Generally, you should receive 80% of the after-tax value of this average. disability. However, a benefit check is not considered \u201clate\u201d until 30 days after the due date.

How long does it take to get workers comp settlement check in Michigan?

How long do workers' comp settlements take in Michigan? A good estimate for how long workers comp settlements take in Michigan is 12 months from the pre-trial date. Michigan law allows people to settle their workers' comp claims after 6 months from their injury date.

How is workers comp pay calculated in Michigan?

The Agency uses your average weekly wage (AWW) and the state average weekly wage (SAWW) to decide your benefit amount. To get your AWW, the Agency looks at your highest 39 weeks of gross wages of the last 52 weeks, leading up to the date of injury/illness. They calculate the average of these 39 weeks to get your AWW.

How long does workers comp take Michigan?

For claims that result in less than 7 days of disability, medical bills are processed within 30 days from the date that they are received by Sedgwick.

Michigan workers compensation application 2025

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How much does Workmans Comp pay in Michigan?

How much does Michigan workers compensation pay?

How long does it take to get workers comp settlement check in Michigan?

How is workers comp pay calculated in Michigan?

How long does workers comp take Michigan?

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Michigan workers compensation application 2025

Here's how it works

How to use or fill out Michigan Workers Compensation Application with DocHub

See more michigan workers compensation application versions

Complete this form in 5 minutes or less

Got questions?

Can I use DocHub to generate legal eSignatures on my michigan workers compensation manual?

How do you edit michigan workers compensation application on Android?

How does workman's compensation work in Michigan?

What is the highest workers comp settlement?

How long do I have to file a workers comp claim in Michigan?

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People also ask

How much does Workmans Comp pay in Michigan?

How much does Michigan workers compensation pay?

How long does it take to get workers comp settlement check in Michigan?

How is workers comp pay calculated in Michigan?

How long does workers comp take Michigan?

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