Michigan workers compensation application 2025

1. Click ‘Get Form’ to open the Michigan Workers Compensation Application in our platform.
2. Begin by filling out your personal information in sections 1-13. This includes your name, social security number, and date of birth. Ensure all details are accurate to avoid delays.
3. In sections 14-19, provide your employer's information, including their name and address. If known, include the Federal Employer Identification Number (FEIN). Remember, a separate application is required for each employer.
4. Complete sections 20-24 with details about your employment dates and the nature of your injury. Specify whether you are claiming hourly or weekly earnings and list all relevant dates of injury.
5. In section 25, describe the nature of your disability and how it occurred. Be clear about the relief you are seeking.
6. Answer yes or no in sections 26-33 regarding other employment and benefits received during your disability period. Provide additional details as necessary.
7. List healthcare providers in section 35 who treated you for injuries related to this claim, followed by any witnesses in sections 36 and 37.
8. Finally, certify that all information is true by signing the application at the bottom before submitting it through our editor.

Start using our platform today to easily complete your Michigan Workers Compensation Application for free!