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Employer Disclosure Questionnaire (fill - State of Michigan

Employer Disclosure Questionnaire (fill - State of Michigan 2025

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The document is an Employer Disclosure Questionnaire from the Michigan Department of Licensing and Regulatory Affairs, designed to collect information regarding an employee's employment details, wages, job duties, and any injuries or disabilities related to workers' compensation claims. It outlines sections for employer and employment information, including specifics about job titles, duties performed, fringe benefits, and any job offers made post-injury. The completion of the questionnaire is voluntary and intended for use in legal proceedings.

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2019	4.8 Satisfied (196 Votes)
2012	4.4 Satisfied (503 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Which of the following is an acceptable reason to deny a workers comp claim in Michigan?

If you were under the influence of alcohol or drugs at the time of the accident, your workers compensation claim may be denied. Michigan law allows employers to deny benefits in such situations.

What is the penalty for not having workers comp insurance in Michigan?

An employer who fails to obtain workers comp insurance is guilty of a misdemeanor and may be fined not more than $1,000.00, or imprisoned for not more than 6 months, or both. Each days failure is a separate offense.

What happens if I dont carry workers comp insurance?

Workers comp penalties vary by state The penalty for not having workers compensation insurance in California is very similar, but can reach up to $100,000 in fines.

Is workers comp mandatory in Michigan?

Chances are, your Michigan business is required to have workers compensation insurance. Youll need workers comp if you have three or more employees, or one employee working more than 35 hours per week for 13 weeks or longer.

What is the 28 day rule for workers comp in Michigan?

The State of Michigan has the right to choose who will provide your medical treatment for the first 28 days following the initial treatment of the injury or illness. If you are not seen at an Occupational Health Care Clinic, the State is not required to pay for any medical bills from other providers during this time.

What is a BWC 337 form in Michigan?

WC-337 (12/15) Notice of Exclusion provided by the Michigan Department of Labor Workers Compensation Agency, is used to exclude certain individuals from insurance coverage as permitted by statute. To. find out whether you qualify for this exclusion and obtain a copy of the form, contact the Compliance Employer.

How long does an employer have to file a workers comp claim in Michigan?

There is no statute of limitations (time limits) to file a workers comp claim in Michigan provided an employee gives notice of the workplace injury within 90 days and makes an initial claim within 2 years. If notice and claim are done correctly, workers comp benefits can be sought at any time in the future.

What is the penalty for not having workers compensation in Michigan?

Failing to provide workers compensation when legally required to do so is a serious offense in the state of Michigan. Employers who are non-compliant can face fines and even jail time.

Employer Disclosure Questionnaire (fill - State of Michigan 2025

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