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 74 State Forms found

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SELF-INSURER REQUEST TO ADD OR DELETE SUBSIDIARY-AFFILIATE

 WC-402A (8/19)

SELF-INSURER’S CLAIMS TRANSFER AGREEMENT

 No Form Number (Revised 08/19)

WORKERS’ COMPENSATION AGENCY SERVICE COMPANY APPLICATION

WC-404 (Rev. 8/19)

SUBPOENA FOR PRODUCTION OF RECORDS (and/or) WITNESS SUBPOENA

 WC-508 (Rev. 8/19)

SUPPLEMENTAL REPORT OF FATAL INJURY

 WC-106 (08/19)

VOCATIONAL REHABILITATION PROVIDER PROFESSIONAL DISCLOSURE STATEMENT

 WC-500 (8/19)

VOCATIONAL REHABILITATION PROVIDER PROFESSIONAL DISCLOSURE STATEMENT (Spanish)

 WC-500 (8/19)

VOLUNTARY PAYMENT FORM

 WC-115 (Rev. 8/19)

WORK HISTORY, WORK QUALIFICATIONS & TRAINING DISCLOSURE QUESTIONNAIRE

 WC-105A (8/19)

WORKER’S SETTLEMENT STATEMENT

 WC-544 (Rev. 12/21)

EMPLOYER'S BASIC REPORT OF INJURY

 WC-100 (Rev. 08/19)

APPLICATION FOR MEDIATION OR HEARING – FORM A

 WC-104A (Rev. 12/20)

NOTICE OF DISPUTE

 WC-107 (Rev. 8/19)

NOTICE OF TERMINATION OF LIABILITY

 WC-401 (Rev. 8/19)

NOTICE OF COMPENSATION PAYMENTS

 WC-701 (Rev. 8/19)
Disclaimer: These forms may not be the most recent version. Michigan may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.
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