Michigan Forms
74 State Forms found
| name | number | revision | print or send online | |
|---|---|---|---|---|
Carrier's Explanation of Benefits |
WC-739 | (Rev. 8/19) | ||
AGREEMENT TO REDEEM LIABILITY (Spanish) |
WC-556 | (Rev. 8/19) | ||
AFFIDAVIT IN SUPPORT OF REDEMPTION (SETTLEMENT) AGREEMENT |
WC-119 | (Rev. 8/19) | ||
AGREEMENT TO REDEEM LIABILITY |
WC-556 | (Rev. 8/19) | ||
AMPUTATION CHART |
WC-728 | (8/19) | ||
APPLICATION FOR ADVANCE PAYMENT |
WC-108 | (Rev. 8/19) | ||
APPLICATION FOR CERTIFICATION OF A CARRIER’S PROFESSIONAL HEALTH CARE REVIEW PROGRAM |
WC-590 | (Rev. 8/19) | ||
APPLICATION FOR REIMBURSEMENT FROM THE COMPENSATION SUPPLEMENT FUND |
WC-114 | (Rev. 8/19) | ||
APPLICATION FOR REIMBURSEMENT FROM THE MEDICAL BENEFITS FUND |
WC-271 | (8/19) | ||
CARRIER’S RESPONSE |
WC-251 | (8/19) | ||
CLAIM/CROSS-CLAIM FOR REVIEW |
WC-262 | (Rev. 9/20) | ||
WORKER’S SETTLEMENT STATEMENT (Spanish) |
WC-544 | (Rev. 8/19) | ||
AFFIDAVIT IN SUPPORT OF REDEMPTION (SETTLEMENT) AGREEMENT (Spanish) |
WC-119 | (8/19) | ||
REDEMPTION ORDER (Spanish) |
WC-113 (SP) | (Rev. 08/19) | ||
EMPLOYER DISCLOSURE QUESTIONNAIRE |
WC-105B | (8/19) | ||
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