Michigan Workers' Compensation Information



Please Note: for Claims assistance or questions about coverage and exemptions You will need to call one of the numbers listed below.

Also be aware that the Workers' Compensation Assistance Offices in different states may go by different names such as "Industrial Accidents".
These are the only numbers that we are aware of and have available for Michigan Workers' Compensation.

Michigan Workers' Compensation Telephone Directory


Workers' Compensation Agency - Main Office: 517-322-1106

Fraud: 888-396-5041

Workers' Disability Compensation Agency -Toll Free Phone Number: 1-888-396-5041

Administration: 517-284-8902

Claims Processing: 517-284-8912

Compensation Supplement Fund: 517-284-8912

Compliance and Employer Records Division: 517-284-8922

Contested Case: 517-284-8942

Customer Service: 517-284-8902

Funds Administration: 517-284-8888

Health Care Services: 313-456-3659

Mediation: 517-322-1106

Self-Insured Programs Administrator: 517-284-8939

Vocational Rehabilitation: 517-284-8891

WC Hearing Site - Baraga: 989-758-1768

WC Hearing Site - Detroit: 313-456-3650

WC Hearing Site - Escanaba: 989-789-1768

WC Hearing Site - Gaylord: 313-456-3650

WC Hearing Site - Grand Rapids: 616-447-2680

WC Hearing Site - Kalamazoo: 269-544-4440

WC Hearing Site - Okemos: 517-284-8944

WC Hearing Site - Pontiac: 248-975-3275

WC Hearing Site - Sault Ste Marie: 989-758-1768

WC Hearing Site - Saginaw: 989-758-1768

WC Hearing Site - Traverse City: 517-636-4718

Resolutions, Rehabilitation & Rules Administrator: 517-284-8900

Workers' Disability Compensation Appeals Commission - Mailing Address: 517-284-9312

Workers' Disability Compensation Appeals Commission: 517-284-9312

Workers' Disability Compensation Agency: 517-284-8947

Rehabilitation Services: 515-241-5324

Occupational Safety & Health Administration (MIOSHA): 517-284-7777

Claims Processing Division Administrator : 517-284-8912

Funds Administration Division Executive Secretary: 517-284-8902

Occupational Safety & Health Administration (MIOSHA) - Toll Free: 800-866-4674

Occupational Safety & Health Administration (MIOSHA) Fatalities & Catastrophies Reporting: 800-858-0397

Occupational Safety & Health Administration (MIOSHA ) Severe Injury Reporting: 844-464-6742

Occupational Safety & Health Administration (MIOSHA) Appeals Division: 517-284-7711

Magistrate Keith Castora - Detroit Hearing Site: 313-456-3650

Magistrate David Grunewald - Detroit Hearing Site: 313-456-3650

Magistrate Kevin Kales - Detroit Hearing Site: 313-456-3650

Magistrate Lenny Segel - Detroit Hearing Site: 313-456-3650

Magistrate David Williams - Detroit Hearing Site: 313-456-3650

Magistrate Michael Heck - Detroit Hearing Site: 313-456-3650

Hearing Officer Assignment - Kevin Kales - Gaylord Hearing Site: 313-456-3657

Magistrate David DeGraw - Grand Rapids Hearing Site: 616-447-2680

Magistrate E. Louis Ognisante - Saginaw Hearing Site : 989-758-1768

Magistrate Chair Luke McMurray - Saginaw Hearing Site: 989-758-1768

Magistrate Kevin Kales - Traverse City Hearing Site: 313-456-3657

Magistrate Phillip Della Santina - Okemos Hearing Site: 517-284-8944

Magistrate J. William Housefield - Okemos Hearing Site: 517-284-8944

Magistrate Lisa Woons - Okemos Hearing Site: 517-284-8944

Magistrate David DeGraw - Sault Ste. Marie Hearing Site: 269-544-4440

Magistrate David DeGraw - Kalamazoo Hearing Site: 269-544-4440

Magistrate Chris Slater - Kalamazoo Hearing Site: 269-544-4440

Magistrate Lisa Woons - Kalamazoo Hearing Site: 269-544-4440

Magistrate Richard Ehrlich - Pontiac Hearing Site: 248-975-3275

Magistrate E. Louis Ognisante - Pontiac Hearing Site: 248-975-3275

Magistrate David Williams - Pontiac Hearing Site: 248-975-3275

Magistrate David DeGraw - Escanaba Hearing Site: 269-544-4440

WC Records Request: 888-396-5041

Magistrate Chris Slater - Grand Rapids Hearing Site: 616-447-2680

Magistrate Lisa Woons - Grand Rapids Hearing Site: 616-447-2680

Magistrate David DeGraw - Baraga Hearing Site: 269-544-4440

Work Force Development: 517-335-5858

Occupational Safety & Health Administration (MIOSHA) Appeals Mailing Address: 517-284-7711

Board of Health Safety Appeals Clerk: 517-284-7706

Ordering a Hearing Transcript : 800-968-8653

Ordering a Hearing Transcript - Questions: 517-284-8902

Workers Disability Compensation Appeals - Commissioner Chair Daryl Royal: 517-284-9312

Workers Disability Compensation Appeals - Commissioner Duncan McMillan: 517-284-9312

Workers Disability Compensation Appeals - Commissioner Granner Ries: 517-284-9312

Department of Insurance Director Anita G. Fox: 517-284-8800

Department of Insurance Mailing Address & Toll Free Number: 877-999-6442

Compliance: 517-284-8922

Self-Insured Programs: 517-284-8939

Forms & Publications


Welcome to the most extensive library of workers' compensation forms available anywhere. Almost 3,600 forms are available for your immediate download and use. Our forms, all of which have been custom programmed by WorkersCompensation.com for Type & Save functionality, are available for individual purchase below.

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Some "Revision Dates" may be displayed as part of the Description.

NOTICE

Optical Character Recognition (OCR) allows data scanning from paper forms. Pursuant to MCL 418.221, the Agency requires that forms 100, 104A, 107, 701, 400 and 401 filed must match exactly those forms found on the Workers' Compensation Agency website, including but not limited to language, block space and positioning, font and dimension. In addition, when data is input into the various forms an Arial 10 point font must be used, with each field limited to one line of data. As a result, these process changes require data to be in very specific locations to prevent future problems. This leaves little tolerance for location variation.

Forms not complying with these requirements will be rejected and returned unprocessed. Forms cannot be faxed and cannot be handwritten. All forms must be mailed or submitted through the Data Exchange Gateway (DEG).

(wc100) OCR-Employer's Basic Report of Injury 8/19
(bwc106) Supplemental Report of Fatal Injury 8/19
(bwc107) OCR-Notice of Dispute 8/19
(bwc108) Application for Advance Payment 8/19
(bwc110) Report on Rehabilitation 8/19
(bwc114) Application for Reimbursment from the Compensation Supplement Fund 8/19
(wc117) Employee's Report of Claim 8/19
(wc117sp) Employee's Report of Claim (Spanish - Used for reference only) 8/19
(wc155) Authorization to Disclose Confidential Workers" Compensation Information 8/19
(bwc271) Application for Reimbursement from the Medical Benefit Fund 8/19
(wc272) Application for First Responder Presumed Coverage 1/22
(wc500) Vocational Rehab Provider Professional Disclosure Statement 8/19
(wc500sp) Vocational Rehab Provider Professional Disclosure Statement (Spanish) 8/19
(wc502) Application for Agency Approval as a Rehabilitation Facility 8/19
(wc701) OCR-Notice of Compensation Payments 8/19
WC-701 Filing Codes 7/12
WC-701 Instructions 2/17
Amputation Chart 8/19
(wc750) Provider's Request for Reconsideration 8/19
(bwc112) Application for Reimbursement (from Funds Administration) 8/19
(wc104b) Application for Mediation or Hearing - Form B 8/19
(wc117h) Provider's Report of Claim and Request for Medical Payment 8/19
(wc406) Annual Medical Payment Report - The form must now be submitted electronically through the agency's website.
(wc590) Application for Certification of a Carrier's Professional Health Care Review Program 9/19
(wc739) Carrier's Explanation of Benefits 8/19
WC-337 Notice of Exclusion - Not available online. To obtain a copy of the form, contact the Compliance and Employer Records Division at (517) 284-8922. 12/15
(wc338) WC-338 Notice to Terminate Exclusion - Not available online. To obtain a copy of the form, contact the Compliance and Employer Records Division at (517) 284-8922. 4/13
(wc400) OCR-Insurer's Notice of Issuance of Policy 8/19
WC-400a Insurer's Notice of Issuance of Specific Risk Policy - This form is not available online. To obtain a copy of this form, contact the Compliance & Employer Records Division at (517) 322-1195.
(wc401) OCR-Notice of Termination of Liability 8/19
(none) WC-401a Notice of Termination of Liability - This form is not available online. To obtain a copy of this form, contact the Compliance & Employer Records Division at (517) 322-1195. 5/17
(wc403) Insurer's Notice of Name or Address Change 8/19
(wc40) Request for Compliance Hearing 8/19
(wc104a) OCR-Application for Mediation or Hearing 12/20
(wc104asp) OCR-Application for Mediation or Hearing (Spanish - for reference only) 12/20
(wc104c) Application for Mediation or Hearing - Form C 8/19
(wc105a) Work History, Work Qualificationsand Training Disclosure Questionnaire 8/19
(wc105b) Employer Disclosure Questionnaire 8/19
(wc113) Redemption Order 8/19
(bwc113sp) Redemption Order (Spanish- used for reference only) 8/19
(wc113a) Multiple Carrier Redemption Form 8/19
(wc115) Voluntary Payment Form 8/19
(wc470) Application For DEG User Account 104 s 12/19
(wc119) Affidavit in Support of Redemption (Settlement) Agreement 8/19
(bwc119sp) Affidavit in Support of Redemption (Settlement) Agreement (Spanish) 8/19
(wc200) Opinion / Order Must be printed on green paper 9/20
(wc251) Carrier's Response 8/19
(wc262) Claim for Review 9/20
(wc508) Witness Subpoena (and/or) Subpoena for Production of Records 8/19
(wc544) Worker's Settlement Statement 12/21
(bwc544sp) Worker's Settlement Statement (Spanish) 8/19
(wc556) Agreement to Redeem Liability 8/19
(wc556a) Addendum to Agreement to Redeem Liability (fill in form) 12/17
(wc450) Application for Authorization by Self-Insured Employer or Group Fund for Servicing Agent FTS User Account 11/20
(wc460) Application for FTS User Account- WC Claims Mailbox 11/20
(bwc556sp) Agreement to Redeem Liability (Spanish) 8/19
(wc402) Self-Insurer Application 8/19
(wc480) Application For FTS User Account – BOM, WDCA, WDCAC, AGENCY 11/20
(wc402a) Self-Insurer Request to Add or Delete Subsidiary / Affiliate 8/19
(wc402g) Group Self-Insurer Application Packet 8/19
(wc402gr) Workers' Disability Compensation Group Self-Insurer Application Packet 8/19
(wc404) Bureau of Workers' Disability Compensation Service Company Application 8/19
(wc650) Group Self-Insurance Notice of Acceptance of Membership 8/19
(wc651) Notice of Termination of Membership 8/19
(letterofcredit) Letter of Credit/Memorandum of Understanding 8/19
(suretybond) Michigan Continuous Surety Bond 8/19
(coeli) Michigan Certificate of Specific/Aggregate Excess Liability Insurance 8/19
(ClaimsTransfer) Self-Insurer's Claims Transfer Agreement 8/19
(miosha-300-300a-301.xls) MIOSHA Recordkeeping Forms 300, 300A and 301 for 2004 (Excel Spreadsheet Version) Forms are Microsoft Excel 2000 spreadsheets and formatted to legal-sized document. To print, computers/printers must be capable of utilizing both of these features. 4/20
(wca fact sheet) BROCHURE - Workers' Compensation in Michigan N/D
(WC-PUB-003) BROCHURE - Vocational Rehabilitation for Injured Employees 2/20
(WC-PUB-005) POSTER - Employees - Know Your Rights! 8/19
(WC-PUB-006) POSTER - Rights and Responsibilities 8/19

EMERGENCY RULES - COVID-19

General Rules (408.31 - 408.59)

Workers’ Disability Compensation Agency, Workers’ Disability Compensation Appeals Commission (418.61 - 418.70)

Workers’ Disability Compensation Agency, Workers’ Compensation Board of Magistrates (418.81 - 418.99)

Health Care Services Rules (418.10101 - 418.101504)

Administrative Appellate Procedures (418.1 - 418.8) REPEALED

Workers' Compensation Board of Magistrates - General Rules (418.51 - 418.58) REPEALED

Chapter 1 Coverage And Liability (418.101 - 418.171)

Chapter 2 Administration (418.201 - 418.274)

Chapter 3 Compensation (418.301 - 418.391)

Chapter 4 Occupational Diseases And Disablements (418.401 - 418.441)

Chapter 5 Funds (418.501 - 418.561)

Chapter 6 Security For Compensation (418.601 - 418.659)

Chapter 7 Accident Fund (418.700 - 418.751) REPEALED

Chapter 8 Procedure (418.801 - 418.899)

Chapter 9 Vocationally Handicapped (418.901 - 418.941)

Misc. Related Statutes