This is one of the official workers' compensation forms for the state of Michigan
Michigan Employees Report of Claim for Workers' Compensation
Category:
State:
Michigan
Control #:
MI-BWC117-WC
Format:
PDF
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FAQ
An employee should file a workers' compensation claim if injuries were sustained on the job or within the scope of employment. This includes occupational accidents, diseases, trauma injuries, or illness caused by exposure to work activities or chemicals.
What RTW / workers' comp information IS confidential? While relevant, recent, work-related medical information is usually not confidential, other medical informationsuch as the individual's medical historyis confidential.
What happens if a claim is approved? If approved, employees will be notified about their compensation, which may cover costs such as medical expenses, disability, lost wages, and more. The employee can choose to accept the compensation amount via either a lump sum or a structured settlement.
Report these payments as wages on Line 7 of Form 1040 or Form 1040A, or on Line 1 of Form 1040EZ. If your disability pension is paid under a statute that provides benefits only to employees with service-connected disabilities, part of it may be workers' compensation. That part is exempt from tax.
If you are a small employer, i.e. your average performance premium is less than or equal to $30,000, your premium will not be impacted by the costs of your workers compensation claims.
In most cases, filing a workers' comp claim in California is actually a three-step process: reporting the injury. filing the actual claim with your employer, and. filing an application for adjudication of claim with the Workers' Compensation Appeals Board (WCAB).
A Workers' Compensation claim must be made within six months of the date of injury or incident.
How Long Does an Employer Have to Report an Accident? As with an employee notifying the employer of an accident, the employer should act as soon as possible in notifying the state's workers comp board.The minimum charge is typically $100, but missed or late reporting can result in a $2,500 fine in California.
A prospective employer has no right to ask whether you have had a previous workers' compensation claim. However, a prospective employer does have the right to know if you have an injury or medical condition that will impact on your ability to perform your work duties.