The Michigan Employer's Basic Report of Injury (fill-in form) is a mandatory form that employers are required to complete and submit to the Michigan Workers’ Compensation AgencyWPACA) within seven days after receiving notification of a workplace injury. The form is used to provide the WPA with basic information about the injured employee and the incident that led to the injury. The form includes sections to be filled out with information about the injured worker, the incident, the employer, the injured worker's supervisor, and a description of the incident. Additionally, there are sections to be completed regarding the injured worker's wages and the employer's insurance policy. There are two types of Michigan Employer's Basic Report of Injury (fill-in form): one for workplace injuries and one for motor vehicle accidents that occur while the employee is performing work-related activities.
Michigan Employer's Basic Report of Injury (fill-in form)
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How to fill out Michigan Employer's Basic Report Of Injury (fill-in Form)?
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The Form 43 is to be completed by the respondent (employer/workers' compensation insurance carrier) to notify the Administrative Law Judge, the claimant (employee/decedent), and all parties to the claim of its intention to deny the compensability of all or part of the claimant's claim to workers' compensation benefits.
The statute states that you should provide notice of injury to the employer within 90 days of the injury. However, you have up to two years from the date of injury, or the date the disability manifests itself, to file a workers' compensation claim.
What Do I Include On My DWC-1 Form? Name, date, and address. Date and location of injury. Brief description of injury. List of injured body parts. Social Security Number.
There is a seven-day waiting period for wage loss benefits in Michigan.
In case of the death of the employee, the claim shall be made within 2 years after death. The employee shall provide a notice of injury to the employer within 90 days after the happening of the injury, or within 90 days after the employee knew, or should have known, of the injury.
If you get hurt at work in Michigan, there are certain procedures that you must follow. For example, by law, you have to notify your employer within 90 days of the injury. Notice can be oral, but you should ask to fill out a company accident report. If your employer does not have an accident report, make one yourself.
All employers are required to notify OSHA when an employee is killed on the job or suffers a work-related hospitalization, amputation, or loss of an eye. A fatality must be reported within 8 hours. An in-patient hospitalization, amputation, or eye loss must be reported within 24 hours.
When an injury/illness occurs: Immediately notify your supervisor. Seek treatment at an Occupational Health Care Clinic. Submit a Workers' Compensation Claim: Apply Online, or. Print, complete, and fax a State of Michigan Workers' Compensation Claim Form.
