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  • Michigan Insurer's Notice of Name or Address Change (fill-in form)

Michigan Insurer's Notice of Name or Address Change (fill-in form)

Category:
Workers Compensation - Official
State:
Michigan
Control #:
MI-WC-403
Format:
PDF
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Description

Insurer's Notice of Name or Address Change (fill-in form)
The Michigan Insurer's Notice of Name or Address Change (fill-in form) is a document used to notify the State of Michigan of a change in the name or address of an insurance company. This form must be completed and signed by an authorized representative of the insurer and then sent to the Michigan Department of Insurance and Financial Services. It is important that this form is filled out accurately and completely so that the department can properly update its records. There are two types of Michigan Insurer's Notice of Name or Address Change (fill-in form): one for a name change and one for an address change. The name change form should include the insurer's current name and the new name, while the address change form should include the insurer's current address and the new address. Once the form is completed, it should be sent to the Michigan Department of Insurance and Financial Services.

The Michigan Insurer's Notice of Name or Address Change (fill-in form) is a document used to notify the State of Michigan of a change in the name or address of an insurance company. This form must be completed and signed by an authorized representative of the insurer and then sent to the Michigan Department of Insurance and Financial Services. It is important that this form is filled out accurately and completely so that the department can properly update its records. There are two types of Michigan Insurer's Notice of Name or Address Change (fill-in form): one for a name change and one for an address change. The name change form should include the insurer's current name and the new name, while the address change form should include the insurer's current address and the new address. Once the form is completed, it should be sent to the Michigan Department of Insurance and Financial Services.

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How to fill out Michigan Insurer's Notice Of Name Or Address Change (fill-in Form)?

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FAQ

A new license is automatically sent to the licensee or agency when a Mailing Address change is processed. All individual licensees must use the Contact Change Request (CCR) page on the NIPR website. Click on the ?Change? button to access the CCR page.

The Michigan Workers' Disability Compensation Act (Act) established protections for workers who get sick or injured from the work they do. It makes benefits available to most workers regardless of who is at fault for the injury or illness.

The good news is no, you do not lose your benefits if you are fired. Your workers' compensation benefits do not end whether your employer has fired you or laid you off. The law requires that you continue to receive wage loss payments and medical benefits through your former employers' insurance company.

Purpose of Form WC-400: To notify the Michigan Workers' Disability Compensation Agency that a policy of workers' compensation insurance has been issued to an employer.

If you're unable to work at all and are entitled to wage-loss benefits, you'll generally receive 80% of your pre-injury wages (based on the after-tax value of the average weekly wages in the 39 highest-paid weeks out of the 52 weeks before you were injured or became ill).

Does Michigan Require Workers' Compensation? Chances are, your Michigan business is required to have workers' compensation insurance. You'll need workers' comp if you have three or more employees, or one employee working more than 35 hours per week for 13 weeks or longer.

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More info

We provide this form online to get information from you, or update information you already gave us. If a new division (assumed name or DBA) is to be added to an existing policy, a Form WC-403, Insurer's Notice of Name or Address Change, must.Enter the employer's name, if applicable. If there is a change in the insured's insurance status, e.g. INSURANCE REPARATIONS ACT (NO-FAULT LAW). Enter your name, EIN, and complete mailing address. Form nameVersion dateNotesAffidavit of Significant Financial Hardship (AS01)June 2018Legislative changesDisability Status Report (DS01)September 2012Employee's Claim Petition (EC04)June 2018Legislative changes The FMCSA does not furnish copies of insurance forms. Need help opening Insurance Forms? How Do I Submit Proof of Insurance to the BMV Using the EIFs Program?

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