This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
If you are injured on the job, you should notify your employer immediately, or as soon as possible. You should aim to notify your employer within ninety (90) days of your injury or learning about a disability caused in the course of your employment. You are not required to provide notice in writing, however you may be expected to fill out a number of forms depending on the circumstances surrounding your injury and your place of work. It may be beneficial to keep written records or copies of notices and forms you fill out in dealing with your claim, although not required. You or your employer may file a claim with the Workers' Compensation Agency.
If the injury or illness is expected to last for longer than a week, your employer should file an Employer's Basic Report of Injury (Form 100) with the Workers' Compensation Agency. This information should be provided to all parties relevant to dealing with filing of the claim, i.e. the employer's insurance provider, the Workers' Compensation Agency, or a third-party administrator if one is hired to deal with the claims process.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
The law requires that most employers provide some benefits system or plan to compensate or protect workers in the event of an injury. Most employers purchase coverage plans from a company; however, Michigan permits employers to be self-insured. All self-insured employers must be authorized to be so by the agency. An employer who does not provide coverage or protection, either by privatized insurance or self-insurance, may be subject to civil penalties, criminal penalties, and impairment to further business function.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
In order to be entitled to benefits, you must be disabled by a work-related injury or illness resulting in a loss of wages. An injury or illness that is work-related is one arising out of and in the course of the employment. However, just because your injury happens at work does not mean you will automatically be granted benefits. If your injury is a result of your own negligence and deliberate disregard for proper workplace rules, you may not be entitled to benefits. Your injury or illness must also qualify as a disability, a limitation of an employee's wage earning capacity in work suitable to his or her qualifications and training. Thus, your disability must also result in a loss of wages.
Your disability must last longer than seven (7) days in order to qualify you for benefits. Should your injury last two weeks or longer, you can redeem the first week of lost wages as benefits. You will be entitled to receive benefits so long as you continue to be disabled.
4. What benefits might I be eligible to receive?
You are entitled to receive and continue benefits for a disability that persists seven days or longer, and in some circumstances should the disability continue through the entirety or your life. Your benefits are paid to compensate wages-lost and are calculated as roughly eighty percent (80%) of your after-tax benefits. In Michigan, it will not matter whether you are totally or partially disabled. Benefit payments will be calculated based on potential or actual wage losses.
Medical benefits are to be provided from the first day of injury. During the first twenty-eight (28) days of treatment, your employer may select the medical professional to provide treatment.
Vocational rehabilitation benefits are also available to you should you seek them or otherwise mandated by the Department. Vocational rehabilitation is considered to be a wide variety of things, ranging from accommodations made to your place of work to help assist you in dealing with your disability or education and job re-training.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
To pursue a claim of benefits, you must file your claim within two years of your injury or knowledge of your work-related disability.
A formal dispute begins when you file an Application for Mediation or Hearing (Form 104). Detailed information concerning the injury and the medical records associated with your claim must be provided as well. The agency will serve the application upon the employer and/or its insurance carrier. The employer will then file a Carrier's Response Form to submit to the agency.
Your claim may be pursued through various mediums. One of those mediums is the mediation hearing. A mediation hearing are often scheduled when a claim involves a closed period of time, where cases involving only medical benefits, cases where the employee is not represented by an attorney, and any claim an agency deems a mediation could settle. The mediator helps to facilitate a settlement if one can possibly be made through a voluntary agreement between parties. If the dispute cannot be resolved, the case is assigned to trial with the workers' compensation magistrate.
Arbitration is a feasible option to resolve your claim. This is where both parties agree to hire an arbitrator to hear the case.
If there is no mediation scheduled or you choose not to pursue one, the first formal action is a pretrial hearing. A magistrate will review the case to determine if all requirements have been complied with. This is the time where attorneys may present any preliminary hearings. At the end of the pretrial, the case is scheduled for a trial before the magistrate.
Trials conducted by the magistrate resemble trials where attorneys or even the party themselves engage in trial-like proceedings, including providing witnesses and evidence. Most often, the evidence and issues at trial will surround the medical condition of the injured employee. At the end of the trial, the magistrate will take the case under advisement and provides an opinion to both of the parties.
If you or your employer disagrees with the opinion of the magistrate, you may file an appeal to the Workers' Compensation Appellate Commission. An appeal will typically involve considering issues of fact and issues of law. The appellate commission can affirm or agree issues of fact made with the magistrate but has the ability to review issues of law completely.
If your disability persists for longer than a week, your employer or your employer's insurance provider should begin to pay disability benefits. In the event you are able to return to work and receive full wages again, you will cease to receive benefits for your disability.
6. If I am not happy with the determination, how do I appeal?
If you or your employer remains unsatisfied with the decision of the appellate commission, either party may seek permission to appeal to the Court of Appeals or the Supreme Court. Only issues of law may be reviewed at this stage of the appeals process.