Michigan Workers Comp Claims: Eligibility, Filing and Appeals

Michigan's first workers compensation law, the Workmen's Compensation Act, was enacted in 1912. Now, almost all Michigan employees are covered by workers compensation, with a few exceptions for federal employees and very small, private employers. The Michigan Workers' Compensation Agency administers the Workers' Disability Compensation Act in the state, adjudicating claims and ensuring compliance and benefit payments. In 2008, the total payout for all medical care and Workers' Compensation benefits in Michigan was $1,385,509,789.

Common Covered Work Related Injuries

Under Michigan law, injuries which “arise out of and in the course of the employment” are covered by Workers' Compensation. This includes accidents as well as injuries that develop over time. Work that causes, contributes to, or aggravates a condition causing a disability may also be covered. Heart diseases, mental disabilities, and conditions due to the aging process must be proven to be aggravated or accelerated by employment in order to be covered. Occupational diseases such as Silicosis are also covered. Workers are also covered while traveling for work related reasons as long as they do not deviate from their business route. Injuries sustained on the way to or from work are not covered.

Filing a Michigan Workers Compensation Claim

Workers should report any injuries to their employers as soon as possible, or at least within 90 days of the injury. They should also seek medical attention. If the disability lasts longer than seven days, the employer should then file an Employer’s Basic Report of Injury Form (Form 100) with the Workers’Compensation Agency. In some cases, an employer or the employer's insurance carrier may request additional medical examinations in order to assess the situation.

Workers Compensation Claim Denials

Claims are often denied due to insufficient proof of a work related injury. Claims may also be denied if the information submitted is determined to be fraudulent, or if the injury or illness does not significantly cause a disability. Injuries that result from wilful misconduct or a violation of workplace rules may also be denied coverage. Improperly filed or incomplete paperwork may also sometimes result in a denial.

Appealing a Michigan Workers Compensation Denial

In approximately 75% of Michigan Workers' Compensation claims, there is no dispute, however workers who wish to appeal a decision do have the ability to do so. They must first file an “application for mediation or hearing form” (Form 104) with the Workers' Compensation Agency, along with all medical records relevant to the claim. An employer will then file a Carrier’s Response Form. A mediation hearing will then be set. If an agreement cannot be made through mediation, the case will then go to a formal trial before a workers’ compensation magistrate. Evidence will be presented and doctors and other witnesses will be questioned. The magistrate's decision may be appealed with Workers’ Compensation Appellate Commission if necessary.

Collecting Benefit Payments

Workers Compensation benefits pay for all medical expenses, death benefits, and may also cover rehabilitation services as well. “Specific loss” benefits entitle workers to a one time payment for a specific loss, such as an amputated finger. Wage loss benefits are generally paid on a weekly basis, though in some cases a lump sum payment may be negotiated. The amount of benefits depends on the type and severity of the injury or illness, as well as the workers' average wage. In most cases, wage loss benefits equal 80% of the after-tax value of a workers' average weekly wage, however the maximum amount of benefits cannot exceed 90% of Michigan's average weekly wage.

Hiring a Lawyer

In the event of a benefits dispute, an experienced Workers' Compensation lawyer should be consulted, especially in the event of a formal hearing. Though it is permissible for a person to represent themselves in Workers' Compensation hearings, it is not recommended due to the complex laws and regulations involved.

Michigan Workers Compensation Office Locations

Michigan Workers Compensation Agency
Street Address:
State Secondary Complex
General Office Building
7150 Harris Drive
Dimondale, MI 48821
Mailing Address:
PO Box 30016
Lansing, Michigan 48909
(888) 396-5041

Michigan Workers Compensation Appellate Commission
Street Address:
Ottawa Building, 2nd Floor
611 West Ottawa Street
Lansing, Michigan 48909
Mailing Address:
PO Box 30468
Lansing, Michigan 48909-7968
(517) 373-8020

Grand Rapids Hearing Site
2942 Fuller St. NE
Grand Rapids, MI 49505-3488

Kalamazoo Hearing Site
940 N. 10th Street
Kalamazoo, MI 49009-9178

Flint Hearing Site
Bristol West Center
G-1388 W. Bristol Road
Flint, MI 48507

Detroit Hearing Site
Cadillac Place
3026 W. Grand Blvd., Suite 3-700
Detroit, MI 48202

Saginaw Hearing Site
Jerome Hart State Office Building
411 E. Genesee
Saginaw, MI 48607