Bureau of Services for Blind Persons
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Michigan Rehabilitation Services
Workers' Disability Compensation Agency
Black Leadership Advisory Council
Michigan Community Service Commission
Executive Order 2020-107 established Michigan Workforce Development Board
MiSTEM convenes a statewide network of leaders in education, business and local communities to empower the next generation of innovators.
Unemployment Insurance Appeals Commission
formerly MI Compensation Appellate Commission
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WC-100 - Employer's Basic Report of Injury (fill-in form)
WC-106 - Supplemental Report of Fatal Injury (fill-in form)
WC-107 - Notice of Dispute (fill-in form)
WC-108 - Application for Advance Payment (fill-in form)
WC-117 - Employee's Report of Claim (fill-in form)
WC-271 - Application for Reimbursement from the Medical Benefits Fund (fill-in form)
WC-272 - Application for First Responder Presumed Coverage (fill-in form)
WC-117H - Provider's Report of Claim and Request for Medical Payment
WC-581 - Application for Adjustment to the Workers' Compensation Maximum Payment Ratio
WC-590 - Application for Certification of a Carrier's Professional Health Care Review Program
WC-104B - Health Care Services Application for Mediation or Hearing (fill-in form)
WC-739 - Carrier's Explanation of Benefits
WC-750 - Provider's Request for Reconsideration (fill-in form)
WC-338 - Notice to Terminate Exclusion
WC-400 - Insurer's Notice of Issuance of Policy (fill-in form)
WC-400A - Insurer's Notice of Issuance of Specific Risk Policy
WC-401 - Notice of Termination of Liability (fill-in form)
WC-401A - Notice of Termination of Specific Risk Policy
WC-403 - Insurer's Notice of Name or Address Change (fill-in form)
WC-104A (Español) - Solicitud Para Mediación O Audiencia - Formulario A
WC-113 (Español) - Demanda de Redención
WC-117 (Español) - Informe de Reclamación Del Empleado
WC-119 (Español) - Declaracion que Apoya el Acuerdo de Redencion
WC-500 (Español) - Proveedor de Rehabilitación Vocacional Declaración de Divulgación Profesional
WC-40 - Request for Compliance Hearing (fill-in form)
WC-104A - Application for Mediation or Hearing (fill-in form)
WC-104B - Health Care Services Application for Mediation or Hearing (fill-in form)
WC-104C - Defendant's Application for Mediation or Hearing (fill-in form)
WC-105A - Work History, Work Qualifications and Training Disclosure Questionnaire (fill-in form)
WC-105B - Employer Disclosure Questionnaire (fill-in form)
WC-113 - Redemption Order (fill-in form)
WC-113A - Multiple Carrier Redemption Form (fill-in form)
WC-115 - Voluntary Payment Form (fill-in form)
WC-119 - Affidavit in Support of Redemption (settlement) Agreement (fill-in form)
WC-200 - Opinion/Order (fill-in form)
WC-251 - Carrier's Response (fill-in form)
WC-262 - Claim/Cross-Claim for Review (fill-in form)
WC-508- Subpoena for Production of Records (and/or) Witness Subpoena (fill-in form)
WC-544 - Worker's Settlement Statement (fill-in form)
WC-556 - Agreement to Redeem Liability (fill-in form)
WC-556A - Addendum to Agreement to Redeem Liability (fill-in form)
WC-402 - Self-Insurer Application Packet (fill-in form)
WC-402A - Self-Insurer Request to Add or Delete Subsidiary/Affiliate (fill-in form)
WC-402G - Group Self-Insurer Application Packet
WC-402GR - Group Self-Insurer Application (fill-in form)
WC-404 - Service Company Application (fill-in form)
WC-650 - Self-Insured Group Notice of Acceptance of Membership (fill-in form)
WC-651 - Notice of Termination of Membership (fill-in form)
Letter of Credit/Memorandum of Understanding (fill-in form)
Michigan Continuous Surety Bond (fill-in form)
Michigan Certificate of Specific/Aggregate Excess Liability Insurance (fill-in form)