The Workers’ Compensation Claims Process in MI from A-Z
In Michigan, the workers’ compensation act applies to all employers with employees working 35 or more hours every week and requires these employers to carry workers’ compensation insurance. The insurance carrier facilitates the Workers’ Compensation Claims, but neither the employer nor the insurance carrier represent the interests of the injured worker.
How Does the System Work?
The Michigan Workers’ Compensation Agency administers all claims for workers’ compensation in the State, whether an employer carries private insurance or qualifies to self-insure. Michigan has a no-fault system, and this means the injured worker does not need to prove the employer is responsible for the injury or illness. Generally, if an injury occurs at the workplace, or off-site while performing a work-related activity, then the worker is entitled to benefits.
The typical benefits received are wage loss recovery, reasonable medical care, and vocations rehabilitation. It is the responsibility of the worker to report any incident to the person designated by the employer and to file a claim for benefits.
How are Claims Filed?
The first step to begin the Workers’ Compensation Claims Process is to notify the employer of an injury. This must be done within 90 days of the date of the incident. If a claim is related to an illness that has progressed over time, then notification must be given within 90 days of discovering the illness is related to the workplace. A workers’ right to benefits under the Workers’ Compensation Act may be forfeited if these reporting time periods are not met.
In addition to proper notification to the employer, the injured worker must also make a demand for workers’ compensation benefits. This demand is made through the claim form. The incident report to the employer and the claim form for the demand of benefits are two separate steps in the process. Although the time limit for making a demand for benefits is two years after the work-related injury, it is advised that the reporting and the demand are made as soon as possible. This is the best time to retain an experienced attorney to inform and guide you when completing these forms.
Insurance companies are skeptical of claims where there is too much time between the date of the incident and the demand for benefits. Any discrepancies in the incident report filed with the employer and in the claim form filed with the insurance company will be used against the worker and may result in a denial of the claim.
Except for emergencies, the injured worker must be treated by the doctor referred by the insurance company for 28 days. It is important for the worker to be honest and accurate in the description of the incident and the injury. The insurance company will rely heavily on the records of the initial visit.
Injured workers do not produce any formal reports to the Michigan Workers’ Compensation Agency. After the worker properly reports the incident to the employer and makes the formal demand for all appropriate benefits, it is the employer who notifies the insurance company of the claim. It is the law that insurance companies must promptly pay workers’ compensation benefits and, typically, accepted claims are paid within a few weeks after the investigation is complete.
It is advisable to retain an attorney certified in workers’ compensation law to represent your interests before filing the claim. The attorney will make sure of the use of appropriate and consistent language in both the incident report and in the demand for benefits. A missed deadline or discrepancies in language could jeopardize the rights of the injured worker to receive entitled benefits. Keep in mind that, no matter how small a claim, you will be up against an insurance company without your interests represented. It is certain that the insurance company will have attorneys representing their interests.