Get the free WC-100 (10/11) - Employer's Basic Report of Injury - State of Michigan

Go to Instructions Print Reset EMPLOYER'S BASIC REPORT OF INJURY Michigan Department of /LFHQVLQJ DOG 5HJXODWRU INFLUX Workers Compensation Agency PO Box 30016, Lansing, MI 48909 An employer shall

(b) Employee's basic wages for the period covered by the basic report, and for any subsequent period. An employer shall maintain a copy of the basic reports for thirty (30) days. (NOTE: The employer is responsible for all payments made under the basic report, including, in some cases, claims made for reimbursement of the cost of medical care and rehabilitation.) © Any other form of benefit payable as a result of an injury or illness which is not specified in (a) or (b). Report on other claims. An employer shall also report to the agency on Form WC-100 any other claim of which the employee is the beneficiary and which is (1) not specified in subdivision (a) of this section, and (2) for which the employee paid or is paying costs in excess of thirty (30) percent of any benefit received, unless (a) the claim is for any part of or benefit other than earnings, and (b) the claim is for the payment of costs in connection with an illness. (4) Employer to report employee's claim. The employer shall report each claim of the employee to the agency by the employer's self-report in a form to be determined by the agency. (a) When the employer files a claim of an employee, it shall certify under penalty of perjury that the claim was filed as required by the Act. (b) An employer is not required to file a required claim if the claim was made or the administrative action was initiated pursuant to the Michigan Voluntary Unemployment Compensation Act. (5) Employee to request form or report when filing claim if disabled, or death. (a) An employee is not required to request Form WC-100 or an alternative form of a statement of injury or illness if the employee is disabled or dies, unless the illness or disability prevents or substantially impairs the employee's ability to receive work. (b) A person who is a parent of an employee is considered “parent” for the purposes of this section if the employee's parent is permanently or temporarily unable to perform the duties of employment. (6) Employee to inform an employer. An employee alleging an occupational disease or injury, when the claim concerns a particular employee or a particular occupational program, shall immediately inform the employer and provide to the employer a medical certificate listing the illness or injury.

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What is wc-100 1011 - employer39s?

WC-100 1011 - employer's is a workers' compensation form used to report injuries or illnesses that occur in the workplace. It is often required by state workers' compensation agencies.

Who is required to file wc-100 1011 - employer39s?

Employers are typically required to file WC-100 1011 - employer's in order to report workplace injuries or illnesses to the appropriate workers' compensation agency.

How to fill out wc-100 1011 - employer39s?

To fill out WC-100 1011 - employer's, you will need to provide information about the injured employee, the nature of the injury or illness, the date and time of the incident, and any witnesses or other relevant details. The form may vary slightly depending on the specific requirements of your state's workers' compensation agency.

What is the purpose of wc-100 1011 - employer39s?

The purpose of WC-100 1011 - employer's is to ensure that workplace injuries and illnesses are properly reported and documented. This helps protect the rights of employees and ensures that they receive the appropriate workers' compensation benefits.

What information must be reported on wc-100 1011 - employer39s?

The information that must be reported on WC-100 1011 - employer's typically includes the injured employee's name, address, and contact information, a description of the injury or illness, the date and time of the incident, the location where it occurred, and any witnesses or other relevant details.

When is the deadline to file wc-100 1011 - employer39s in 2023?

The deadline to file WC-100 1011 - employer's in 2023 may vary depending on the specific requirements of your state's workers' compensation agency. It is important to consult the agency or their official website for the exact deadline.

What is the penalty for the late filing of wc-100 1011 - employer39s?

The penalty for the late filing of WC-100 1011 - employer's may vary depending on the specific laws and regulations of your state. It could result in fines or other penalties imposed by the workers' compensation agency.

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