Mich. Admin. Code R. 408.31a - Report of injury; claim for compensation, additional reports; weekly rate of compensation

Rule 1a.

(1) An employer shall report immediately, to the agency, on form WC-100, or its electronic equivalent, all injuries, including diseases, which arise out of and in the course of the employment, or on which a claim is made, and result in any of the following:

(a) Disability extending beyond 7 consecutive days, not including the date of injury.

(b) Death.

(c) Specific losses.

(2) Any report of injury filed with the agency by an employer that fails to meet the requirements of subrule (1) of this rule shall not be maintained as a record of the agency unless filed with a form WC-107, or its electronic equivalent.

(3) An employer shall immediately give a copy of the report of injury form WC-100, or its electronic equivalent, to the injured employee or, in the case of death, to the dependents. The employer or its carrier shall include a written notice to the injured employee or dependents on a form prescribed by the director of the agency, advising of their rights under the act. Any filing required in this section shall indicate compliance with this requirement. In case of death, an employer shall also immediately file an additional report on form WC-106, or its electronic equivalent.

(4) An employee may make a claim for compensation to the agency on form WC-117, or its electronic equivalent. The agency shall provide a copy of form WC-117, or its electronic equivalent, to the employer and carrier. The carrier shall respond to a form WC-117 in the same manner as a form WC-100.

(5) No later than 28 days following report of an injury, the employer or carrier shall deliver to the employee a form or its electronic equivalent, as prescribed by the director of the agency, describing the employer or carrier's obligation to furnish reasonable and necessary medical care for the work-related injury or disease. After an employee has given an employer the name of the physician with whom he or she intends to seek treatment and has commenced treatment with the physician under section 315 of the act, MCL 418.315, the employee shall obtain and promptly furnish a report to the employer, insurance company, private employer group self-insurers' security fund (PEGSISF), first responder presumed coverage fund, or self-insurers' security fund. The report must set forth the history obtained, the diagnosis, the prognosis, and other information reasonably necessary to properly evaluate the injury, the disability, and the necessity for further rehabilitation or treatment. Thereafter, at reasonable intervals of not more than 60 days, an employee shall obtain and furnish a current medical report, paid for by the carrier, containing the same information, together with an itemized statement of charges for services rendered to date.

(a) A self-insured employer, insurance company, PEGSISF, first responder presumed coverage fund, or self-insurers' security fund is not required to make payment to the physician until reasonable proof and itemized charges have been furnished to it.

(b) Medical fees may not exceed the maximum allowable payment (MAP) established by the fees considered usual and reasonable for the services performed in accordance with the health care service rules or the provider's usual and customary charge, whichever is less.

(6) For a case that requires the payment of benefits, a carrier, the second injury fund, the PEGSISF, the first responder presumed coverage fund, the self-insurers' security fund, and the silicosis, dust disease and logging industry compensation fund, shall file all of the following reports, notices, or statements in the format required by the agency:

(a) Form WC-701, or its electronic equivalent, on the day after the first payment of compensation. The carrier or fund shall furnish a copy of form 701 to the employee.

(b) Form WC-701, or its electronic equivalent, on the day after the stopping of payment of compensation, showing the amount of compensation paid in every case.

(c) Form WC-701, or its electronic equivalent, within 30 days from the annual anniversary of the date of injury on claims where the starting of weekly compensation benefits has been reported and weekly compensation benefits have not been stopped. The annual report must include a weekly summary of wages earned when partial wage loss benefits pursuant to section 301(9)(c) of the act, MCL 418.301, are being paid or have stopped prior to the anniversary date if not already reported.

(d) Form WC-701, or its electronic equivalent, on the day after due to:

(i) The application of section 301(8), 354, 357, 358, 401(6), or 827 of the act, MCL 418.301, 418.354, 418.357, 418.358, 418.401, and 418.827.

(ii) A change in the number of dependents.

(iii) Recoupment of an overpayment.

(iv) Reimbursement or adjustment resulting from involvement of a fund created under section 501 of the act, MCL 418.501.

(e) If benefits have been reduced to zero for 30 days or longer, a WC-701, or its electronic equivalent, shall be filed in accordance with R 408.31(b).

(f) The form WC-701 shall state the reason for any change and include the calculation applied.

(7) The carrier or fund shall send a copy of any WC-701 to the employee.

Notes

Mich. Admin. Code R. 408.31a

1998-2000 AACS; 2021 MR 23, Eff. 12/10/2021