6319
This form is used for applying for certification of a carrier's professional healthcare review program in Michigan.
This Form is used for insurers to notify Michigan authorities of any changes in their name or address.
This document is used for filing an employee's claim report in Michigan.
This document is a form used in Michigan for the redemption of a demand.
This Form is used for healthcare providers to request a reconsideration of a denied claim in the state of Michigan.
This Form is used for filing a claim or cross-claim for review in Michigan. It is used to initiate a legal process for review of a decision made by an administrative agency or court.
This form is used for redeeming abandoned property in Michigan. It allows individuals or organizations to request the release of their abandoned property held by the state.
This form is used for issuing a subpoena in Michigan to obtain records or compel a witness to testify in a legal proceeding.
This form is used for claiming a redemption from multiple insurance carriers in Michigan.
This form is used for an agreement in the state of Michigan to redeem liability for the WC-556.
This form is used for authorizing the disclosure of confidential workers' compensation information in Michigan.
This form is used as an addendum to an agreement to redeem liability in the state of Michigan. It provides additional details or modifications to the original agreement.
This form is used for applying for workers' disability compensation as a group self-insurer in Michigan.
This form is used for self-insured employers in Michigan to request the addition or deletion of a subsidiary or affiliate to their coverage.
This Form is used for applying as a workers' compensation agency service company in Michigan.
This form is used for self-insured groups in Michigan to provide a notice of acceptance of membership.
This document is a type of surety bond specific to Michigan. It is used to provide continuous coverage for certain business activities in the state.
This form is used for self-insured groups in Michigan to notify the termination of membership.
This Form is used for transferring claims between self-insurers in the state of Michigan.
This document is used for providing proof of specific or aggregate excess liability insurance coverage in the state of Michigan.
This Form is used for reporting on rehabilitation in the state of Michigan. It is used to gather information about the progress and outcomes of rehabilitation programs.
This Form is used for individuals or organizations in Michigan to apply for agency approval as a rehabilitation facility.
This form is used for vocational rehabilitation providers in Michigan to provide a professional disclosure statement.
This form is used for declaring support for the Redemption Agreement in Michigan.
This form is used for camp registration in the state of Michigan. It is required for individuals who want to register for a camp in Michigan.
This form is used for submitting a land transaction application for a purchase in Michigan.
This document is used for providing verification of Social Security Number when applying for licensure in the state of Michigan.
This document is in Spanish and is used for requesting a license-exempt provider for Child Development and Care services in Michigan.
This form is used for reporting serious injuries involving license exempt providers in Michigan.