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Workers' Compensation Fund Blue Arrows

Claims Reporting Guide & Forms

 

If you have trouble emailing these forms, please either fax or mail it to: 

MML WC Claims
3196 Kraft Avenue, S.E., Suite 206
Grand Rapids, MI  49512-2065
Phone: 800-752-7477
NEW *** Fax: (616) 649-1796 *** NEW

***After hours emergency number***
248-358-1100 ext. 6116

Guidance Materials

Claim Forms

Employer’s Report of Injury – Short Form

Download and complete an Employer's Report of Injury Short Form (MS WORD)

  • On-the-job injury whether medical treatment is required or not, and

  • Employee’s time away from work does not exceed seven (7) days, and

  • Circumstances of incident/injury are not questionable.

Supporting Forms

Order for Medical Treatment
Print Blank Copy

 

 

 



 

 

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