Reporting Procedures

Use the Employer’s Report of Injury – Short Form When:

• Employee reports an on-the-job injury, whether medical treatment is required or not, and
  
  

• Employee misses up to 7 consecutive days from work, and
  
  

• Circumstances of incident/injury are not questionable.
  

Use the Employer’s Report of Injury – Long Form / Form 100 When:

• Employee reports an on-the-job injury and requires medical treatment, and
  
  

• Employee misses 8 or more consecutive days from work, or
  
  

• Circumstances of incident/injury are questionable.
  
  

• Payroll information must be submitted.

Always Include:

• Employer Incident Report, if applicable.
  
  

• All medical reports/notes.
  
  

• All medical bills

Do not hold the Employer’s Report of Injury form pending wages, medical reports/ notes, or medical bills. Send the Injury Report in immediately and submit additional information when available.

Notice of Hearing/Attorney Letter

• Submit all hard copies of attorney letters and petitions directly to Connie See, Claims Supervisor in Grand Rapids. Her contact information is: Fax: 616-825-5948; Phone: 800-752-7477 x 4122

• Do not provide records to the employee or the attorney.

Acknowledgement

• You will receive an email containing copies of all the forms you’ve submitted online for your records.
  

• You will receive a phone call from a claims representative within 48 hours on all lost-time claims.

• Contact the MML Fund/Meadowbrook Claim Service with questions.