Archive for October, 2008

Workers’ Compensation Litigation Forms

Wednesday, October 29th, 2008

In an effort to assist our clients, we have placed links here to locate specific litigation documents at the Michigan Workers’ Compensation Agency. Clicking on a link below will cause you to navigate away from this site briefly in order to open or download the PDF form from the WCA site. To ensure the most current versions of form, you may wish to visit WCA directly. (This link will open in a new window.)

-WC-104A (2/04) – Plaintiff’s Application for Mediation or Hearing

-WC-104B (4/06) – Health Care Services Application for Mediation or Hearing (fill-in form)

-WC-104C (4/05) – Defendant’s Application for Mediation or Hearing

-WC-105 (8/08) Work History, Work Qualifications & Training Disclosure Questionnaire (fill-in form)

-WC-113 (1/04) – Redemption Order (fill-in form)

-WC-113A (8/05) – Multiple Carrier Redemption Form (fill-in form)

-WC-115 (5/05) – Voluntary Payment Form (fill-in form)

-WC-119 (8/05) – Affidavit in Support of Redemption (settlement) Agreement (fill-in form)

-WC-251 (8/05) – Carrier’s Response (fill-in form)

-WC-262 (4/05) – Claim/Cross-Claim for Review (fill-in form)

-WC-508 (2/07) – Subpoena for Production of Records (and/or) Witness Subpoena (fill-in form)

-WC-544 (7-05) – Worker’s Settlement Statement (fill-in form)

-WC-556 (5/05) – Agreement to Redeem Liability (fill-in form)

Self-Insured Forms

Wednesday, October 29th, 2008

In an effort to assist our clients, we have placed links here to locate specific claim documents pertaining to Self-Insured companies at the Michigan Workers’™ Compensation Agency. Clicking on a link below will cause you to navigate away from this site briefly in order to open or download the PDF form from the WCA site. To ensure the most current versions of form, you may wish to visit WCA directly. (This link will open in a new window.)

-WC-402 (7/04) Self-Insurer Application Packet

-WC-402A (2/06) Self-Insurer Request to Add or Delete Subsidiary/Affiliate (fill-in form)

-WC-402G (8/05) Group Self-Insurer Application Packet

-WC-402GR (1/04) Group Self-Insurer Application (fill-in form)

-WC-404 (1/04) Service Company Application (fill-in form)

-WC-650 (3/05) – Self-Insured Group Notice of Acceptance of Membership (fill-in form)

-WC-651 (3/05) – Notice of Termination of Membership (fill-in form)

-Letter of Credit/Memorandum of Understanding (8/08) (fill-in form)

-Michigan Continuous Surety Bond (12/03)

-Michigan Certificate of Specific/Aggregate Excess Liability Insurance (1/04)

-Self-Insurer’s Claims Transfer Agreement

The Impact of the Stokes Decision

Wednesday, October 29th, 2008

In the recent decision of Stokes v Chrysler LLC, 481 Mich 266 (2008), the Michigan Supreme Court set up a multi-step test which plaintiffs must meet to establish disability.

(1) plaintiff must disclose all prior qualifications and training, which include educational skills, experience and training;
(2) Plaintiff must consider other jobs that pay his/her maximum pre-injury wage to
which his/her qualifications and training translate;
(3) Plaintiff must be able to establish the work injury prevents the performance of any of the jobs identified as being within his/her qualifications and training;
(4) If plaintiff is capable of performing some or all of those jobs, plaintiff must show he/she cannot obtain any of those jobs; and
(5) Plaintiff must make a good faith effort to procure post-injury employment if there are jobs at the same salary or higher that he/she is qualified to perform and plaintiff’s work-related injury does not preclude performance. Plaintiff will also have to demonstrate a good faith effort to obtain employment and present proof the injury would preclude the type of work which any of the available jobs would require.

Once plaintiff establishes all of the above factors, defendant/employer then has the burden of presenting evidence there were jobs within plaintiff’s qualifications, training and physical limitations that were reasonably available and which would have allowed plaintiff to earn his/her “maximum wage.” These proofs will generally require the use of a vocational rehabilitation expert to perform an assessment with job search activities, as well as personally interview plaintiff to determine the necessary information to perform the assessment and job search activities. The decision does establish the right to such a vocational interview.

If the defendant presents evidence which indicates there are jobs available for plaintiff within his/her qualifications, background and training, then plaintiff would have the opportunity to present additional vocational evidence, potentially in the form of their own vocational counselor.

Overall, the impact of the Stokes decision will obviously depend on the specific facts in each case and Plaintiff’s qualifications, background and training, as well as the level of wages being earned with the employer. The decision will have a greater impact on cases involving low wage earning employees since the burden of establishing the inability to obtain work at minimum paying jobs will be quite difficult.

If you have any questions regarding the impact of this decision on any claims please feel free to contact Grzanka Grit McDonald.

Workers’ Compensation Claim Forms

Wednesday, October 29th, 2008

In an effort to assist our clients, we have placed links here to locate specific claim documents at the Michigan Workers’ Compensation Agency. Clicking on a link below will cause you to navigate away from this site briefly in order to open or download the PDF form from the WCA site. To ensure the most current versions of form, you may wish to visit WCA directly. (The link will open in a new window.)
-WC-100 (10/05) – Employer’s Basic Report of Injury (fill-in form)

-WC-106 (7/05) – Supplemental Report of Fatal Injury (fill-in form)

-WC-107 (11/04) – Notice of Dispute (fill-in form)

-WC-108 (9/04) – Application for Advance Payment (fill-in form)

-WC-110 (3/05) – Report on Rehabilitation (fill-in form)

-WC-114 (8/05) – Application for Reimbursement from the Compensation Supplement Fund (fill-in form)

-WC-117 (9/05) – Employee’s Report of Claim (fill-in form)

-WC-500 (6/08) VR Provider Professional Disclosure Statement

-WC-701 (9/05) – Notice of Compensation Payments (fill-in form)

-Need to Know How to Complete a Form 701?

-WC-728 (8/05) – Amputation Chart