Employee Claim Report
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Business Negosyo HR report employee claim employer carrier Workers Injury Employee Report Date
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Print Reset EMPLOYEE’S REPORT OF CLAIM Michigan Department of Licensing and Regulatory Affairs Workers’ Compensation Agency P.O.. Was the injury reported to your employer Yes No If yes, date reported Making a false or fraudulent statement for the purpose of obtaining or denying benefits can result in criminal or civil prosecution, or both, and denial of benefits..
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