Updated WC-104C Form

Workers’ Compensation Agency (WCA) releases updated Application for Mediation or Hearing — Form C.

The WCA has published a new Application for Mediation or Hearing — Form C. It now includes two additional check boxes for “Redemption Only” and “Petition to Determine Medical Treatment.” Changes were made based upon user feedback and to streamline operations/procedures.

Claimants who wish to settle for a lump sum cash payment must request the WCA file be sent from Lansing to the appropriate hearing site. A magistrate will then make a determination about whether the settlement is just and proper. Form WC-104C is used to streamline the file request procedure and the box “Redemption Only” should be checked.

Some claims involve disputes about just medical treatment. These issues can sometimes be resolved through an informal telephone mediation process with WCA staff. Each side will be given the opportunity to discuss relevant issues and come up with a resolution. It is anticipated this will be more frequently used with disputes involving the new opioid treatment rules. The box “Petition to Determine Medical Treatment” should be checked in this situation.

We strongly recommend contacting an experienced workers’ compensation lawyer before taking any action on your own.

Michigan Workers Comp Lawyers never charges a fee to evaluate a potential case. Our law firm has represented injured and disabled workers exclusively for more than 35 years. Call (855) 221-2667 for a free consultation today.

Related information:

MEMO: Updated WC-104C, Application for Mediation or Hearing

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