How frequently are workers’ compensation claims disputed in Michigan?

Workers’ Compensation Agency (WCA) releases its 2018 Notice of Dispute Report and how various entities stack up.

Claim Denied

Michigan law requires payments of workers’ compensation benefits to employees hurt on-the-job. This includes medical care, lost wages, and vocational rehabilitation if needed. It is the exclusive remedy against the employer. Employees cannot sue for pain and suffering.

Employers purchase workers’ compensation insurance to cover these claims. It is also possible to join a group fund that pools resources to pay claims. Businesses can also become self-insured for claims under specific circumstances.

Most people who get hurt at work quickly return to their jobs. These claims are typically paid voluntarily without any controversy. It is not until additional medical treatment or time off is requested that claims get disputed. We see this with employees who need additional medical care down the road. It is common for them to be told a claim has been closed.

Workers’ compensation benefits can be disputed with little notice to the employee. This usually occurs after the independent medical examination (IME) has been completed. The burden falls on the disabled employee to file an Application for Mediation or Hearing (Form 104A) and challenge the dispute. It can be a difficult and lengthy process.

We thought it would be interesting to look at how frequently voluntarily paid claims get disputed in Michigan. The WCA has published its 2018 Notice of Dispute Report and that can provide some good insights. Please note that it only covers initial voluntary payment claims and excludes those in which a Form 104A was ultimately filed. The dispute percentages would be higher if litigated cases were included.

Group Funds disputed 11.3% of their initial voluntary payment claims. Insurance companies disputed 7.9% of their initial voluntary payment claims. Self-insureds disputed 5.9% of their initial voluntary payment claims. The average was 7.8% across the state. Here is a breakdown of some of the more well-known group funds, insurance companies, and self-insured employers. Make sure to call an experienced attorney if workers’ compensation benefits are disputed.

Group Funds (Disputed %)

Associated Builders & Contractors of MI Fund (12%)
MI Municipal League Workers Compensation Fund (4%)
Michigan Restaurant & Lodging Fund (13%)
School Employers Group Fund (20%)

Insurance Companies (Disputed %)

Accident Fund Insurance Co of America (10%)
American Zurich Insurance Company (5%)
Amerisure Mutual Insurance Company (12%)
Auto-Owners Insurance Company (10%)
Frankenmuth Mutual Insurance Company (7%)
Hartford Accident & Indemnity Company (11%)
Hastings Mutual Insurance Company (3%)
Indemnity Insurance Company of North America (4%)
Liberty Mutual Insurance Company (4%)
Manufacturing Technology Mutual Insurance Co (11%)
Michigan Insurance Company (17%)
New Hampshire Insurance Company (6%)
Old Republic Insurance Company (8%)
Safety National Casualty Corporation (11%)
Zurich-American Insurance Company (4%)

Self-Insured (Dispute %)

General Motors Company (6%)
Ford Motor Company (12%)
FCA US LLC (12%)
Ascension Health (2%)
Beaumont Health (9%)
Henry Ford Health System (5%)
McLaren Health Care Corporation (11%)
Trinity Health Michigan (4%)
City of Detroit (8%)
County of Oakland (0%)
County of Wayne (3%)
County of Macomb (11%)
State of Michigan (12%)

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 (844) 201-9497 for a free consultation today.

Related information:

10 red flags that could trigger a notice of dispute

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