Updated WC-104C Form (Rev. 6/18)

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Michigan Workers Compensation Agency releases updated Application for Mediation or Hearing – Form C.

The WCA has published an updated Application for Mediation or Hearing — Form C. It now includes a “check box” for adding a non-employer entity to a case. This change was made based upon user feedback and to streamline operations/procedures. The updated form can be used immediately.

Adding a non-employer entity is appropriate when another party could have some potential liability. Situations where a non-employer entity could have liability include dual employment, statutory employment, labor brokers, and loaned employees.

Dual employment is when an individual has two jobs. Statutory employment occurs when a general contractor is held liable for a subcontractor who did not maintain required workers’ compensation insurance. Labor brokers provide workers to other entities on a leased basis. Loaned employees might be temporarily assigned to a different entity for a project.

Situations involving multiple entities can be complicated. It is best to speak with an experienced workers’ compensation lawyer to ensure the appropriate parties are in the case.

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:

Alex Berman and Jeffrey Kaufman obtain $2 million settlement

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Author Bio Jeffrey Kaufman

Author
Jeffrey E. Kaufman
Michigan Workers Comp Attorney

Jeffrey E. Kaufman has extensive experience in workers compensation cases and has recovered millions of dollars in benefits for his clients. He believes all injured workers deserve to be on equal footing with insurance companies and employers, and fights tenaciously so their rights are secured and protected.


“Jeff also helped me with getting my Blue Cross bills paid. I would absolutely recommend him and the whole firm. Jeff and the firm did everything they were supposed to do for me and my case.”
Ricardo Perfetto

Hundreds of 5-Star Reviews

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Get Help From our Michigan Workers’ Comp Lawyers Today

You’re not alone. Our Michigan workers’ comp lawyers have been called the best in the state, and our clients love how they’re treated with care, respect, and responsiveness. We will give you the time you need, we will explain your legal rights, and we will always treat you with respect.

Our workers’ compensation and Social Security disability lawyers always put your needs first. Get to know your legal team.

Our attorneys post regularly about common issues related to workers’ comp, including common injuries, settlement calculations, laws, and more.

Injured? It’s Time to Get Some Answers

Don’t let the insurance adjuster push you around. Request your free consultation today.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Our attorneys post regularly about common issues related to workers’ comp, including common injuries, settlement calculations, laws, and more.

Our workers’ compensation and Social Security disability lawyers always put your needs first. Get to know your legal team.