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Disability Management

Workers' Compensation Claim Form


  • Employees of State of Michigan agencies participating with the Disability Management Office (DMO) or Disability Management Unit (DMU) complete this form to report a work-related injury or illness. View list of participating agencies

  • If this is a medical emergency seek treatment at the closest emergency room.

  • If this is not an emergency and you are seeking treatment, you must be seen at an approved occupational healthcare clinic.

  • The State of Michigan has the right to direct medical treatment for the first 28 days following initial treatment of a work-related injury or illness.

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