In the event of an injured employee, Workers’ Compensation Employee Report of Injury Form must be filled out in its entirety to ensure proper handling. Once the form is filled out, it must be sent to Gallagher Bassett Services, Inc. to be processed.
The preferred way to submit all WC forms is by direct fax to:
517-351-5528 Attn: Tyler
The other option is to email it to:
If neither of those options are available, please mail the completed form to:
300 W. Lake Lansing Rd.
East Lansing, MI 48823
If you have any questions about the form or the incident, contact Tyler at Gallagher Bassett Services at 517-318-8109.
Reminder: Send the completed form directly to Tyler Drouare at the Gallagher Bassett Services office so he can review it and verify the information. He will then forward it to the State of Michigan Workers’ Compensation Agency accordingly.
The form is located on the State of Michigan’s website.