The Michigan WDCA Petition for Lump Sum Settlement, officially called Form WC-104C, is the application an injured worker, dependent, employer, or insurance carrier files with the Michigan Workers’ Disability Compensation Agency to ask a magistrate to approve a one-time cash payout, called a redemption, that closes a workers’ compensation claim. Filing this petition triggers a formal redemption hearing where a magistrate reviews the deal under MCL 418.835 and either approves it, rejects it, or sends the parties back to negotiate.
The petition is the legal trigger that turns a private settlement talk into a binding, court-style closeout. Once the magistrate signs the redemption order, the worker gives up the right to weekly checks, future medical care for the injury, and most other claim rights. According to the Michigan WDCA’s published statistics in its annual report, more than 6,000 redemption agreements are approved every year in Michigan, and rejection or adjournment rates run high when the WC-104C is incomplete or the supporting paperwork is thin.
In this guide, you will learn:
- 📝 How to fill out every box on Form WC-104C in plain English
- ⚖️ Which Michigan statutes and admin rules govern lump sum redemption hearings
- 💰 How attorney fees, Medicare set-asides, and Social Security offsets affect your number
- 📂 What attachments and proofs to bring so the magistrate signs on the first hearing
- 🚫 The most common mistakes that get redemption petitions rejected and how to avoid them
What the Form Is and Who Must File It
Form WC-104C is the Petition form used inside the Michigan Workers’ Disability Compensation Agency for several closing actions, including the Petition for Lump Sum (also called a redemption). The form is published by the Michigan Department of Labor and Economic Opportunity through the WDCA Forms page and is the formal vehicle Michigan recognizes under Mich. Admin. Code R 408.34 for asking the agency to act on a closed-file request.
The statute that powers the petition is MCL 418.835, which lets the parties redeem all liability for a single payment, and MCL 418.837, which requires a magistrate to approve or reject every redemption. The agency cannot release money under a private contract; the magistrate must sign first.
Anyone with a stake in a Michigan workers’ comp claim may file: the injured employee, a surviving spouse, a minor child’s guardian, the employer, the insurance carrier, a third-party administrator, the Second Injury Fund, the Self-Insurers’ Security Fund, or the Silicosis, Dust Disease, and Logging Industry Compensation Fund. Most petitions are filed jointly after the parties reach a deal, but a single party can file to propose a redemption and force the other side to respond.
The form is neutral about which side starts it, which matters because the filer pays nothing in filing fees but does carry the burden of putting a complete, signed package in front of the magistrate. A worker filing alone, with no carrier signature on the agreement, will get the petition docketed but not approved until the carrier joins.
Before You Start: Documents and Information You Need
Gathering the file before you open the form prevents the most common rejection: a redemption packet missing one signed page. The magistrate reads from a checklist, and if anything is missing, the hearing is adjourned. Use the list below as your pre-filing checklist.
- Worker’s full legal name, address, date of birth, Social Security number, and date of injury. The agency uses these to pull the claim file; a wrong SSN or injury date sends the petition to the wrong magistrate.
- WDCA case number. This is the agency’s internal docket number assigned after Form WC-100 (Employer’s Basic Report of Injury) was filed; without it, your petition gets a new number and may not link to prior payments.
- Employer’s legal name, FEIN, and address at time of injury. A DBA name will not match the carrier’s records and will trigger a hold.
- Insurance carrier or self-insured employer name, NCCI carrier code, and claim number. The magistrate cross-references these against the agency’s coverage database.
- Average weekly wage (AWW) and the current weekly comp rate. Without the AWW, the magistrate cannot test the redemption number for fairness under Rule 408.43.
- Medical records summary covering diagnosis, treatment, work restrictions, and current status. A redemption without medical proof is almost always adjourned.
- Medicare status check and, if needed, a Workers’ Compensation Medicare Set-Aside (WCMSA) approval letter from CMS. Federal law under 42 CFR 411.46 requires Medicare’s interests to be considered.
- Social Security Disability or retirement information. The worker’s age and SSDI status drive the offset calculation under MCL 418.354.
- Dependents’ affidavits when the worker is married or has minor children. A spouse’s written acknowledgment of the redemption is standard practice and many magistrates require it.
- Proposed Redemption Order and Release. This is the order the magistrate will sign; bring a clean copy on the WDCA’s standard format.
- Carrier’s Report of Payments (often called the WC-701 reconciliation). The magistrate uses it to verify accrued benefits before computing attorney fees.
- Photo ID for the worker and a current W-9 if the payee is anyone other than the worker. The carrier will not cut the check without it.
Where to Get the Form and How to Access It
The official, fillable PDF version of Form WC-104C lives on the Michigan.gov LEO server. Always pull a fresh copy for every petition because the WDCA periodically updates the revision date in the bottom corner; an outdated version may not be accepted by the clerk.
The form is also available on the WDCA Forms page along with the related Form WC-104A (Application for Mediation or Hearing) and Form WC-104B (Petition to Stop Benefits). Pick WC-104C when your goal is to fix fees, recoup, stop benefits with explanation, or — most commonly — to file the formal petition tied to a redemption agreement.
You can complete the form three ways: type directly into the Adobe fillable PDF, print and hand-write in black ink, or use the WDCA’s electronic case management portal where the form’s digital equivalent is built into the redemption submission flow. Hand-written forms are accepted, but the clerks reject any form filled out in pencil or with whiteout corrections.
If you do not have Adobe Reader, the WDCA recommends downloading the free version because the form’s date fields and signature lines do not save correctly in some browser PDF viewers. Do not use a screenshot or scanned image of the form because the agency’s docketing system reads form metadata to route filings.
Step-by-Step: How to Fill Out Form WC-104C Line by Line
Form WC-104C is a single-page form with a caption block at the top, a section to identify the type of petition, an explanation area, a signature block, and a certificate of mailing at the bottom. Work through it from top to bottom, and treat every box as a chance to either help or hurt the magistrate’s review.
Caption: Employee Name
What it asks in plain English. The agency wants the injured worker’s full legal name as it appears on the original injury report.
How to answer it. Type or print the worker’s first name, middle initial, and last name in capital letters. Match the name exactly to the spelling on Form WC-100 and on the worker’s Social Security card.
Example. MARIA T. LOPEZ — Maria is a 47-year-old assembler who hurt her back in 2023 and is now seeking a $95,000 lump sum.
Nuance or edge case. If the worker has legally changed names since the injury (marriage, divorce, court order), enter the current legal name and add the prior name in parentheses, such as MARIA T. LOPEZ (formerly RIVERA).
Common mistake and consequence. Using a nickname like Mary instead of Maria causes the docketing system to open a duplicate file, which freezes the redemption check until the agency merges the records.
Misconception. Many filers think the name field can be the name on the worker’s driver’s license; it must be the name on the SSA record because the carrier reports the redemption payment to the IRS using the SSN.
Caption: Social Security Number
What it asks in plain English. The worker’s nine-digit SSN.
How to answer it. Enter all nine digits with hyphens, like 123-45-6789. Do not redact or mask digits on the form filed with the agency, even though redacted versions appear in some public attachments.
Example. Maria writes 371-22-8845.
Nuance or edge case. If the worker is an unauthorized worker without a valid SSN, enter the ITIN if one exists; if not, write NONE and attach an affidavit. Michigan’s WDCA still processes the redemption because workers’ comp coverage is not tied to immigration status.
Common mistake and consequence. Transposing two digits (a very common error) routes the petition to the wrong file and can delay the redemption check by 30–60 days.
Misconception. Filers think they can put the last four digits only; the agency requires the full SSN to comply with Section 111 reporting to CMS.
Caption: Date of Injury
What it asks in plain English. The exact date the work injury happened, or, for an occupational disease, the date of last injurious exposure.
How to answer it. Use the format MM/DD/YYYY. For an occupational disease such as carpal tunnel, use the date the worker last worked in the harmful job.
Example. Maria writes 07/14/2023.
Nuance or edge case. For repetitive trauma, list the date of disablement, not the date the worker first felt symptoms. The Michigan Supreme Court has confirmed this rule in occupational disease cases.
Common mistake and consequence. Using the date the worker reported the injury instead of the date it happened can shift the case to the wrong year’s benefit rate, costing the worker thousands.
Misconception. Filers believe they can write VARIOUS for repetitive injuries; the magistrate needs one date to anchor the AWW calculation.
Caption: Employer Name and Address
What it asks in plain English. The exact corporate name and address of the employer at the time of injury.
How to answer it. Type the legal entity name (LLC, Inc., Corp.) followed by the street address used on the worker’s W-2 for that year.
Example. Maria’s employer is ACME ASSEMBLY LLC, 1450 Industrial Blvd., Warren, MI 48089.
Nuance or edge case. If the employer has since gone out of business, write the last known address and add (closed). The carrier remains liable.
Common mistake and consequence. Listing a parent company instead of the actual employing entity creates a coverage mismatch and the carrier’s adjuster may refuse to approve payment until the petition is amended.
Misconception. Filers think a DBA name is fine; the agency matches by FEIN, so the legal name must appear.
Caption: Insurance Carrier
What it asks in plain English. The workers’ comp insurance company or self-insured plan that covered the employer on the date of injury.
How to answer it. Write the carrier’s full name and the claim number assigned to the case. If the employer is self-insured, write SELF-INSURED and the third-party administrator’s name.
Example. Maria writes ZURICH AMERICAN INSURANCE CO., Claim No. WC-2023-44831.
Nuance or edge case. If coverage was through the Michigan Workers’ Compensation Placement Facility (the assigned-risk pool), name the issuing carrier, not the pool itself.
Common mistake and consequence. Using the agent or broker’s name instead of the carrier triggers a coverage verification hold from the WDCA’s Insurance Compliance section.
Misconception. Filers assume any old claim number works; if the case has been re-numbered after a portfolio transfer, use the current number, not the original.
Box: Type of Petition (Check One)
What it asks in plain English. Which kind of action you want the magistrate to take. The form lists petitions to stop benefits, to fix fees, to recoup overpayments, and a write-in Other line.
How to answer it. For a lump sum redemption, check Other and write in the words PETITION FOR LUMP SUM REDEMPTION UNDER MCL 418.835. Some practitioners also check Petition to Fix Fees in the same filing because the magistrate must approve the attorney fee at the same hearing under Rule 408.44.
Example. Maria’s attorney checks Other and writes PETITION FOR LUMP SUM REDEMPTION ($95,000) AND TO FIX ATTORNEY FEES.
Nuance or edge case. If the worker is also still receiving voluntary weekly checks, the carrier should also check Petition to Stop Benefits so the magistrate’s order ends the weekly stream cleanly.
Common mistake and consequence. Checking only Petition to Fix Fees without writing in the redemption language causes the clerk to docket the case as a fee-only matter, which is a different hearing track and delays the redemption by weeks.
Misconception. Filers think the form has a built-in Redemption checkbox; it does not, which is why the Other line must be used with specific statutory language.
Section: Explanation / Statement of Facts
What it asks in plain English. A short narrative explaining why the magistrate should grant the petition.
How to answer it. Write a one-paragraph summary that includes the date of injury, the body parts involved, the current dispute, the proposed redemption amount, and the reason a lump sum serves the worker’s best interest. Keep it under 200 words because the form has limited space.
Example. Maria’s attorney writes: Plaintiff, age 47, injured her lumbar spine on 07/14/2023 while lifting auto parts. She has reached maximum medical improvement with permanent restrictions. Defendant disputes ongoing wage loss. The parties have negotiated a redemption of $95,000 inclusive of attorney fees and a CMS-approved MSA of $11,400. Plaintiff requests approval under MCL 418.835.
Nuance or edge case. If the worker has dependents, add a sentence stating that dependents have been notified and have signed the redemption acknowledgment. Many magistrates require this.
Common mistake and consequence. Writing settlement reached with no detail leads to an immediate adjournment because the magistrate cannot test the deal against MCL 418.836.
Misconception. Filers think the explanation is optional because the redemption agreement says it all; the petition itself must stand on its own as a pleading.
Section: Relief Requested
What it asks in plain English. What you want the magistrate to do.
How to answer it. State the precise dollar amount, the breakdown between accrued benefits and future benefits, the attorney fee, the MSA amount, and any liens being satisfied. Reference the proposed redemption order attached to the petition.
Example. Plaintiff requests approval of a lump sum redemption of $95,000, allocated as: $11,400 to a CMS-approved Medicare Set-Aside; $19,000 attorney fee under Rule 408.44(6); $4,200 in case costs; balance of $60,400 to plaintiff. See attached proposed Redemption Order.
Nuance or edge case. If the redemption resolves a third-party lien or a child support arrearage, list those allocations here. The Michigan State Disbursement Unit must receive child support arrears directly under MCL 552.605a.
Common mistake and consequence. Listing a gross number without the breakdown forces the magistrate to do the math on the bench and often results in a fee approval at a lower percentage than the parties expected.
Misconception. Filers believe the relief section can simply say as agreed; magistrates routinely deny petitions that lack itemization.
Signature Block: Petitioner’s Signature and Date
What it asks in plain English. Whoever is filing the petition signs and dates it.
How to answer it. Sign in blue or black ink. Print the signer’s name, title (attorney, claim adjuster, party in pro per), and bar number if an attorney is filing.
Example. Sarah K. Whitman, Esq., P-67821, Attorney for Plaintiff, signed 04/22/2026.
Nuance or edge case. If the worker is unrepresented (pro se), the worker signs personally. A spouse cannot sign on the worker’s behalf without a power of attorney filed with the agency.
Common mistake and consequence. Using an electronic signature image that the magistrate’s software does not recognize causes the petition to be flagged as unsigned, and the clerk will not docket it.
Misconception. Filers think any office staff can sign for the attorney; only the attorney of record or a duly authorized substitute may sign.
Certificate of Mailing / Service
What it asks in plain English. Proof that you sent a copy of the petition to every other party.
How to answer it. List each party served, the address used, the method (mail, email, e-service), and the date served. Sign and date the certificate.
Example. I served this petition on 04/22/2026 by U.S. Mail on Zurich American Insurance Co., 1299 Zurich Way, Schaumburg, IL 60196, and by email on opposing counsel John Mercer, jmercer@defensefirm.com.
Nuance or edge case. When the carrier is registered for WDCA e-service, email service is enough; otherwise mail is required.
Common mistake and consequence. Forgetting to serve the Second Injury Fund in dependency or specific-loss cases causes the redemption to be void as to the Fund and may force a re-hearing.
Misconception. Filers assume filing the petition with the agency counts as service; service on opposing parties is a separate, mandatory step under Rule 408.34.
Three Filled-Out Examples Using Real Scenarios
The next three tables show how three different filers — each with a different fact pattern — would fill out the most important fields of Form WC-104C. Use these as templates, not as legal advice for your case.
Scenario 1: Maria Lopez — Mid-Range Redemption with CMS-Approved MSA
| Form Section | What Maria Enters |
|---|---|
| Employee Name | MARIA T. LOPEZ |
| Social Security Number | 371-22-8845 |
| Date of Injury | 07/14/2023 |
| Employer | ACME ASSEMBLY LLC, 1450 Industrial Blvd., Warren, MI 48089 |
| Insurance Carrier | ZURICH AMERICAN INSURANCE CO., Claim No. WC-2023-44831 |
| Type of Petition | Other — Petition for Lump Sum Redemption under MCL 418.835 |
| Explanation | Lumbar spine injury, MMI, dispute over ongoing wage loss; $95,000 inclusive redemption with $11,400 CMS-approved MSA |
| Relief Requested | Approval of $95,000 redemption: $11,400 MSA, $19,000 fee, $4,200 costs, $60,400 to plaintiff |
| Signature | Sarah K. Whitman, Esq., P-67821 |
| Service | Mailed to Zurich; emailed to defense counsel; copy to MSA vendor |
Scenario 2: James Carter — Dependents’ Redemption After Worker’s Death
| Form Section | What James (Surviving Spouse) Enters |
|---|---|
| Employee Name | ROBERT D. CARTER (DECEASED) |
| Social Security Number | 218-44-7790 |
| Date of Injury | 11/02/2019 (date of fatal injury) |
| Employer | NORTHWOODS LOGGING CO., 4422 Forest Hwy., Marquette, MI 49855 |
| Insurance Carrier | AMERICAN ZURICH; Self-Insured Logging Industry Compensation Fund involved |
| Type of Petition | Other — Petition for Lump Sum Redemption of Dependency Benefits under MCL 418.835 and 418.321 |
| Explanation | Worker killed in logging accident, leaving spouse and two minor children; $325,000 redemption proposed |
| Relief Requested | $325,000 allocation: $250,000 to surviving spouse trust, $75,000 minor’s trust under MCR 5.409, $0 MSA (no Medicare beneficiary), $48,750 fee at 15% |
| Signature | Anna L. Bishop, Esq., P-54992, Counsel for Surviving Dependents |
| Service | Served on Logging Industry Compensation Fund and Second Injury Fund |
Scenario 3: Aisha Bennett — Older Worker with SSDI Offset
| Form Section | What Aisha Enters |
|---|---|
| Employee Name | AISHA M. BENNETT |
| Social Security Number | 400-19-2233 |
| Date of Injury | 03/08/2017 |
| Employer | DETROIT GENERAL HOSPITAL, 2799 W. Grand Blvd., Detroit, MI 48202 |
| Insurance Carrier | SELF-INSURED, TPA: SEDGWICK CMS, Claim No. SDG-117-9981 |
| Type of Petition | Other — Petition for Lump Sum Redemption with Section 354 Coordination |
| Explanation | Age 63, on SSDI since 2018, shoulder and cervical injuries; carrier coordinating with SSDI under MCL 418.354; $185,000 redemption proposed |
| Relief Requested | $185,000: $32,000 MSA seed plus annuity, $27,750 fee at blended rate, $3,150 costs, balance to plaintiff after Medicaid lien of $4,800 |
| Signature | Marcus J. Reed, Esq., P-71450 |
| Service | Served on Sedgwick, Michigan Department of Health and Human Services lien unit, and Second Injury Fund |
How to File the Completed Form
You can file Form WC-104C by mail, in person at a hearing site, or electronically through the WDCA’s case management portal. Each channel has different timing, proof, and packaging rules.
Mail filing. Send the original signed petition, the redemption agreement, the proposed order, the medical summary, and any MSA approval letter to the Workers’ Disability Compensation Agency, P.O. Box 30016, Lansing, MI 48909. There is no filing fee. Use certified mail with return receipt and keep the green card as proof of filing. Expect 5–10 business days for docketing.
In-person filing. Drop the package at one of the WDCA hearing sites listed on the WDCA contacts page. The clerk will date-stamp a copy for you on the spot, which is the cleanest proof of filing. There is no fee, no appointment is needed during normal business hours, and the docket usually opens the same day.
Electronic filing. Registered attorneys and carriers may upload the petition through the agency’s secure portal. The portal time-stamps the filing automatically and emails a confirmation. Pro se workers cannot use the portal; they must mail or hand-file. There is no fee.
Fax. The WDCA does not accept fax filings of redemption petitions. Do not fax the petition; it will be discarded and you will lose your filing date.
Whichever channel you use, always retain a complete copy of the filed packet for at least seven years because the redemption order is enforceable for that long and the IRS may request the allocation breakdown.
What Happens After You File
Once the petition is docketed, the agency assigns a magistrate and a hearing date, usually within 30 to 60 days. The hearing under MCL 418.837 is brief — often 15 to 30 minutes — but the magistrate questions the worker on the record to confirm the worker understands the deal is final.
The magistrate reviews the medical records, the AWW calculation, the MSA, the dependents’ acknowledgments, and the attorney fee. If everything checks out, the magistrate signs the redemption order at the bench. The order becomes final 15 days after it is mailed under MCL 418.837(3), which is when the carrier must pay.
If the magistrate has concerns — for example, the redemption seems too low compared with the worker’s likely future entitlement — the magistrate can adjourn and ask for more proofs, or reject the deal outright. A rejected redemption is not appealable in the usual sense, but the parties can rework the deal and refile.
After payment, the carrier closes the file and reports the redemption to the WDCA and to CMS under Section 111. The worker generally cannot reopen the claim except in the narrow case of fraud or mutual mistake.
Mistakes to Avoid When Filling Out the Form
The redemption process is paperwork-driven, and small errors create big delays. The following list captures the mistakes that magistrates and clerks see most often.
- Wrong SSN or date of injury — the petition routes to the wrong file and the redemption check is delayed by weeks.
- Missing dependents’ acknowledgment — the magistrate adjourns to require spouses or guardians to be notified.
- No MSA when the worker is Medicare-eligible — CMS may seek reimbursement years later, exposing the worker to denial of future Medicare benefits.
- Failing to itemize the relief requested — the magistrate cannot compute fees and may approve at a lower rate than negotiated.
- Using a parent company name instead of the legal employer — the carrier’s coverage system rejects the match and freezes payment.
- Submitting unsigned or pencil-filled forms — the clerk will not docket the petition.
- Forgetting to serve the Second Injury Fund — any redemption affecting the Fund is void as to the Fund.
- Using outdated form versions — older revisions of WC-104C may be rejected by the docketing system.
- Listing only the last four digits of the SSN — the agency requires the full nine digits for CMS reporting.
- Skipping the medical summary — the magistrate has no basis to find the deal fair and adjourns.
- Not deducting case costs before computing fees — the magistrate will reduce the fee to comply with Rule 408.44(2).
- Using fax or email-only service when mail or e-service is required — service is defective and the hearing is rescheduled.
Do’s and Don’ts
The list below distills the etiquette and procedure that experienced redemption practitioners follow.
- Do pull a fresh copy of the form for every petition, because revision dates change and an older form may be rejected.
- Do match the worker’s name to the SSA record, because the IRS reporting depends on a clean match.
- Do itemize every dollar in the relief section, because the magistrate cannot approve a lump number on faith.
- Do include CMS approval letters when the worker is Medicare-eligible or has a reasonable expectation of becoming eligible within 30 months.
- Do serve every party, including state liens and dependent funds, because missed service voids the order as to that party.
- Do keep the filed packet for at least seven years, because the order is enforceable that long and the IRS may audit the allocation.
- Don’t use whiteout or pencil on the form, because the clerk will reject it on sight.
- Don’t assume the redemption agreement substitutes for a complete petition; the petition stands on its own.
- Don’t sign for the worker without a written power of attorney filed with the agency.
- Don’t fax the petition; the WDCA does not accept fax for redemption filings.
- Don’t wait until the hearing to address Medicaid or child support liens, because the magistrate will adjourn until they are resolved.
- Don’t treat the magistrate’s questions as a formality; the worker must understand the deal is final, in plain words, on the record.
Pros and Cons of Filing on Your Own vs. With Help
Most Michigan redemptions are filed by attorneys because the rules are dense and the consequences are permanent, but pro se filing is allowed.
- Pro: Filing pro se costs nothing in fees, since the WDCA charges no filing fee and there is no attorney fee to pay.
- Pro: A worker who is fully informed and represents themselves keeps 100% of the recovery, with no 15% to 20% fee carve-out.
- Pro: Pro se filers can move at their own pace without coordinating with a busy attorney’s calendar.
- Pro: Simple cases with small numbers and no MSA may be straightforward for an attentive pro se worker.
- Pro: The WDCA’s redemption handbook and clerks provide procedural guidance to unrepresented parties.
- Con: Pro se filers routinely undervalue future medical exposure, especially for Medicare beneficiaries, leaving thousands on the table.
- Con: Magistrates scrutinize pro se redemptions more closely and adjourn for the smallest paperwork gap.
- Con: A pro se worker who signs without understanding waives rights forever, with no realistic path to reopen.
- Con: Carriers’ defense attorneys negotiate hundreds of redemptions per year, creating a large experience gap against an unrepresented worker.
- Con: Pro se filers cannot use the WDCA’s e-filing portal, which slows docketing.
Redemption Petition vs. Application for Mediation or Hearing
The two forms look alike but solve different problems.
| Feature | Form WC-104C (Petition) | Form WC-104A (Application for Mediation/Hearing) |
|---|---|---|
| Primary purpose | Closing actions, including lump sum redemption | Opens a contested benefits dispute |
| Filing fee | $0 | $0 |
| Triggers | Redemption hearing under MCL 418.835 | Mediation under Rule 408.35 |
| Magistrate role | Approve, reject, or adjourn the deal | Hear evidence, decide entitlement |
| Typical timing | 30–60 days to hearing | 90–180 days to mediation |
| Result | Final redemption order; claim closes | Order on benefits; claim continues |
FAQs
Is there a filing fee for Form WC-104C?
No. The WDCA charges no filing fee for petitions, including lump sum redemptions filed under MCL 418.835.
How long does a redemption hearing take?
No redemption hearing should run long. Most are 15 to 30 minutes, with the magistrate questioning the worker on the record and signing the order at the bench.
Do I have to attend the redemption hearing in person?
No. Most magistrates allow telephonic or video appearances, especially after 2020. Confirm with the assigned magistrate’s clerk before the hearing date.
Can I redeem if I am on Medicare?
Yes. You can redeem, but a CMS-approved Workers’ Compensation Medicare Set-Aside is generally required to protect Medicare’s interest.
What attorney fee will the magistrate approve?
Yes, fees are capped. Under Rule 408.44, redemptions with a pending WC-104A allow up to 20% of the first $100,000 and 15% above that, after costs.
Do I write my maiden name or married name in the Employee Name box?
Yes, write your current legal name and add the prior name in parentheses if records were filed under it.
What goes in the Type of Petition box for a lump sum?
Yes, you check Other and write Petition for Lump Sum Redemption under MCL 418.835; the form has no dedicated redemption checkbox.
Should I list the full SSN or just the last four digits?
Yes, list the full nine digits with hyphens. The agency and CMS require the complete SSN for reporting.
Can my spouse sign the petition for me?
No, unless a written power of attorney has been filed with the agency. Otherwise, the worker must sign personally.
Does a redemption end my future medical coverage?
Yes. Unless the redemption order specifically leaves medical open (rare in Michigan), all future medical for the injury closes when the order becomes final.
Can I reopen the case after the order is signed?
No, except in the narrow cases of fraud or mutual mistake of fact. The redemption order is final 15 days after it is mailed under MCL 418.837(3).
What if I have unpaid child support when I redeem?
Yes, the State Disbursement Unit must be paid arrears first under MCL 552.605a. List the allocation in the Relief Requested section.
Will the redemption affect my Social Security Disability check?
Yes, it can. SSA prorates the lump sum over the worker’s life expectancy under 42 U.S.C. § 424a; a properly drafted redemption can soften the offset.
Can the magistrate reject my redemption?
Yes. A magistrate can reject any redemption that is not in the worker’s best interest under MCL 418.836, and the parties must rework and refile.
Related reading
- How to Fill Out Michigan Form DC 100d (w/Examples) + FAQs
- How to Fill Out Illinois IWCC Settlement Contract Lump Sum (w/Examples) + FAQs
- How to Fill Out Michigan WDCA Form 100 (w/Examples) + FAQs
- How to Fill Out Michigan WDCA Form 101 + FAQs
- How to Fill Out Michigan WDCA Form WC-105 + FAQs
- How to Fill Out the New Jersey Division of Workers’ Comp Order Approving Settlement (+ FAQs)