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Work-Related Personal Injury/Illness FMLA

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Phone: (734) 615-0643
Toll-free: (877) 869-5266
Fax: (734) 936-1913
E-mail:  [email protected]

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3003 South State Street
Ann Arbor, MI 48109-1269
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  • About
  • Employees
    • Work Related Illness or Injury
    • Personal Injury or Illness
    • FMLA
  • Supervisors & Departments
    • Work-Related Illness or Injury
    • Personal Injury or Illness
    • FMLA
  • Health Care Providers
  • Forms
    • COVID Questionnaire
    • Authorization to Release Patient Information
    • Claim Form (Download)
    • Claim Form (Online)
    • Functional Abilities Form
    • Mileage Reimbursement Form (Download)
    • Mileage Reimbursement Form (Online)
    • Medical Leave Form
  • Resources
  • MIOSHA
  • FMLA
  • ? FAQ
    • Employee FAQ
    • Supervisor FAQ
    • Physician FAQ
    • Confidentiality
    • Returning to Work
    • Where to go for treatment
    • COVID