How to file a claim

To file a claim, follow the steps outlined below.

Click here for a list of Occupational Facilities

1) Complete the Employer Claim Form .  Have the employee complete the incident report employee report of accident.

2) Notify CompOne by phone (517-913-1704) or by e-mail with the initial report of injury

Once a claim has been submitted, you will receive an acknowledgment back from CompOne with the file number assigned to the claim.

When notifying by email, include the following information:

  • Your name and fax number so we can send you an acknowledgment of the claim and claim number assigned to the file
  • Your member name and address
  • Your MBWCF ID number.  (This appears on your certificate of insurance as well as the premium statement.)


CompOne will complete and submit form BWC-100 to the Insurance Bureau. They will take immediate action upon notice and will contact the member with any additional information and/or form filing that may be necessary. This includes but is not limited to medical authorization forms, wage statements, and mileage forms.

Members are responsible to notify CompOne if an employee is losing more than seven (7) days from work.  Claims are typically filed within the first seven (7) days and, at times, CompOne is not informed of the employee’s continued absence from work.

MBWCF members will receive monthly claim activity reports indicating the expenses and/or reserves established for each claim submitted.  The member is responsible for reviewing this data and reporting any discrepancies as soon as known to either the MBWCF Assistant Fund Administrator or CompOne.  It is important that attention be given to this detail as claim activity establishes the member’s individual experience modification that is used in determining your workers’ compensation premium charges.

The Fund’s third-party administrator for claims processing is:

P.O. Box 2530
Okemos, MI 48805

For claim correspondence send to:  P.O. Box 2530, Okemos, MI 48805, please include the claim# on all correspondence

Providers, please call Provider Relations at 248-344-2295 to check on the status of medical bills

Claim Submission E-Mail Address:

Claim Representative: Jenny Killips
Telephone: 517-913-1704
Fax: 248-675-2229
Alternate: Kathleen Larsen ; 517-913-1705