How to Fill Out a Michigan No-Fault Disability, Wage, Salary & Benefits Verification Form Video

Michigan’s no-fault insurance law provides important benefits after a car accident, including coverage for medical bills, lost wages, attendant care, household services, medical mileage, and more.

To receive wage loss benefits, a properly completed Disability, Wage, Salary, and Benefits Verification Form is often required. If you’ve been injured in an accident, understanding how this verification form works is essential. Your employer typically completes this form and helps confirm your income, employment status, and the wages or benefits you’ve lost as a result of your injuries.

Completing and submitting this form can be complicated, especially when you’re dealing with injuries. An experienced car accident attorney can help ensure the form is filled out correctly and submitted on time. This video will teach you how to fill out the disability, wage, salary, and benefits verification form.

Click here for a Printable Disability, Wage, Salary & Benefits Verification Form.

A no-fault disability, wage, salary, and benefits verification form is a form that must be completed and signed by your employer so you can receive Michigan no-fault insurance wage loss benefits.

Many employers are familiar with this form. You may need to complete the top portions of the form to fill in the date, policyholder name, date of accident, and insurance claim number. You can then provide it to your employer to fill out and sign.

You are entitled to receive 85% of your wages for time missed from work due to your accident-related injuries for up to 3 years after the accident. If you were not employed but were actively looking for a job, you’re still entitled to wage loss benefits if you can prove you applied for jobs or were actively seeking employment.

In this circumstance, you’ll need your attorneys to assist you with this claim. You’ll also need a physician’s disability certificate to show the insurance adjuster that there is a medical basis for restricting you from returning to work for a specified period. You can watch our video that discusses this required form. The insurance company should provide you with a form to take to your employer, but if not, you can download it here.

Contact Buckfire Law For Help Filling Out Your No-Fault Disability, Wage, Salary, and Benefits Verification Form

This video should help you with filling out this form, but feel free to call your lawyer or case manager at the Buckfire Law Firm if you have any questions.  If you do not have a lawyer and need assistance filing your insurance claims, call us now so we can help you every step of the way.