ࡱ> \^[g NbjbjVV .Pr<r< rrD$"rrrrM#!!!!!!!$y#+&!EMM!rr;"rr!!$!p!rŠe'. R s!jh`POJQJU^J!jGh`POJQJU^J!jh`POJQJU^Jh`PCJOJQJ^J!jh`POJQJU^J&jh`POJQJU^JmHnHu!jIh`POJQJU^Jjh`POJQJU^Jh`POJQJ^J(6 ^ ` skd1$$Ifl4 Fd$*, 06    4 laf4$If  < d icccc$Ifkd$$Ifl \d$*$  064 laR T V ` b f  & ( * Z \ x z | ¶taQjh`PCJOJQJU^J%jRh`PCJOJQJU^J%jh`PCJOJQJU^J%jjh`PCJOJQJU^Jjh`PCJOJQJU^Jh`PCJOJQJ^Jh`PCJOJQJ^Jh`POJQJ^J&jh`POJQJU^JmHnHujh`POJQJU^J!j/h`POJQJU^Jd f icc$Ifkd$$Ifl \d$*$  064 la $Ifpkd$$Ifl 0* 064 la  %ܺ}wkk[kH[k[k%j h`PCJOJQJU^Jjh`PCJOJQJU^Jh`PCJOJQJ^J h`PCJ&jh`POJQJU^JmHnHu!jh`POJQJU^Jh`POJQJ^Jjh`POJQJU^Jh`PCJOJQJ^J*jh`PCJOJQJU^JmHnHujh`PCJOJQJU^J%jeh`PCJOJQJU^J  ~ $IfskdM $$Ifl4 0* 064 laf4 2|vvv$Ifkd $$IflhF$*  06    4 la%&'23rsXjklz{|гРЍzn[%jh`PCJOJQJU^JhxCJOJQJ^J%j h`PCJOJQJU^J%j h`PCJOJQJU^J%j h`PCJOJQJU^J%j h`PCJOJQJU^Jh`POJQJ^Jh`PCJOJQJ^Jjh`PCJOJQJU^J%j h`PCJOJQJU^J#23r|vvv$Ifkdu $$IflhF$*  06    4 la|vvv$Ifkd $$IflhF$*  06    4 lak|vvv$Ifkd$$IflhF$*  06    4 la|./=>?EFTUV[]XZde{iZh`P5CJOJQJ\^J"h`P56CJOJQJ\]^J%jh`PCJOJQJU^J%j.h`PCJOJQJU^J%jh`PCJOJQJU^J%jh`PCJOJQJU^Jh`POJQJ^J%jh`PCJOJQJU^Jjh`PCJOJQJU^Jh`PCJOJQJ^J#|vvv$Ifkd$$IflhF$*  06    4 la.E[|vvv$Ifkd$$IflhF$*  06    4 la[\]X|zt$Ifkd$$IflhF$*  06    4 laXYZhijuoooooo$If h$If^h & F hh$If^hjkd$$Ifl*+  064 lap ejkyz{*+,12lY%jh`PCJOJQJU^J%j_h`PCJOJQJU^J%jLh`PCJOJQJU^J%jh`PCJOJQJU^Jh`POJQJ^J%jh`PCJOJQJU^J%jMh`PCJOJQJU^Jjh`PCJOJQJU^Jh`PCJOJQJ^Jh`P6CJOJQJ]^J"1|nd^^^^$If h$If^hh$If^h`kd9$$Ifl`F$*  06    4 la12|nhhhh$Ifh$If^h`kd$$Ifl`F$*  06    4 la*+,23ABCHJLrMsMMN#N;NNٯ٧ٯhnj h`PCJUh`P%j^h`PCJOJQJU^J%jh`PCJOJQJU^Jh`POJQJ^Jh`PCJOJQJ^Jjh`PCJOJQJU^J2H|vvv$IfkdK$$Ifl`F$*  06    4 laHIJrMsMMNN|zxzvztkd$$Ifl`F$*  06    4 lal toll free at 1 (877) 901-7361. If you answered Yes to question 4 in Section II above, and are unhappy with the services you are receiving, please call your adjuster to discuss a change in services. If you answered No to any question in Section 2, please complete these tasks and then call toll free 1 (877) 901-7361. Thank you for your interest in our program. Questions related to Workers Compensation benefits and/or rights should be directed to the Workers Compensation Agency at 1-888-396-5041. Questions related to Auto No-Fault or Long Term Disability benefits and/or rights should be directed to the Consumer Services Division at 1-877-999-6442. ,1h/ =!"#$% $$If!vh#v#v,#v :V l 06,55,5 / / / / 4tDText1tDText2tDText3$$If!vh#v#v,#v :V l4 06,55,5 / / 4f4$$If!vh#v#v$ #v#v :V l 06,55$ 55 / / / / 4tDText4tDText5tDText6tDText7$$If!vh#v#v$ #v#v :V l 06,55$ 55 / / 4tDeCheck1tDeCheck2vDeCheck24$$If!vh#v#v :V l 06,55 / 4tDText8tDText9$$If!vh#v#v :V l4 06,55 / 4f4$$If!vh#v #v#v :V lh06,5 55 4tDeCheck5tDeCheck4$$If!vh#v #v#v :V lh06,5 55 4tDeCheck6tDeCheck7$$If!vh#v #v#v :V lh06,5 55 4tDeCheck8tDeCheck9$$If!vh#v #v#v :V lh06,5 55 4vDeCheck10vDeCheck11$$If!vh#v #v#v :V lh06,5 55 4vDeCheck12vDeCheck13$$If!vh#v #v#v :V lh06,5 55 4vDeCheck14vDeCheck15$$If!vh#v #v#v :V lh06,5 55 4$$If!vh#v+:V l  065+4p vDeCheck16vDeCheck17$$If!vh#v #v#v :V l`06,5 55 4vDeCheck18vDeCheck19$$If!vh#v #v#v :V l`06,5 55 4vDeCheck20vDeCheck21$$If!vh#v #v#v :V l`06,5 55 4vDeCheck22vDeCheck23$$If!vh#v #v#v :V l`06,5 55 4^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH >@>  Heading 1$@& 5CJ\J@J  Heading 2$@&5CJOJQJ\^JL@L  Heading 3$$@&a$5OJQJ\^JP@P  Heading 4$$@&a$5CJOJQJ\^JDA D Default Paragraph FontVi@V  Table Normal :V 44 la (k (No List DB@D Body Text5CJOJQJ\^JBP@B Body Text 2CJOJQJ^JBQ@B Body Text 3CJOJQJ^JPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] P R %|eN "6 d 2[X1HN  !#$ !-35AG|.GWp|)0@  0HX_o-5E5 E L \ F4F4F4F4F4F4F4G$G$G$F4F4G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$8@0(  B S  ? Text1Text2Text3Text4Text5Text6Text7Check1Check2Check24Text8Text9Check5Check4Check6Check7Check8Check9Check10Check11Check12Check13Check14Check15Check16Check17Check18Check19Check20Check21Check22Check23"6}Hq1 !I`66 M   4H/X*A1Yp.FF ] %%KK SS 9H*urn:schemas-microsoft-com:office:smarttagsState?y*urn:schemas-microsoft-com:office:smarttags stockticker  ,J t,4 333 ,J  !45H|-.7_p()?@CC/0rWXnowwrr.5F5 F L a c CJ an& ,^`o(.^`.pLp^p`L.@ @ ^@ `.^`.L^`L.^`.^`.PLP^P`L.an&ź          k&;OL`PjSEAUgYnj L{x a"& @@/ @ @@UnknownG* Times New Roman5Symbol3. * ArialA$BCambria Math"1hQQm  Y24 3QHX(?x:!xx RA-2948 Rev 5-2006 AdministratorBrzezinski, Paula (DELEG) Oh+'0 8D d p | RA-2948 Rev 5-2006AdministratorRA-2948.1-2009c.docBrzezinski, Paula (DELEG)2Microsoft Office Word@F#@vEl@Ze'@Ze' ՜.+,0  hp  State of Michigan  RA-2948 Rev 5-2006 Title  !"#$%&'(*+,-./012345689:;<=>?@ABCDEFGHIJLMNOPQRTUVWXYZ]Root Entry F}e'_Data )q1Table7&WordDocument.PSummaryInformation(KDocumentSummaryInformation8SCompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q