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Labor and Economic Opportunity

WC-581 (8/19) - Application for Adjustment to the Workers' Compensation Maximum Payment Ratio

This form is used for hospitals that may meet the criteria for an adjustment to their current cost-to-charge ratio per the Health Care Services Rules.  To find out additional information on this process and to obtain a copy of the form, contact the Resolutions, Rehabilitation and Rules Division at 517-284-8900.