Michigan assigned claims application 2026

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The document is an application form for Personal Injury Protection benefits under the Michigan Assigned Claims Plan. It outlines the necessary information required from the injured person, including personal details, accident specifics, injury information, medical treatment history, and employment status. The application must be submitted within one year of the accident and includes a fraud warning regarding false claims. Additionally, it authorizes the release of health information to facilitate the claims process.
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  1. Click ‘Get Form’ to open the Michigan Assigned Claims Application in our platform's editor.
  2. Begin by filling out the 'Injured Person Information' section. Enter your full name, date of birth, and any previous names you may have used. Ensure that all fields are completed accurately.
  3. Proceed to the 'Accident Information' section. Provide details about the accident location, whether you had auto insurance at the time, and a description of how the accident occurred.
  4. In the 'Injury Information' section, indicate if you are claiming injuries from the accident and provide details about your treatment and any medical conditions prior to the accident.
  5. Complete the 'Employment Information' section by detailing your employment status at the time of the accident and any missed work due to injuries.
  6. Finally, review all sections for completeness before signing and submitting your application. Attach any required documents such as police reports or medical records.

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