Why the forms matter
Under MCL 500.3142, PIP benefits are overdue if not paid within 30 days after the insurer receives reasonable proof of the fact and amount of the loss. Overdue benefits earn 12% interest. The forms below are how you give that proof. Missing or late forms are the most common reason payments stall.
The forms, and who fills them out
| Form | Completed by | What it proves |
|---|---|---|
| Application for no-fault benefits | You | Opens the claim: crash, injuries, household, vehicles, employment |
| Attending physician’s report | Your doctor | Diagnosis and that the injuries came from the crash |
| Disability certificate (work) | Your doctor | Dates you cannot work, for wage loss |
| Wage and salary verification | Your employer | Your pay before the crash |
| Replacement services disability certificate | Your doctor | That you cannot do household tasks |
| Household services statement | The person helping you | Each day’s chores and charge, for replacement services |
| Attendant care prescription or certificate | Your doctor | The care you need and how many hours |
| Attendant care log or affidavit | Your caregiver | Hours and services actually provided, for attendant care |
| Medical mileage log | You | Trips to treatment, for mileage |
Insurers use their own versions with their own titles. The content is what matters.
The application
The application asks where you lived, who lived with you, which vehicles everyone in the household owned and insured, your injuries, your doctors, prior injuries and your work. Answer every question accurately and completely. Insurers compare the application to your medical records and later statements, and errors can lead to a denial or a rescission claim.
The written notice that protects your deadline must include your name and address, the injured person’s name, and the time, place and nature of the injury (MCL 500.3145(4)). A completed application does that.
Assigned claims plan forms
If no policy applies, file the MAIPF’s Application for Personal Injury Protection Benefits Through the Michigan Assigned Claims Plan. The MAIPF’s filing instructions say to complete it online at michacp.org, print and sign it, and upload it with proof of loss, such as the police report or EMS run report. Its current form also asks for proof of the steps you took to find other insurance. Incomplete or illegible applications are returned without assignment.
Once the claim is assigned, the servicing insurer will send its own wage, household and care forms. It must tell you in writing what proof it needs within 60 days after receiving a complete application (MCL 500.3172(3)). See the Michigan Assigned Claims Plan.
Tips that prevent denials
- Send forms monthly. Old forms run into the one-year-back rule in MCL 500.3145.
- Keep copies of everything you send, and proof of when you sent it.
- Fill in logs as you go. Reconstructed logs carry less weight.
- Keep doctor’s notes current. When a disability slip expires, many insurers stop paying wage loss and household help the next day.
- Read authorizations before you sign them, and limit them to records related to the claim where you can.
One year to give notice. If the insurer does not get written notice of your injury within one year of the crash, and has paid nothing, the PIP claim can be barred entirely. For assigned claims, the application must be received within one year. The deadline calculator shows your date.
Sources: MCL 500.3142; MCL 500.3145; MCL 500.3172; MCL 500.3174; MAIPF application form ACP-01 and online filing instructions (michacp.org).
Questions people ask us
Where do I get Michigan no-fault forms?
From the insurer paying your claim. Each insurer uses its own versions. If no policy applies, the Michigan Assigned Claims Plan application is filed through the MAIPF at michacp.org, and the servicing insurer assigned to the claim then sends its own forms.
Is there a deadline to send in the application?
Give written notice to the insurer within one year of the crash, and for an assigned claims plan application, it must be received within one year. Sending the application within days is better. Benefits are not overdue until the insurer has reasonable proof.
Should I sign the medical authorization in the application?
You must give the insurer reasonable access to records related to the claim. Read authorizations carefully. Some ask for unlimited records, including unrelated mental health or substance treatment history. A lawyer can narrow them.