Michigan No-Fault Insurance Forms You Need

The Buckfire Law Firm has a dedicated team of lawyers to help you with your Michigan no-fault insurance forms after a motor vehicle accident. We provide free resources to assist you with your claims.

This page provides downloadable Michigan no-fault insurance PDF forms to help you document and claim Personal Injury Protection (PIP) benefits after a car accident. Whether you’re dealing with medical expenses, wage loss benefits, or attendant care, having the right forms ready can make a significant difference in your claim.

After an auto accident in Michigan, your no-fault insurance company requires written documentation before paying PIP coverage benefits. These forms serve as the “reasonable proof” insurers need to process your claim. Below are the forms you need to file with the insurer.

Application for Michigan No-Fault Benefits Form

This is typically the first form an injured person must submit after a crash. Insurers may call it “Application for Benefits,” “Application for No-Fault Benefits,” or “Notice of Injury.”

Under Michigan law, this application must be received by the proper auto insurance company within one year of the accident date to preserve your PIP benefit rights. Missing this deadline can forfeit your claim entirely. Insurers may have their own version, but should accept this form.

Click to download an Application for No-Fault Benefits PDF

Completed forms can be submitted by mail or fax to your insurer. Keep a photocopy of your completed form before sending it to the insurer. Make sure to list all injuries, even if minor.

Attending Physician’s Report (APR) and Medical Disability Certificates Forms

Insurers require written confirmation from a treating doctor that connects your injuries to the crash and documents your restrictions. Without proper medical proof, claims for wage loss, household services, and attendant care often get denied. This form should be filled out by your main treating physician or specialist, like an orthopedist or neurologist.

Click to download an Attending Physician’s Form PDF

Work Disability Certificate Form

This shorter form specifies whether you’re disabled from work, the dates of disability, and your expected return-to-work date or duty restrictions.

Click to download a Work Disability Certificate PDF

Wage Verification and Work-Related No-Fault Forms

Michigan no-fault benefits include wage loss benefits. These pay 85% of gross lost income for up to three years after a crash, subject to an indexed monthly cap. Insurance companies require this form to prove wage loss, and your inability to work must be supported by a treating doctor.

Self-employed individuals should provide profit-and-loss statements, tax returns (Schedule C), or accountant letters instead of employer forms.

If you have multiple jobs or variable/seasonal income, gather several months of pay records to establish your average earnings. Review the employer’s completed form for accuracy before it goes to the insurer, as inconsistencies delay payment.

Click to download a Wage Verification Form PDF

Replacement Services and Household Services Forms

Michigan No-Fault allows up to $20 per day in reimbursement for household chores the injured person cannot perform due to crash-related injuries.

Click to download a Replacement Services Form PDF

Attendant Care Forms and Logs (In-Home Nursing/Personal Care)

Attendant care refers to hands-on personal care services required after serious injuries, like help with bathing, dressing, toileting, medication management, and supervision for cognitive issues.

Attendant care benefits are available for individuals who cannot care for themselves due to significant injuries from an accident, covering the cost of hiring someone to assist them.

Click to download an Attendant Care Form PDF

Transportation Expense Forms (Medical Mileage)

Michigan PIP can reimburse mileage and transportation costs for medical appointments related to the crash, like trips to physical therapy, specialists, imaging centers, and pharmacies. A transportation expense log must be completed to record mileage for medical appointments related to the accident for reimbursement.

Click to download a Medical Mileage form PDF

Submit transportation logs monthly instead of waiting several months. This keeps payments current and documentation organized.

Michigan Assigned Claims Plan Form

If no applicable auto insurance policy exists, you don’t own a car, don’t live with an insured relative, and the involved vehicles were uninsured, Michigan’s Assigned Claims Plan may be your last resort option. If you do not live with a relative who has car insurance, the priority shifts depending on whether you are a driver, passenger, pedestrian, or on a motorcycle.

Click to download a Michigan Assigned Claims Application Form PDF

Contact The Buckfire Law Firm for Help Filling Out No-Fault Forms

If you were injured in a motor vehicle accident and need help with your no-fault insurance claims, call the award-winning lawyers at The Buckfire Law Firm now.

We will assist with your claims and discuss with you the possibility of making a claim to compensate you for your personal injuries and mental anguish caused by the crash.

We charge no money to get started and if you do not receive a settlement, you own us nothing!