How To Fill Out a Michigan Attendant Care Services Form Video

How To Fill Out a Michigan Attendant Care Services Form Video

This video shows you how to fill out a Michigan Attendant Care Services Form. Michigan no-fault law provides payment of attendant services if you require personal care assistance due to injuries suffered in the crash. This includes assistance with dressing, bathing, medications, wound care, and other needs. It also includes supervision and monitoring for the safety and well-being of the accident victims. Your family member, neighbor, or even a hired person can get paid for providing these services while you recover from your injuries.

To qualify for these benefits, you need a doctor’s certificate stating you need this assistance and must submit an attendant care services statement to the insurance adjuster monthly. This video will teach you how to fill out the attendant care services statement form.

Click here for the Printable Attendant Care Service Form.

Step one

You need to fill in your name and the no-fault insurance claim number. You should have the claim number in a letter you received from the adjuster.

Step two

Next, fill in the name of the person who provided the services to you. Also, put in their address, telephone number, and social security number. The social security number is required so the insurance company can issue payment to the household service provider.

Step three

The next step is filling out the calendar chart to list the services that were provided on specific dates. The form lists services, each assigned a letter.

For example, the service of assisting with dressing is assigned letter A, and assisting with medication is assigned letter E. You must complete a new form each month and submit it to the insurance adjuster after the month ends. If on the first day of the month your service provider provided services of assistance with dressing, bathing, and medications, you’ll write A.B.E in the date one box. If on the fifth day of the month, your service provider provided services of assistance with medications and was on call for your needs, you’ll write E.H in the date five box.

You must fill out the date boxes for each day of the month that you receive services. You may have these same services provided daily, like dressing, toileting, and medications, and other services provided just a few times a month, like assisting at home with physical therapy. The amount paid to your attendant care provider is an hourly rate determined by Michigan law. It varies depending on the level of care and the skill level needed of the provider.

Step Four

Finally, the form must be signed and dated by the service provider on the signature line. You should then make a copy to keep as proof and send the original to the insurance adjuster for payment. You should be paid within 30 days of submitting your claim. The adjuster should provide you with this form, but if not, you can download it here.

Contact Buckfire Law For Help Filling Out Your Attendant Care Service Form

This video should help you with filling out this form, but feel free to call your lawyer or case manager at the Buckfire Law Firm if you have any questions.  If you do not have a lawyer and need assistance filing your insurance claims, call us now so we can help you every step of the way.