How to Fill Out a Michigan No-Fault Mileage Reimbursement Form

Michigan’s no-fault law provides benefits after a car crash, including coverage for lost wages, medical bills, attendant care, household services, medical mileage, and more. To receive reimbursement for medical mileage, a properly completed form is required.

Filling out a mileage reimbursement form involves several important steps, including:

• Recording the date of each medical appointment
• Listing the starting location and destination
• Tracking the total number of miles traveled
• Identifying the purpose of each trip as medical-related
• Keeping consistent and accurate logs to support your claim

This video will teach you how to fill out the mileage reimbursement form.

Click here for the Printable Medical Mileage Reimbursement Form.

Michigan’s no-fault law provides you with payment for driving to and from medical appointments. This includes doctor’s visits, chiropractic care, physical therapy, psychological therapy, and all other trips for accident-related medical care.

You’ll complete a new form each month to reimburse your travel expenses.

First, at the top left of the form, fill in your no-fault insurance claim number.

Next, for each day you traveled to a medical appointment, you’ll write the date, the address you started your trip from, which is most often your home address, the address of the medical appointment, and the total miles round-trip. If you have multiple appointments on a given day, you should make a separate entry on the form for each appointment that same day.

The reimbursement amount per mile is determined by Michigan statute, and the insurance company is supposed to pay you that rate. The amount increases yearly due to adjustments for gas prices, inflation, and other factors. 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 Medical Mileage 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.