You will need to have a copy of your current insurance policy in front of you to fill out this form completely and accurately.
The Michigan Auto Insurance No-Fault Reform went into effect on July 2nd, 2020 and the new suggested state minimum Bodily Injury limits have increased from $100K/$300K to $250K/$500K. The reform also now gives you the option to choose how much Personal Injury Protection (PIP) medical coverage you want on your auto insurance policy.
It is important to find out if you have auto accident coverage through your health insurance plan and if your plan qualifies you to opt out of PIP. Your health insurance plan may pay auto insurance claims on a PRIMARY or SECONDARY basis and your health carrier should be able to provide you with a Coordination of Benefits Letter providing this information.
*You will be asked to provide a QHC letter from your health insurance carrier with proof of all members covered OR a copy of your Medicare (A + B) card to opt out of PIP coverage completely. Many health insurance policies DO NOT provide coverage for attendant care, custodial care, home and vehicle modifications, and other benefits provided by the auto policy medical benefit and may limit rehabilitation benefits. It is also important to remember that your health insurance will still require co-pays, deductibles and co-insurance that your auto policy may not require.
Date of Birth *
Enter ANY Tickets/Accidents/Claims within the last 5 years. (Description, Date of Occurrence, Claim amount paid)
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company.
If you have any questions, please feel free to contact us.