Forms

When you’re recovering from an injury, staying organized can make a big difference. These forms help document your care, expenses, and services related to your personal injury claim. At Shibley Law, we’ll guide you through which forms apply to your case and help ensure they’re completed correctly and on time.

If you’re unsure which form you need, call (231) 725-8444. We’ll walk you through it.

These forms are used to apply for benefits after a car accident under Michigan’s No-Fault and Personal Injury Protection (PIP) systems.

• Application for Benefits
  Submit this form to your auto insurance company to request No-Fault benefits after an accident. These benefits can help cover medical care, wage loss, and essential services while you recover.

• Application for Personal Injury Protection Benefits (Michigan Assigned Claims Plan)
  Use this form if you don’t have active auto insurance. It allows you to apply for PIP benefits through the Michigan Assigned Claims Plan (MACP).

• Affidavit of No Insurance
  If you or the vehicle involved in your accident were not covered by an active policy, this affidavit confirms your lack of insurance coverage.

These forms help ensure you’re reimbursed for your medical treatment, prescriptions, lost wages, and travel to and from appointments.

• Medical & Wage Authorization
  Allows Shibley Law to obtain medical records and wage statements on your behalf. This helps us accurately document your treatment, missed work, and related expenses.

• Transportation Expense Log
  Tracks mileage and travel costs for doctor visits, physical therapy, and other medical appointments. These expenses may be reimbursable under Michigan’s No-Fault insurance.

If you’ve needed help around the home or personal assistance while recovering from your injuries, these forms document that support for reimbursement.

• Affidavit of Attendant Care Services Performed
  Records the daily hours and tasks performed by a family member, friend, or caregiver who assists with your recovery.

• Household Services Statement
  Tracks help with cooking, cleaning, shopping, childcare, or other household duties while you’re unable to perform them.

You don’t have to complete these on your own. Your attorney will tell you which ones apply and when to use them.

• Fill out only the forms your attorney or case manager recommends.
• Keep copies of all completed documents for your records.
• Submit forms to your attorney’s office by email, mail, or in person.
• If you’re unsure how to fill something out, call us before submitting it.