No-fault automobile insurance personal injury protection claim forms (amendment)

Issued and entered July 27, 1984 by Nancy A. Baerwaldt Commissioner of Insurance

On April 4, 1984, the Insurance Bureau issued Bulletin 84-03, transmitting three forms for use in gathering information necessary to pay insurance claims resulting from automobile accidents. An important question was inadvertently omitted from one of the forms.

The Wage, Salary and Benefits Verification Form does not contain a request for the amount of time lost from work. This is to let you know that it is appropriate to ask for this information and that a question to that effect may be added to the form prior to reproduction.

I regret any inconvenience this may have caused. If you have any questions, please contact Teri Creamer at (517) 373-2984.