Get Mva Information Sheet

Filling out the MVA Information Sheet online can seem daunting, but it is a crucial step in managing your personal injury claim efficiently. This guide will walk you through each section of the form to ensure your information is accurate and complete.

Follow the steps to successfully complete the MVA Information Sheet online:

1. Press the ‘Get Form’ button to access the MVA Information Sheet and open it for editing.
2. Identify your role during the accident by selecting one of the following options: driver of car, passenger in car, pedestrian hit by car, or other. Provide an explanation if you select 'other'.
3. Fill in your Patient’s PIP or UM/UIM Insurance details by entering the claim number, insurance address, and city, state, and ZIP code.
4. Enter the patient’s name and the Date of Incident (DOI). Specify the adjuster’s name and phone number.
5. Indicate whether the patient is the insured party by selecting 'Yes' or 'No.' If 'No,' complete the fields for the insured’s name, date of birth, and address.
6. Specify if there is an open Personal Injury Protection (PIP) claim by selecting 'Yes' or 'No.' If 'No,' proceed with the next question regarding the uninsured/underinsured (UM/UIM) claim.
7. Answer if this is an open UM/UIM motorist claim by selecting 'Yes' or 'No.' If applicable, include information about policy limits and health insurance subrogation.
8. Provide the health insurance carrier’s name, group number, policy number, and their contact details.
9. Complete the third party’s insurance information by entering the claim number, at-fault party’s name, phone number, and adjuster’s details.
10. Indicate if the third party's carrier has accepted liability. Also, state whether there is an attorney involved and provide their details if applicable.
11. List any healthcare providers that have previously treated you for the injury. Include each provider’s name, specialty, and treatment dates.
12. Review all entered information thoroughly. After confirming accuracy, you can save changes, download, print, or share the completed form.

Complete your MVA Information Sheet online today to streamline your personal injury claim process.