Get Fis 0030 Form Michigan

The Fis 0030 Form is essential for filing complaints regarding insurance disputes in Michigan. This guide will provide you with step-by-step instructions to complete the form accurately and efficiently online.

Follow the steps to fill out the Fis 0030 Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in your name in the designated area. Ensure that you provide your full legal name as it appears on official documents.
3. Enter the name of the insurance company you are filing a complaint against. Make sure this is the official name as it may appear in correspondence.
4. Provide your address, including city, state, and zip code. This information will be used for correspondence by the Department of Insurance and Financial Services.
5. If applicable, enter the name of the agent or agency involved in the dispute.
6. Fill in your email address and daytime phone number. Alternate phone number is optional but recommended if available.
7. Indicate the name of the insured person, especially if different from your own name.
8. Specify the date of service or date of loss. This could be related to an accident, medical treatment, or any incident leading to the complaint.
9. Provide the policy or claim number relevant to your complaint.
10. Check the box to indicate if the policy is an employer or group plan, and provide the employer name or group number if applicable.
11. Choose the type of coverage that applies to your situation (e.g., auto, life, home, liability, etc.).
12. State whether you have hired an attorney for representation or filed a lawsuit regarding this issue.
13. Detail the events related to your complaint in chronological order. Attach additional pages if necessary.
14. Attach copies of supporting documentation to your complaint, such as proof of insurance, letters, bills, or any other related documents. Remember to only send copies, not originals.
15. Clearly state your desired outcome at the end of the form.
16. After completing the form, save your changes and either download, print, or share the completed form as needed.

Complete your Fis 0030 Form online today to ensure your complaint is submitted effectively.