Get Pip Application

Filling out the Pip application is a crucial step in seeking benefits under the Pennsylvania Motor Vehicle Responsibility Law. This guide provides clear, step-by-step instructions to help you complete the application accurately and efficiently online.

Follow the steps to successfully complete the Pip application online:

1. Click ‘Get Form’ button to access the Pip application and open it in the appropriate online form editor.
2. Begin with your personal information. Provide your full name, phone number, and complete address, including street, city, state, and ZIP code.
3. Indicate the date and time of the accident. Use the provided fields to enter this information accurately.
4. Write a brief description of the accident in the designated section. Be concise but include relevant details.
5. Answer the question regarding automobile ownership within your household by selecting 'Yes' or 'No'.
6. Provide the name of your insurance company if applicable.
7. Fill in your date of birth and the location of the accident.
8. Answer the injury-related questions: confirm if you were injured as a result of the accident and describe your injury if applicable.
9. Provide the names and addresses of any doctors you have seen for treatment, as well as the hospital's name and address if you received care.
10. Indicate whether you were an in-patient or out-patient at the hospital and provide details about lost wages or salary related to the injury.
11. List your employment information for up to one year prior to the accident, including names, addresses, occupations, and dates of employment.
12. Check if you expect additional medical expenses and whether you are eligible for any other benefits like workers' compensation or Medicare.
13. Review all your entered information carefully to ensure accuracy.
14. Once completed, save changes, and choose to download, print, or share the form as needed.

Complete your Pip application online today to ensure you receive the benefits you deserve.