Get Mi Bcbsm Wf 10345 2011-2025

Filling out the MI BCBSM WF 10345 form is a crucial step for individuals involved in an injury or liability case. This guide will provide you with a clear, step-by-step approach to filling out the form efficiently online.

Follow the steps to complete the MI BCBSM WF 10345 form online.

1. Click ‘Get Form’ button to obtain the form and open it in the relevant editor.
2. Enter the date in the specified field at the top of the form.
3. Provide the client's name in the relevant section for personal identification.
4. Fill in the date of birth for the client.
5. Input the contract number, which is the 9-digit number located on the BCBSM card.
6. If applicable, include the spouse's name if they are also on the BCBSM policy.
7. If the policy holder's name differs from the client’s name, specify the policy holder's name.
8. Enter the policy holder’s date of birth.
9. Include the client's phone number for contact purposes.
10. Select the type of case from the provided options, such as personal injury or motor vehicle accident.
11. Indicate the state where the incident occurred.
12. If a vehicle was involved, select 'Yes' or 'No' accordingly.
13. Provide the state of residence of the liable party.
14. Fill in the venue or jurisdiction for the cause of action.
15. Specify the date of injury.
16. Describe the type of injury and the area of the body that was injured.
17. If you have notes, add them in the designated section.
18. Enter the attorney’s name and their law firm name.
19. Provide the attorney's street address, city, state, zip code, and phone number.
20. Input the attorney's fax number if available.
21. Fill in the name of the insurance company and the insurance adjuster's name.
22. Enter the insurance company’s street address and adjuster’s phone number.
23. Include the insurance claim number, the city, and the adjuster’s fax number.
24. Specify the date and type for the next scheduled hearing.
25. Once all fields are completed, save your changes, and select options to download, print, or share the form as needed.

Complete and submit your documents online for a smooth filing experience.