How to Complete the Michigan Auto Insurance Resident Relative Attestation Form

The Michigan auto insurance resident relative attestation form is the section of the Michigan Assigned Claims Plan (MACP) application where you identify every person living in your household and disclose whether each one carries auto insurance. You file it when no private auto policy — yours, your spouse’s, or a resident relative’s — covers your injuries from a Michigan motor vehicle accident. The Michigan Automobile Insurance Placement Facility (MAIPF) administers the plan, and your completed application must reach them within one year of the accident date.1Michigan Legislature. Michigan Code 500.3174 – Notice of Claim Through Assigned Claims Plan

The attestation exists because the MACP is a last resort. Michigan law sets a strict order for who pays PIP benefits: your own insurer first, then your spouse’s, then a relative domiciled in your household.2Michigan Legislature. Michigan Code 500.3114 – Persons Entitled to Personal Protection Insurance Benefits The MAIPF uses your household disclosures to confirm that none of those private policies exists before assigning your claim to an insurer.

Who You Have to List as a Household Member

List every person who genuinely lives in your household, regardless of age or how they are related to you. The legal test is domicile, not just a shared address. Michigan courts apply the multi-factor framework from Workman v. Detroit Automobile Inter-Insurance Exchange to decide whether someone is a resident relative for insurance purposes.3Justia. Workman v Detroit Automobile Inter-Insurance Exchange The key questions:

  • Does the person intend to stay at the residence permanently or for an indefinite period?
  • How formal is the living arrangement with the other people in the home?
  • Do they live in the same house, on the same property, or within the same curtilage?
  • Do they keep another place to live somewhere else?

Later Michigan cases added practical indicators: the address on the person’s driver’s license, whether they keep personal belongings at the home, where they receive their mail, whether a room is maintained for them, and whether they depend on other household members for financial support.4Michigan Courts. Automobile Club Insurance Association v State Farm Mutual Automobile Insurance Company

No single factor decides it. A college student away at school can still be domiciled with parents if they come home on breaks, keep their room, and use the family address on their license. A friend sleeping on your couch for two weeks after a breakup probably does not qualify. Work through the factors for anyone whose status is uncertain, and when in doubt, list them — a person you disclose who turns out not to be a resident relative causes no harm, while a resident relative you omit can sink the claim.

What Insurance Information You Need for Each Person

For every household member you list, the form asks whether they own a vehicle, whether that vehicle is insured, and if so, the policy number and the name of the carrier. Gather this before you sit down with the form:

  • Full name of each household member
  • Whether each person owns a motor vehicle
  • Whether each vehicle carries insurance required under Michigan law
  • Policy number and insurance company name for every insured driver in the home

If it turns out anyone in your household has an auto policy you failed to disclose, the MAIPF will deny your claim and send you to that insurer. Get the details from the declarations page rather than from memory.

The Rest of the Application

The attestation section sits inside a longer MACP application. You will also need to provide:

  • Injured person details: full legal name, Social Security number, date of birth, current address, address at the time of the accident, phone numbers, email, marital status, and driver’s license or state ID number.
  • Spouse information if you are married, including whether they carry auto insurance.
  • Accident details: location, description of what happened, police report information, your position in the vehicle, and contact details for anyone you spoke with about the accident.
  • Injury and treatment information: what your injuries are, whether EMS responded, hospital and doctor details, the status of your medical bills, and whether you have applied for Social Security disability.
  • Health insurance: the name of your health insurer, policy details, and Medicare or Medicaid enrollment.
  • Employment: employer name, income, work status, and whether you have access to a wage continuation plan.

Attach a copy of the police report, the EMS run form, and any other documentation you have. A valid Michigan driver’s license showing your current address is the primary proof of residency; utility bills in your name add support. If you are enrolled in Medicare or Medicaid, include proof of enrollment. Your health coverage matters because it can affect what level of PIP medical benefits you are entitled to receive.5DIFS Auto Insurance. Choosing PIP Medical Coverage

Where to Send the Completed Form

Submit the application to the MAIPF in one of three ways:

  • Mail: Michigan Assigned Claims Plan, c/o Michigan Automobile Insurance Placement Facility, PO Box 532318, Livonia, MI 48153-2318
  • Fax: 734-744-8552
  • Email: info@michacp.org

If you mail it, use certified mail or delivery confirmation so you have proof it arrived within the one-year window. Keep a complete copy of everything — the application, every attachment, and your proof of delivery. The current version of the form is available at michacp.org.

What Happens After You File

The MAIPF reviews your application to decide whether you are eligible for benefits, and the statute directs the facility to promptly assign eligible claims to a private insurer.1Michigan Legislature. Michigan Code 500.3174 – Notice of Claim Through Assigned Claims Plan No fixed number of business days is set in the law, so timing depends on the complexity of your case and the facility’s workload.

If the MAIPF determines you are not eligible, it must send you written notice explaining the denial. If you are approved, your claim is assigned to a specific insurance company, which then manages your PIP benefits. The initial assignment is not a final determination — the assigned insurer can still deny the claim later if it finds you were ineligible all along.6Michigan Legislature. Michigan Code 500.3173a – Review and Assignment of Claims Accuracy on the attestation is what keeps the claim from unraveling months down the road.

When the MACP Application Is the Right Path

You use this form only if you have no private route to PIP benefits. Under MCL 500.3172, the MACP is available when no PIP insurance covers your injury, when the applicable insurer cannot be identified, when insurers are disputing which one is responsible, or when the responsible insurer is insolvent.7Michigan Legislature. Michigan Code 500.3172 – Assigned Claims Plan Eligibility If you were hit as a pedestrian or bicyclist and the vehicle is unidentifiable — a hit-and-run, for example — the MACP is also the route.8Michigan Legislature. Michigan Code 500.3115 – Priority for Nonoccupant Claims

Disqualifications That Bar Benefits Regardless of the Form

Some people cannot collect PIP benefits at all, through the MACP or a private insurer. Under MCL 500.3113, you are disqualified if:

  • You owned or were the registrant of the vehicle involved and it lacked the insurance required under MCL 500.3101.
  • You were willingly operating a vehicle you knew or should have known was taken unlawfully.
  • You are a non-Michigan resident and did not own a vehicle registered and insured in Michigan.
  • You were specifically named as an excluded driver on the applicable policy.
  • The vehicle’s coverage was excluded under an authorized policy exclusion.
9Michigan Legislature. Michigan Code 500.3113 – Persons Not Entitled to Personal Protection Insurance Benefits

The uninsured vehicle owner rule catches people by surprise most often. If you owned a car without the required insurance and were injured while driving it, no PIP benefits are available from any source, including the MACP. The attestation asks about every vehicle in your household for exactly this reason.

Penalties for False or Incomplete Answers

The application includes a fraud warning directly above the signature line. By signing, you attest that everything in the form is true. Presenting a statement with false information material to the claim is a fraudulent insurance act under MCL 500.4503.10Michigan Legislature. Michigan Code 500.4503 – Fraudulent Insurance Act

The penalty is a felony carrying up to four years in prison, a fine of up to $50,000, or both, along with mandatory restitution.11Michigan Legislature. Michigan Code 500.4511 – Violation as Felony and Penalty The application itself also states that any claim supported by a fraudulent statement is ineligible for payment under the Assigned Claims Plan. Concealing a household member’s insurance policy to qualify for MACP benefits is exactly the kind of misrepresentation the statute targets, so take the household section slowly and answer it as though the assigned insurer will verify every name later. That is what they do.