The following forms require Adobe Reader. Please download and complete the form pertaining to your loss in its entirety.
Mail the completed form to:
MPCGA
PO Box 531266
Livonia, MI 48153-1266
Breaking News: On March 11, 2020, upon consideration of the Petition for Declaration of Insolvency of Bedivere Insurance Company filed by Jessica K. Altman, Insurance Commissioner of the Commonwealth of Pennsylvania, it is ORDERED that the petition is GRANTED and Bedivere is hereby declared insolvent.
Claims: If you have a claim from the insolvency of Bedivere Insurance Company, American Country Insurance Service, or American Insurance Services, please complete the statement of Claim with the Auto-Personal Injury Protection (PIP) and/or Workers Compensation (WC) forms listed under Claim Information.
The following forms require Adobe Reader. Please download and complete the form pertaining to your loss in its entirety.
Mail the completed form to:
MPCGA
PO Box 531266
Livonia, MI 48153-1266