On 8/22/2023, the Shawnee County District Court signed a Final order and Judgment of liquidation of MutualAid eXchange. If you were affected by this order and would like to present a claim, please submit a “Statement of Claim” to MPCGA by mail. This form is located under CLAIM INFORMATION on this website; Click on “SERVICES” then “CLAIM INFORMATION”.

Last updated 08/28/2023

Forms

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

AC Script

AC_Script_Request_r2

Attendant Care Form

Attendant_Care_r2

Authorization of Release of Records

Authorization_of_Release_of_Records_r2

Auto - Personal Injury Protection (PIP)

PIP_Form_v2

Mileage Reimbursement Form

Mileage_Reimbursement_r2

Prescription Reimbursement Form

Prescription_Reimbursement_r2

Replacement Services Form

Replacement_Services_r2

Statement of Claim

Statement_of_Claim_v2

Workers Compensation (WC)

Web_-_Initial_WC_PEO_Questionnaire_with_Affidavits_REVISED_r2

Form W9

fw9_2018-1