You MUST provide the following: 1) Medical documentation supporting an injury occured; 2) Any Insurance Explination of Benetifs you have received; 3) Proof of the expense you wish to be reimbursed; 4) Your health insurance policy information (also known as your Schedule of Benefits); 5) Photos of the location/cause of the injury; 6) Police Report or report number if applicable. Failure to provide this information will delay the claim process and could result in a denial of your claim.

DO NOT START THIS FORM IF YOU DO NOT HAVE THE REQUIRED INFORMATION.

PLEASE NOTE THE FOLLOWING: 

1. Submitting a claim does not guarantee reimbursement to you for damages. The City of Grand Rapids reviews each claim on an individual basis.
2. You must provide medical documation supporting you sustained an injury. 

For questions regarding this form or the claim process, please contact the Liability Analyst at 616-456-4670 or email RiskClaims@grand-rapids.mi.us