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:
- Submitting a claim does not guarantee reimbursement to you for damages. The City of Grand Rapids reviews each claim on an individual basis.
- 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
