• How Do I Submit the "Claimant's Statement and Authorization" Form?

    You may submit this form to us in one of the following ways:

    • Electronically via Client Zone at zone.hccmis.com/clientzone or Student Zone at zone.hccmis.com/studentzone
    • By uploading it to the Submit Claim Request form via our Customer Service page at service.hccmis.com. Click "Submitting a Claim or an Appeal" under the "Contact Us" header. Then choose "Submit Claim." Fill out the form and upload the completed Claimant's Statement and Authorization form. Click "Submit."
    • By email to [email protected]
    • By mail to:

    Claims Department
    Box No. 2005
    Farmington Hills, MI 48333-2005