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:
Box No. 2005
Farmington Hills, MI 48333-2005