Claims Help

Personal Injury and Medical Payments Forms

State Farm® provides Personal Injury Protection (PIP) and/or Medical Payments Coverage (MPC) forms for your information. Talk to your claim associate about forms that may be needed for your claim.

Connecticut, Maine, New Hampshire, Rhode Island, and Vermont Medical Payments Coverage (MPC) Policyholders and Injured Parties

Medical Authorization [PDF-84.4KB]

Pennsylvania Medical Payments Coverage (MPC)

Policyholders and Injured Parties

Application for Benefits

Medical Authorization