Arbitration Agreement Form

MIEC does not require arbitration for claims processing/resolution, and therefore the use of this agreement by MIEC Members is voluntary.

For members who choose to utilize arbitration agreements in their practice(s), we have provided this sample agreement for reference purposes.  Please note, if printing this form for use in your practice, it MUST be printed in color.

Printable PDF:

Arbitration Agreement Form
Note this form MUST be printed in color. If the notice on the page isn’t in red, it isn’t legally binding.

Hard copy:

As of 5/1/2024, MIEC will no longer provide hard copies.  If you would like more information from MIEC regarding claims resolution and/or the use of arbitration agreements, please complete the contact form below, and a member of our Claims staff will follow up with you.

Abritration Agreement Questions/Contact
Preferred Method of Contact