Form · Personal Injury & Compensation

Notice of accident claim, fatal injury (MAIC Form F4)

Link to the MAIC Notice of Accident Claim Form (Fatal Injury). The claimant certificate is a statutory declaration.

Kind: Form. A form to complete, or a guide to completing an official one.
Where it applies: Queensland
AI use: Yellow You and the tool draft together, with you directing. You check every statement you rely on.
Law stated as at: 23 October 2026
Status: Maintained. Checked on 23 October 2026 against the official form at maic.qld.gov.au and the 3 authorities it cites, for Queensland.
Version: 1
Source: Link to the official form. Licence: © Motor Accident Insurance Commission. Link only: download the current form from the official page each time. The form says reproduction is prohibited except for making a claim.

Where this comes from

The official form is published by maic.qld.gov.au; this page is a completion guide. Last checked on 2026-10-23.

When to use it

Use when a Queensland motor accident has caused death and the claimant gives notice under the Motor Accident Insurance Act 1994 before a damages action. Part A alone is for funeral and other expenses. A dependency claim needs Parts A and B. A living claimant uses the non-fatal form.

Used for these tasks

Each task page says how far AI may help with the task and what the lawyer must review.

How AI may be used

AI may check the current official form against the file and list what is missing; it writes nothing in a declaration or certificate, and the lawyer settles every statement the client signs or gives.

AI may

Check the draft is the current file from the official page and list every blank field and missing attachment
Index the documents already on the file that the form calls for, with date and author
Turn the published giving and response steps into a checklist for this matter

AI must not

Must not write any words in a statutory declaration, claimant certificate, medical certificate or other verification
Must not sign, lodge, give or serve the form
Must not decide whether a time limit has been met or whether an excuse is reasonable
Must not choose between Part A only and Parts A and B

The lawyer checks

Death arose out of a Queensland motor vehicle accident and this fatal form is the current one
Part A only is used for funeral and other expenses; dependency uses Parts A and B
Section 37 is applied to [DATE OF ACCIDENT] and the first lawyer consultation
The claimant certificate is made by the signatory as a statutory declaration

Method: how the Green, Yellow and Red levels are decided. This is guidance for planning, not legal advice.

Authorities

Official form

Open the official form. Always use the current version from the issuer. Licence: © Motor Accident Insurance Commission. Link only: download the current form from the official page each time. The form says reproduction is prohibited except for making a claim..

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