File A Claim
If your hearing instrument is accidentally damaged, complete this claim form in its entirety and return it to Midwest Hearing Agency with the damaged hearing instrument. The hearing instrument should be packaged securely and insured through the postal services.
Lost Hearing Instrument
If your hearing instrument is lost or damaged beyond repair, complete this claim form in its entirety and return it to Midwest Hearing Agency. In the event of an in the ear instrument, an ear impression must be sent with the claim form to Midwest Hearing Agency (unless there is a laser scan on file with the manufacturer).
The manufacturer will repair or replace your hearing instrument and return it to your dispensing office/clinic and Midwest Hearing Agency will make payment direct to the manufacturer for the repair or replacement. All incidental charges by that dispensing office/clinic for hearing test, ear impressions, or other services will be your responsibility.
Please mail your completed claim form to the address below:
Midwest Hearing Agency
4510 West 77th Street, Suite 109
Minneapolis, MN 55435