"First Party" No Fault Law - Collecting Your Michigan Auto Accident Benefits
Under Michigan "no fault" law, drivers of most motor vehicles are required to obtain "first party" insurance, to cover the cost of medical treatment and rehabilitation for persons injured as drivers or passengers of their own vehicles. When somebody is injured in an accident, they will ordinarily file a claim for first party benefits with their own no fault insurance company. If they aren't covered by their own policy, then they would file a claim with the insurance company that insures the vehicle in which they were traveling. The rationale is that, under Michigan's No Fault Act, people (as opposed to motor vehicles) are insured against loss. Ordinarily, your insurance policy will cover your spouse, as well as any relatives living in your household.
Under some circumstances an injured person will be covered by more than one no fault policy. If this happens, the insurance companies will determine which one has "priority" for the claims, and that company will have primary responsibility to provide first party benefits.
Under some circumstances, an injured person will not be entitled to coverage at all. This typically happens where the injured person knowingly drives a vehicle that is not insured. It also may result if the only first party policy which could cover an injured driver specifically identifies the injured person as an excluded driver.
The absence of insurance coverage of itself will not necessarily prevent you from collecting first party benefits. If you are injured but neither the car in which you were riding nor the other vehicle(s) involved in the action were covered by no fault insurance, you should contact the Assigned Claims Facility for an application form, and apply for benefits with that Facility:
Assigned Claims Facility
There are special rules under Michigan law for motorcycles. A motorcycle owner is required to carry liability insurance, but is not obligated to carry "first party" insurance to cover such things as medical expenses, wage losses, and replacement services. If a motorcycle driver who carries a valid liability insurance policy is injured in an accident with a car, truck or commercial vehicle, the motorcycle driver will be able to make a claim for first party benefits with the no fault carrier for that other vehicle, regardless of who was at fault. If the motorcycle driver is injured in a single vehicle accident, first party benefits will probably not be available unless the driver specifically opted to obtain such coverage along with the mandatory liability coverage. Even if the motorcycle driver owns another vehicle which is covered by a policy of first party no fault insurance, the motorcycle driver will probably not be able to make a first party claim under the other policy. Given the severity of injury that can result from motorcycle accidents, motorcycle riders should seriously consider obtaining first party coverage for their motorcycles.
When you purchase "first party" coverage, most insurance companies will offer what is called "coordinated" coverage. This means that if you have insurance from other sources to cover insured expenses, such as a health insurance policy which covers your medical costs from an automobile accident, the costs are first paid by the other polices. Covered expenses that exceed the limits of coverage for those other policies, or which are not otherwise covered, are then paid by your no fault carrier. If you choose, you may ask your insurance agent about obtaining a first party no fault policy that is not coordinated with your other insurance coverage, although the cost of the policy will be somewhat higher. (Please note that even if you obtain uncoordinated benefits, you will only be able to recover your expenses from one insurance company.)
If you are injured in an automobile accident within Michigan, and the vehicle in which you were riding was required to registered in Michigan, you are probably entitled to the following first party "Personal Injury Protection" ("PIP") benefits:
For cases involving serious disability, the determination of long-term benefits can be very tricky. You will very much benefit from discussing your benefits with an attorney. You cannot count on your insurance company to inform you of the full scope of your benefits, and in fact should anticipate that they will not disclose the full scope of their obligations. Similarly, in accidents involving death, the family of the accident victim should consider discussing their benefits with an attorney.
Please note that there are limits to all of these benefits, and you should check with your lawyer or insurance company for the current limits to avoid incurring expenses that will not be reimbursed. Please also note that you are entitled to mileage reimbursement for travel necessary for seeking medical care or rehabilitation. If you wish to claim mileage reimbursement, it is necessary to maintain records of your mileage. Insurance companies often offer an inadequate amount (such as 10 cents per mile) for reimbursement, but will typically offer substantial increases in this amount upon request. Similarly, if you are paying somebody to perform replacement services, such as cleaning or lawn care, keep records of the payment and, whenever possible, pay by check or get receipts so that you have a clear record of your payment. As of the time of writing, reimbursement for replacement services is limited to $20 per day.
Please also note that you may be entitled to first party coverage even if you were neither a driver nor a passenger in a moving car at the time of your injury. If the injury could just as well have occurred in another setting, it is probably not the type of injury that will be covered by the No Fault Act. Otherwise, if the act which immediately precipitated the injury is identifiable with the normal use of a motor vehicle, the injury probably is covered.
While coverage will not ordinarily result from injuries associated with a parked car, injuries associated with such actions as entering, occupying, or maintaining the car, or associated with a car that is parked in an unreasonably dangerous manner, may result in coverage. Please note, though, that if the car was parked at the time of the injury, the person claiming benefits has the burden of establishing that an exception to the parked vehicle rule applies. A lawyer can assist you in assessing and making such a claim.
Before you can claim benefits, you must report your injury to your first party no fault carrier. Please note that pursuant to statute, unless your no fault carrier has already provided you with accident-related personal injury protection benefits, the notice must made be in writing within one year of the accident. Most insurance companies have simple, one-page claims forms that they will provide to you upon request. It may be helpful use the insurance company's form, to avoid argument that your report was somehow inadequate – some insurance companies will engage in very technical argument to avoid paying your valid claim. If your insurance company won't provide a form, write them a letter describing your injuries, and explaining that you requested a form but that their agent refused to provide one. Again, please recall that this notice must be provided in writing within one year of the accident. (While in some cases exceptions may apply which extend this limitations period, you should anticipate that if you file a late claim you will lose your benefits. If you miss the deadline, you should consult with an attorney as soon as you possibly can to see if there is any basis to argue that the limitations period does not apply.)
Your insurance company is only obligated to reimburse you for expenses which are reasonable and necessary. At times, disputes will arise between accident victims and insurance companies over benefits. Insurance companies may require that an insured attend what is commonly called an "IME" or "Independent Medical Examination", where a doctor hired by the insurance company will examine the insured to see if further benefits should be awarded. You should be aware that some of these doctors will almost always find that benefits should be cut off – and thus you may wish to consult with an attorney who handles first party no fault cases before attending a medical examination with an insurance company doctor. (Do not refuse the examination – instead, as soon as the request comes, call an attorney to discuss your facts and circumstances, and to get a reality check on what the insurance company may be planning.) You must cooperate with your insurance company to ensure that your benefits are honored – but you have every right to check with a lawyer to make sure that your insurance company's demands are reasonable and within the law.
Additionally, your insurance company is only required to reimburse you for expenses incurred during the year prior to your claim. That is, even if you make a valid written report of your injuries within one year of the accident in order to secure coverage, if you don't submit your claim for specific benefits in a timely manner, you may lose your ability to obtain reimbursement for part or all of those expenses. For example, if you are not aware that you are entitled to replacement services, and have incurred expenses for cleaning help over the course of two years prior to making a claim for reimbursement, you will only receive reimbursement for the most recent year. If you incur expenses for replacement services during the month after the accident, but don't make a claim for those benefits until thirteen or more months have passed, you will not receive any reimbursement.
In some cases, an insurance company will ask that you sign a document that releases them from providing future benefits, in association with the grant of benefits. This is quite common in association with the provision of home modification or vehicle benefits to the severely injured. It is not a good idea to sign a release without having it reviewed by a lawyer. It is rare that such releases are not designed to deprive you of benefits to which you are legally entitled, either in the present or in the future.
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