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An 18 year old moved out of his family home and into a friend’s home to attend school in another town.  The son, however, kept his family home address on his driver’s license and provided his school and a part-time employer with it as opposed to the friend’s.  His checking account also kept his home address.  He maintained possessions in a bedroom at his family’s home.  Often, he would return home during breaks, catch up with his family, sleep in his bedroom, eat with his family and clean his laundry before going back to school.  He was allowed to drive the family cars and he was listed as a driver on the family auto policy.  His parents provided clothing, food, a cell phone and other maintenance items including cash.  He was maintained on his mother’s health insurance through her employer because she represented he still lived with the family. Finally, the son intended to return to the family home after school concluded.

While away at school, the son borrowed his friend’s car and was involved in a motor vehicle accident and suffered bodily injuries requiring medical care.  The family auto insurance and the friend’s auto insurance each denied liability to pay the injured son’s medical bills pointing the liability finger at each other instead.  Under the no-fault law, one is covered by family auto insurance provide s/he is considered “domiciled” in the family household.  MCL 500.3114(1).  The Court of Appeals held that the son was domiciled in the family home, thus holding the family auto insurer liable to pay his medical bills.  The court reasoned that while young adults who transition from parental homes to independent living arrangements pose special problems in determining domicile, children studying abroad who clearly have not severed ties to the family household such as this case, remain legally domiciled in the family home.

What this means for injured persons:

Frankly, the outcome really does not matter for the injured person because either way, s/he is going to be covered by no-fault insurance.  If the facts were tilted in the opposite where a return to home or fewer ties existed, then the injured son would have been covered by the friend’s auto insurance.  MCL 500.3114(4).  What this case importantly illustrates, however, is the correct decision by the injured person to timely file a lawsuit against both insurance companies to protect his rights under the no-fault law.  Failure to file suit within one year [MLC 500.3145] and/or to name both insurers could have been fatal to his claim.   Has he not done either, the medical bills could have become his legal responsibility.

Thus, always submit your claims to all potential auto no-fault insurers in the chain of priority under MCL 500.3114 and/or MCL 500.3115.  The general rule is that one of the insurers will accept responsibility and then settle its dispute with the other; regrettably, more often than not, no-fault insurers do not follow the law hoping instead that the injured person will not learn that if s/he does nothing about it within one year, the claim is lost.  MCL 500.3145.

Another recommendation to follow is that when two or more auto insurers are disputing liability, the injured person should file a claim with the Michigan Assigned Claims Facility [MCL 500.3172].  The MACF, by law, will literally randomly assign the claim to a third auto insurer which must pay the benefits and seek recoupment from the other insurers who are later determined to be legally liable.  Failure to timely submit a claim to the MACF within the one-year rule [MCL 500.3145] is likewise fatal to that claim, too.

What this means for medical service providers:

This case illustrates is that medical providers must continue to be diligent on intake and discover the identity of all potential auto insurers within the chain of priority [MCL500.3114 and MCL 500.3115] and then submit the claim to them all.  And where the potential insurers refuse responsibility, the provider must file its own claim with the MACF, too.  Finally, the one-year time limitation [MCL 500.3145] applies to medical providers too and therefore, they must be equally cognoscente of this fact and keep watch.  Medical providers cannot rely on patients to take action on his/her own; often they do not and ignore repeated efforts at collection.  Therefore, providers must be pro-active and pursue their claim directly against the auto insurers.

Injured people and medical providers can obtain an application to file a claim with the MACF here.

And, you can read the Opinion that provided the back-drop for this discussion here.

Authored by L. Page Graves

Facts & Ruling by Court:

An adult was placing personal items into her motor vehicle which was parked.  She had reached into the passenger side of the vehicle with its door open.  In one fluid motion, she stood back up to regain her upright balance and stepped away from the car while also shutting the door with her hand.  It was at this point that she slipped and fell on a patch of ice beneath her feet and suffered bodily injury requiring medical care.  The no-fault law provides coverage when a person is “entering” or “alighting” from a parked motor vehicle [MCL 500.3106(1)(c)].  The Michigan Supreme Court ruled that the injured person was not “alighting” from her motor vehicle because, it reasoned, she was in no way reliant upon the vehicle itself to maintain her balance.  The Court said she had already alighted and that closing a car door is not part of the alighting process.

 

What this means for injured persons:

 

This is new law created by the Court.  Closing the door used to be considered a part of the alighting process since the no-fault act was enacted in 1973.  Now it is not.  Therefore, in fact patterns identical to this case, injured persons are no longer covered by their auto no-fault insurance which they must purchase as mandated by law.  Instead, coverage for their medical care falls to any other accident or health coverage applicable (e.g., BC/BSM, Medicare, Medicaid, etc.) or private pay.

 

What this means for Medical Service Providers:

 

In fact patterns identical to this case, medical providers can no longer pursue auto no-fault coverage in cases just like this.  Instead, they must submit their claims to the patient’s applicable health coverage.

 

You can read this Opinion here.

 Authored by L. Page Graves


Michigan consumers are shocked when they learn that their auto insurer is not their advocate but instead is their primary adversary. Despite responsibly paying those costly premiums for mandatory no-fault insurance, injured accident victims are repeatedly dismayed when they learn that their very own no-fault insurer’s/adjuster’s strategic goal in handling their claim is to find (or many times, manufacture) an excuse to deny paying medical bills and lost wages. Michigan consumers need to know what their legal rights are and how to fight back to recover the benefits they paid for, for all those years without having to make a claim.

Your No-Fault Rights and What You Must Do to Protect Them

Introduction

This article provides you a general understanding of your rights under the Michigan No-Fault Insurance Law. It also provides you helpful suggestions to protect your potential benefit claims. This article is not all-inclusive because there are several exceptions and exclusions to No-Fault benefits which may be applicable to your claim or case; therefore, you should not rely on this post as legal advice.
Your Legal Rights
When you are involved in an automobile accident, you are entitled to certain benefits under the Michigan No-Fault Insurance law, regardless of fault. Your basic no-fault benefits potentially available to you include coverage for your medical expenses, wage loss, household services and survivor’s loss.

Your auto insurance company is required to pay these benefits to you within 30 days from when it receives reasonable proof of your claim, e.g., copies of your medical records validating your injury and temporary disability from work. If your insurance company does not pay your benefits after 30 days, it is also required to pay you 12% interest per annum as to each claim. If your auto insurer unreasonably denies your claim, you may also be able to recover reasonable attorneys fees.

Also recognize that because you were injured, you may have a separate legal claim against the at-fault driver, the owner of the vehicle involved and/or your own insurance company (if the at-fault driver was not insured) for fair compensation for your injury, disfigurement, pain and suffering.
What Should You Do If Your Auto Insurance Company Does Not Pay or
Denies Your Claim?

You must file a lawsuit within 12 months from the date that you incurred the particular expense not paid or denied; otherwise, you will lose all rights to be reimbursed for that particular expense. While you have 12 months to file a lawsuit, it is advisable to seek legal representation as soon as you are experiencing difficulty with your auto insurance company so that your lawsuit/claim is properly documented and preserved.

Your No-Fault Benefits

Medical expenses: all reasonable charges for products, services and accommodations reasonably necessary for your care, recovery or rehabilitation for injuries caused by the auto accident. These benefits are available to you for as long as you live. Common examples include hospital care, doctor visits, physical therapy, and prescriptions and family provided attendant care; related expenses may also include mileage to and from the medical care providers or handicapper modifications to your home and/or vehicle.

Importantly, your no-fault insurer cannot direct or dictate where, when or why you receive medical care. You should resist any attempt by it or a nurse case manager it assigns to you, to manage your care. And regarding nurse case managers, you can choose your own too and not accept the person “assigned to you”. The assigned case manager typically has one motivation and that is to please the no-fault insurer’s ultimate goal: reduce payments.

Wage loss: you are entitled to a minimum of 85% of your lost wages for time off due to your injuries caused by the auto accident. This benefit is available to you for up to 3 years from the date of the accident but is subject to a maximum monthly benefit, adjusted every year by the Michigan Insurance Bureau.

Replacement services: you are entitled up to $20.00 dollars a day for up to 3 years from the date of the accident, for reasonably incurred expenses for ordinary services performed by family or friends, that you traditionally performed but now cannot because of your injuries. Examples of such services include, but are not limited to, ordinary household tasks like mowing the lawn, cleaning, laundry, etc.

Survivor’s loss: the dependents (spouse and children) of a deceased individual who is killed in an automobile accident are entitled to a survivor=s loss benefit for up to 3 years from the date of the accident, subject to the same maximum monthly benefit formula applied to wage loss.
Coordinated Benefits & Setoffs
If you have other health or accident coverage through you employer or spouse, you may have purchased coordinated auto no-fault coverage for a lesser premium. If so, then your health coverage is primary and your auto coverage only pays for expense not covered by your primary health coverage.

Whether you have purchased coordinated no-fault coverage, your auto insurer is able to reduce your benefits that are available to you under state of federal law. A critical exception is that neither Medicare nor Medicaid is responsible for medical expenses when no-fault coverage is available. In that instance, no-fault is always primary.
What Should You Do?
A. If injured, immediately seek legal counsel regarding your potential claim for injury, disfigurement and suffering against the other driver.

B. Immediately file an Application for No-Fault Benefits with your insurance company. Failure to do so within 12 months of your automobile accident will prevent you from ever obtaining those benefits that you are entitled to receive.

C. Monthly, submit a claim letter for reimbursement of medical expenses, wage loss and replacement services. Always include your name, claim number and date of the accident. Always submit, if available, copies of your receipts, work releases or notes from your doctors or your employer, and summaries of household jobs done on your behalf (see below).

Medical Expenses:

A. Inform all medical providers (hospitals, doctors, etc.) of your insurance company name and claim number.
B. Submit copies of all receipts for medical expenses incurred (e.g., prescriptions) to your insurance company.
C. Keep a log or diary of all miles driven to and from medical providers.
D. Request letters from physicians/therapists recommending needed expenditures for rehabilitation devices or equipment.
E. If requested to submit to an independent medical exam set up by your insurance company, take a family member or friend with you and time the duration of the entire exam.

Wage loss:

A. Request letters or notes from your doctor(s) who have placed you on work restrictions with the applicable dates; diary or log each and every day missed from work (if an hourly employee, calculate hours for potential overtime loss).

Replacement services:

A. Orally or in writing agree to pay family members or friends up to $20.00 dollars a day for help around the home.
B. Diary or log all services performed on your behalf identifying the nature of the service performed and who performed it.
C. Request letters or notes from your doctor(s) who have placed you on general restrictions (e.g., no lifting).

Authored by L. Page Graves