By L. Page Graves, Smith & Johnson, Attorneys, P.C.
This brochure 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 brochure 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 brochure 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 assistance 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 attorney 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 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. This includes services provided by a Certified Nurse Case Manager of your own choosing; if your insurance company assigns a case manager, you have the right to discharge that individual and select your own, instead.
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?
- If injured, immediately seek legal counsel regarding your potential claim for injury, disfigurement and suffering against the other driver.
- Immediately file an Application for No-Fault Benefits with your insurance company. Failure to do so within 12 months of your automobile accident will forever bar your rights to collect benefits.
- 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. Inform all medical providers (hospitals, doctors, etc.) of your insurance company name and claim number. Keep a log or diary of all miles driven to and from medical providers. Request letters from physicians/therapists recommending needed expenditures for rehabilitation devices or equipment. 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. 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). Orally or in writing agree to pay family members or friends up to $20.00 dollars a day for help around the home. Diary or log all services performed on your behalf identifying the nature of the service performed and who performed it. And, request letters or notes from your doctor(s) who have placed you on general restrictions (e.g., no lifting).