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A Brief
History
The Michigan No-Fault law went into
effect in 1973. The law was enacted in
large part because injured Michigan
drivers without private health insurance
were forced to file a lawsuit against
the party at fault to collect payment
for medical bills. Because those
lawsuits frequently took years to
resolve, Michigan citizens injured in
automobile accident were not getting
appropriate medical care.
As a result, automobile insurance
companies in Michigan struck a
compromise. Insurance companies insuring
automobiles in Michigan agreed to pay
various benefits, including medical
care, to its own insured drivers and
passengers without regard to who was at
fault in the accident. In exchange,
automobile insurance companies no longer
had to pay compensation for pain and
suffering for injuries caused to third
persons by its own insureds -
unless the injured party could prove
that his or her injuries reached a
threshold of - serious impairment of
body function.-
No-Fault
Benefits Available
No-Fault benefits are also referred to
as First-Party benefits or PIP (Personal
Injury Protection) benefits. The
No-Fault benefits available to
individuals injured in a collision
include:
-
LIFETIME MEDICAL CARE, including
medical bills, attendant care
services, hospital and doctor
co-pays, and prescription costs
-
LOST WAGES up to three years after
the collision
-
HOUSEHOLD REPLACEMENT SERVICES up to
three years after the collision
-
REIMBURSEMENT FOR MILEAGE to and
from medical and rehabilitation
facilities
With respect to medical care, the
automobile insurance company is
obligated to pay medical bills for the
life of the insured as long as the
medical care is reasonably related to
the injuries sustained in the automobile
accident and the type and cost of the
care is reasonable. The medical care
benefit also includes payment for
-attendant
care.-
Attendant care is where the injury was
so severe that another person, typically
a nurse or a family member, is required
to provide some level of medical care
for the injured person. The attendant
care provider is usually paid an hourly
fee. The medical care benefit also
provides reimbursement for mileage to
and from the doctor's office and can
include the cost of remodeling a home to
accommodate the special needs of the
injured individual.
If the injured individual also has
private health insurance, that medical
coverage and the automobile insurance
company is usually
-coordinated.-
When the coverages are coordinated, the
private health insurance company is
primarily responsible for paying the
medical bills and, to the extent the
private insurance carrier does not cover
certain medical care or covers only a
portion of certain procedures, the
automobile insurance carrier must pay
the balance. Automobile insurance is
never coordinated with Medicaid or
Medicare health plans and, therefore,
the automobile insurance would be
primary for individuals covered under
those health plans. A complete review of
one's automobile insurance policy is
necessary to determine the specific
coverage for that individual.
Lost Wages
If the accident-related injury causes
the individual to miss work, the
automobile insurance company must pay
85% of the gross wages lost for a period
of up to three years after the
collision.
Household
Replacement Services
If the injured individual is unable to
provide help in the upkeep of the home
which he or she used to provide prior to
the injury, the automobile insurance
company must pay another individual,
including family members, up to $20.00
per day for up to three years to provide
these services.
Whose
Automobile Insurance Company Has To Pay
The No-Fault Benefits?
In Michigan, determining which car
insurance company is responsible to pay
your no-fault benefits is complicated.
Regardless of whether you are injured in
your own automobile or while driving or
a passenger in someone else's vehicle,
you must make your claim for No-Fault
Benefits to the automobile insurance
company which insures the vehicle you
own. If you do not own a vehicle, you
must make the claim for No-Fault
Benefits to the insurance company which
insures your spouse's vehicle or insures
any vehicle owned by a relative living
in your home. If other relatives living
in your home do not own a vehicle, then
you must make the claim for No-Fault
Benefits to the insurance company of the
owner of vehicle you were in and if the
owner of that vehicle was uninsured, you
must make the claim for No-Fault
Benefits to the insurer of the driver of
the vehicle you were in at the time of
the injury.
It is important to note that if you are
injured while occupying a vehicle you
own which is uninsured, you are
precluded from obtaining any No-Fault
Benefits from any insurance company. It
is also imperative that you make a claim
for No-Fault Benefits to the appropriate
insurance company, in writing, within
one year of the date of the injury or
you will forever lose your right to
obtain these benefits.
As with any set of complicated statutory
laws, the above outline is intended
simply to provide general information.
There are always exceptions to the
general rule and there can be shorter
time limits involved in pursuing your
specific claim. We recommend that you
consult with an experienced No-Fault
attorney at Powers Chapman before you
make the initial claim so that your
claim is appropriately and timely made
and you receive all of the benefits to
which you are entitled under the law. |
