Frequently Asked Questions
What are the benefits that I am entitled to under the no-fault law? The benefits that you may be entitled to may include: 1. Work loss benefits, 2. Replacement service benefits, 3. Allowable expense benefits which includes payment for medical bills and attendant care, and 4. Survivors loss benefits. Other benefits may include reasonable expenses necessitated by the injuries sustained in the accident for the care, recovery or rehabilitation of the injured person.
What are first-party benefits? First-party benefits are benefits that an injured person may obtain from their own insurance company or other applicable automobile insurance company or from an applicable insurance company.
How do I obtain first-party benefits? To obtain first-party benefits you or your representative must first notify your automobile insurance company or other applicable automobile insurance company that you were injured in an accident. Then you should provide the applicable insurance company with the proper proof of loss which includes proving reasonable proof of the fact and the amount of loss sustained. The law does not require that this be done on any particular forms or document. The forms for making claims provided by an insurance company may be designed to actually limit your claims so you must be very careful about what you fill out.
What are third-party damages? Third-party damages are very different from first-party benefits. Third-party damages are claims that are made against the owner or operator of the automobile that was at fault for the collision. Third-party benefits are generally for noneconomic loss like pain and suffering and mental anguish. Third-party claims generally do not include claims for economic loss, but there are exceptions such as excess wage loss.
How long do I have to wait for the insurance company to pay my claim? An insurance company has 30 days to pay any benefit after reasonable proof of the amount of loss sustained has been provided to the insurance company. Many times the insurance company will claim that it is “investigating” as an excuse for delaying benefits.
The insurance company asked me to fill out an application for benefits. Should I? Yes. Properly notifying the insurance company in the proper method and in the proper timeframe is essential to preserving your rights. As with all dealings with an insurance company, you or your representative must be very careful how you notify the company and what information you provide to the insurance company.
The insurance company assigned me a case manager – should I use that person? It is your choice to use the insurance company case manager or select your own. Although there are many reputable case managers in Michigan, whose role is to serve as a patient advocate, some who are hired by the insurance company feel their first duty is to the insurance company and not to you. Therefore, you should be very careful to ensure that the case manager is looking out for your benefits.
My family member is wheelchair bound as a result of the accident. How can I transport him to his doctor appointments? Providing transportation to medical appointments is an essential part of your no-fault benefits. If you are not able to provide transportation, the insurance company is responsible to pay for the reasonable costs of providing a transportation service. Under certain circumstances, the insurance company may also be responsible to modify a vehicle to meet an injured person’s physical requirements.
My house needs to be modified to fit my physical limitations because of the accident. How do I pay for this? Modifications to a home are considered an allowable expense and the responsibility of the no-fault insurance company in some situations. Because of the large expense of many home modifications, some insurance companies do not fully explain what is available. They often claim that certain expenses will not be allowed. Great care must be taken with how these expenses are presented to the insurance company.
What insurance company papers need to be signed? Documents that should be signed by the injured person relating to claims are of tremendous importance. Some forms that the insurance company requests to be signed can significantly limit your rights to current and future benefits.
What is attendant care? “Attendant care” is not defined in the no-fault law but is considered part of “allowable expenses” which are those services provided for an injured person’s care, recovery or rehabilitation. Typically, attendant care comprises those services that are provided as part of in-home care and rehabilitation. Often in-home services of this type are provided by family members. These services can cover a wide variety of care for injuries as varied as traumatic brain injuries, spinal cord injuries and many others. The type of care ranges from providing services such as the administration of medication to care for individuals with cognitive and emotional conditions. The services are often varied and depend on the individual’s needs and the directives and prescriptions of doctors, therapists, and the treatment team.
If a family member provides attendant care, can they get paid by the insurance company? Yes. Attendant care benefits are considered “allowable expenses” under the no-fault act and therefore the insurance company must pay properly presented claims. If a family member expects to be paid, the services are provided for the injured person and the treating doctor prescribes the services for the care, recovery or rehabilitation of the injured person then the insurance company is responsible to pay the reasonable value for these services.
What are Replacement Services? This is when someone replaces the injured person in an activity the injured would have done if the injured person had not been injured in a motor vehicle accident. Common examples include taking the trash to the curb or performing lawn maintenance. Michigan no fault benefits include a maximum of $20.00 per day for the first 36 months after an accident for replacement services.
Is there a limit to wage loss? Yes. Wage loss benefits are limited to 36 months. There are also monthly dollar limitations that change every year and are published by the Commissioner of Insurance.
Is there a limit to replacement services? Yes. Replacement service expenses are limited to 36 months and a maximum of $20 per day.
Is there a limit to medical expenses? There is no time limit to medical expenses. The costs of medical expenses are limited to reasonable costs for the goods or services. Medical expenses related to injuries sustained in the accident can be for millions of dollars and last a lifetime so long as the need for the medical care and treatment is related to injuries suffered in the accident.
Is there a limit to attendant care expenses? Benefits are available to an injured person for life, so long as the need for the attendant care is related to injuries suffered in the automobile accident. The cost of the attendant care is limited to reasonable costs for the services.
How much time do I have to pursue a claim for expenses sustained in an auto accident? You have only one year to notify the insurance company of your claim for benefits. You have only one year from the date each expense is incurred to properly present a claim for each expense.
Are motorcycle accidents covered by the no-fault law? In certain situations, motorcycle accidents are covered. Typically, the motorcycle must be involved in an accident with a motor vehicle. The no-fault act’s definition of “motor vehicle” excludes motorcycles and the meaning of “involved” has been hotly debated in case law interpreting the no-fault act.
What is the Michigan Catastrophic Claims Association? The MCCA is a legislatively created entity that reimburses no-fault insurance companies for all benefits paid above a certain dollar amount adjusted annually. The MCCA is not a private insurance company and much of its operation and accounting practices are shrouded in secrecy. It is believed by some that the MCCA is attempting to control and limit the no-fault benefits that are paid.
What is the Michigan Automobile Insurance Placement Facility? The MAIPF is a legislatively created organization responsible to ensure that certain owners of automobiles can still purchase no-fault insurance. Another organization, called the Michigan Assigned Claims Facility, which is managed by the MAIPF, provides a source of insurance coverage for certain situations where there may not be insurance coverage for an injured person.
How long am I entitled to first-party benefits? Work loss and replacement service benefits last up to 36 months. Allowable expense benefits – typically medical bills, attendant care benefits, transportation, and housing expenses – are available for as long as the injured person lives, so long as the expenses are reasonable and related to the injuries suffered in the motor vehicle accident.
What does it mean that “the expense must be incurred?” The no-fault act does not define the meaning of this word but case law suggests that to be incurred means there must be a legal responsibility to pay. In the situation where a family member is providing a service the rule would be the same; the family member must expect to be paid for the services they provide even though they may not be presenting a formal bill.
Can my family members be compensated for providing attendant care? Yes. Under current case law, family members may be compensated for the services they provide at home to an injured person needing care. The law recognizes that services are purchased at the reasonable market value.
What is the difference between replacement services and attendant care services? The law defines what are commonly referred to as “replacement service expenses” as those services “in lieu of those that, if he or she had not been injured, an injured person would have performed during the first 3 years after the date of the accident.” These are very different from “attendant care services.” Attendant care services are not defined in the no fault act but are considered by case law to be allowable expenses which are expenses for services rendered for an injured person’s care, recovery and rehabilitation. Many of the forms that insurance company’s send to family members for making attendant care claims ask for services often considered “replacement services” and are not only much less expensive for the insurance company but limited to a three year time period. When making a claim for any services provided to the injured person great care must be taken to ensure that the persons providing the care are properly compensated.
I’ve been injured. Under the no-fault law who is responsible for paying my medical bills? If you were injured in an automobile accident typically your own automobile insurer pays your medical bills. However, there are not only exceptions but depending on whether you were an occupant or pedestrian, if you were riding in public transportation, or even an employer owned vehicle, there are different “priorities” for making claims. Depending on the type of policy purchased –coordinated versus non-coordinated – your health insurer may be in a higher priority than your automobile insurer. There is no simple answer to this question and individual facts play a key role in answering this question.