What If I’m in a Crash?
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Michigan No-Fault Law: Frequently Asked Questions (FAQ)
The most important thing to do after a SERIOUS AUTO, MOTORCYCLE or TRUCK ACCIDENT occurs is to make sure that everyone involved is in a safe place and out of harm’s way. The next step is to call the police and EMT assistance. If you or anyone else is injured, get medical help right away. Once this is done, it is important to immediately begin gathering as much information from the motor vehicle accident scene. You must write down details about the facts and your observations at the scene of the accident. If you or someone you know is able to, TAKE PICTURES of the accident scene showing the location of the vehicles after the crash and showing the damage to the vehicles – as soon as possible after the crash. Take pictures of the damage to the vehicles and pictures of all injuries and wounds.
Michigan’s no-fault law, adopted in 1973, can be confusing. It is a “no-fault” system, which means that certain benefits are paid by your own insurance company even if the other person was at fault. It also means that you are entitled to certain benefits even if you are at fault for the crash.
If you have been injured in an accident involving a car, truck, bus or other motorized vehicle, the insurance company that pays for your benefits depends on a variety of factors. However, the benefits themselves are the same regardless of which company pays.
Even if someone else is at fault for your injuries, your major focus should be on getting better and following the recommendations of your doctors and therapists. Do not under any circumstances refuse to follow medical advice because “it might help a lawsuit.” That is the worst thing you could do. Your full recovery and rehabilitation should be your primary goal after you are injured in an accident. You should get written medical restrictions from your treating doctor and follow those completely. You should also get pictures of your injuries (lacerations, casts, bruises, etc.).
Yes, generally. There are very few circumstances in which you would not be covered for no-fault Benefits. The term “No-Fault Benefits” is also sometimes referred to as “First-party Benefits” since you make a claim to and receive these benefits from your own insurance company, regardless of who was “at-fault” for the motor vehicle accident. You should consult an attorney if your application for benefits to your no-fault insurance carrier is denied. However, if you were the owner of an uninsured vehicle and operating that vehicle when involved in an accident, you would not be eligible for benefits.
You fill out a simple one-page application that your insurance company will send you upon request. The form is a notice to the insurance company about the accident. You provide your name, address, details about the accident, and the nature of your injuries. It also includes permission for the insurance company to investigate your claim. You have one year from the date of the accident to make an “application for benefits” with your insurance company.
If you own a car or truck that is insured under Michigan law, your own insurance company will pay your benefits (medical bills and wage loss) under most circumstances. It does not matter if you were the driver, a passenger, a bicyclist, or a pedestrian. Injuries from motorcycles crashes are one of the rare exceptions to this rule and are treated differently.
If you were injured while in a motor vehicle and you do not have auto insurance on a vehicle you own, you would collect your benefits from the insurance company that covered any vehicle owned by a relative you live with. If no one you live with is covered by auto insurance, you would collect your benefits from the insurance company covering the car (or driver) in which you were riding (driving) or if that car is uninsured, from the no-fault insurer of the other car (or driver).
Remember, if you knowingly own and drive an uninsured car or truck, you are probably not eligible for no-fault benefits.
This is one of the rare exceptions under the no-fault laws. You would collect benefits from the insurance carrier for the commercial vehicle in which you were a paying customer.
Under these circumstances, Michigan has the “Assigned Claims Facility.” The State of Michigan will assign an insurance company to provide your benefits. You would file the application for benefits form with the Assigned Claims Facility:
Assigned Claims Facility
7064 Crowner Drive
Lansing, MI 48917
In summary, your rights consist of payment of reasonable and necessary medical bills, including medical services, accommodations and rehabilitation for the rest of your life for injuries suffered in the accident. Your benefits also include wage loss. You must have written medical restrictions from your doctor to qualify for wage loss benefits. These wage loss benefits from your insurance carrier are subject to monthly maximums and are paid only for the first three (3) years from the date of the crash.
Your insurance company will also pay up to twenty dollars ($20.00) per day for services you used to provide for yourself or your family (dishwashing, snow removal, lawn mowing, etc.) that you are medically restricted from doing and must hire someone else to perform. These are called “replacement services” and may be paid by your insurance carrier for services done within three years from the date of the crash. Additional benefits include mileage to and from medical and physical therapy appointments and payment to people who provide medical assistance to you at home, even if they are your relatives.
Long-term benefits for seriously injured people (spinal cord injury, brain injury, amputation, etc.) are perhaps the most complex area of no-fault law. These may include extended rehabilitation benefits as prescribed by your doctor. These also may include payment for the daily specialized care given to an injured individual, even if that care is provided by a family member. Your treating doctor should provide you with a script for these long-term benefits. It is beneficial to consult with an experienced attorney to discuss the full range of benefits that are available under Michigan law.
Benefits are also available to survivors of someone who has died as a result of an automobile accident. Children and spouses of a person who has died in a car crash may be entitled to a burial expense benefit and survivor loss benefits for a period of three years from the date of the crash. This complex area includes probate law issues and may require the assistance of an experienced attorney.
Under some no-fault policies, your health insurance company pays the medical benefits it provides and your no-fault carrier pays the rest. These will be identified as “excess” or “coordinated” medical benefits in the insurance policy itself. Other no-fault policies are not “coordinated” and those policies pay your entire medical bills even if you have health insurance. The declaration page (first page) from your no-fault insurance policy must state clearly whether your medical benefits in that policy are “coordinated” or “excess.”
In some situations, your general health insurance provided by an employer may not cover injuries related to automobile accidents and shifts primary responsibility for your medical benefits to your no-fault carrier. This will be stated in your benefits handbook from your employer. Your no-fault insurance carrier may then become primarily responsible for your medical bills. If you have a “coordinated” or “excess” no-fault policy and you do not have health insurance, you will probably have to pay a “deductible,” but your no-fault carrier will be responsible for these bills after the deductible is paid.
Your no-fault carrier has the right to subtract from the wage loss benefits it pays to you all workers’ compensation and Social Security payments you receive as a result of the injury from the crash. Medical benefits you may be entitled to through Medicaid or the Federal Medicare programs are always “secondary” to any medical benefits a no-fault insurance carrier is required to pay. You must make sure your healthcare provider (doctor or hospital) sends the bills to the no-fault insurance carrier for payment.
The Michigan law permits you to make a claim against the at-fault driver for these “human losses” (or non-economic losses) under limited circumstances. First, you must have been seriously injured. The law defines serious injury as “death” or the “serious impairment of an important body function” that affects a person’s “ability to lead his/her normal life” or “permanent serious disfigurement.” You cannot be more than fifty percent (50%) at fault in the accident. The extent of the physical limitations caused by your injury and the duration you will suffer with these limitations are important factors in deciding if your injury qualifies as a “serious impairment of a body function” under the no-fault statute. This is a complex determination that looks at how an injured person’s life has changed as result of the injuries from a crash. The extent to which the physical limitations have affected your life should be documented by your health care providers through written medical restrictions.
The law in this area is constantly changing. If you have suffered “serious injuries” and another person is 50% or more at fault in the crash, then you should seek the help of an attorney experienced in Michigan no-fault law. This is the only way your rights will be protected. Attorney Richard J. Stolcenberg has been protecting the rights of people seriously injured in auto crashes and their families for more than twenty years.
If there is a dispute over the seriousness of your injury, most likely a Judge will make the decision on this issue. The Judge will decide this using the definitions created by the Michigan Supreme Court. In some limited circumstances, a Jury may be allowed to make the decision.
Wage Loss After an Accident
Your own no-fault insurance carrier pays your wage loss while you are unable to work because of your injuries. This is for a maximum of three (3) years from the date of the accident. This is paid to you even if you were at fault for the accident or were a passenger in the car or a pedestrian. You must get written medical restrictions from your doctor to qualify for wage loss benefits. You will get your no-fault benefits from one of the no-fault insurance carriers in the following order of priority:
- Your no-fault carrier.
- If you do not have coverage, then the no-fault carrier of your spouse or other relative living with you who owns an insured motor vehicle.
- If no one in your household has no-fault coverage, then from the owner/driver of the car in which you were a passenger.
- If the car in which you were a passenger does not have no-fault coverage and another car was involved in the accident, the other driver’s/owner’s insurance carrier.
- If none of the vehicles involved in the accident are insured, then from the Assigned Claims Facility.
Remember, if you were the owner and the driver of an uninsured vehicle, you may not be eligible to recover wage loss benefits, even if the other driver was at fault.
85% of your average gross wages (based upon the previous six months earnings), including overtime and any wage increases and bonuses you would have received had you been working. Wage loss benefits are tax-free, which is the reason you receive only 85%. Self-employed people are paid based on the adjusted gross income reported on their prior year’s tax returns.
Maximum wage loss benefits are set by law, based on of the date the crash occurred. For example, for an accident occurring between October 1, 2003 and September 30, 2004, the maximum wage loss benefit is limited to $4,156 per month, or $49,872 per year.
The authorization form you sign for your insurance company will permit your employer to release your employment records to your insurance company. Your treating doctor must provide you with written medical restrictions to qualify for no-fault work loss benefits. You should always keep a copy for your records of these restrictions and all documents sent to your insurance carrier.
This is a limited situation where you are permitted to make a claim against the at-fault driver (and owner of the car) and their insurance carrier, for an economic loss not covered by your no-fault insurance carrier. You may make this claim even though you may not have suffered a serious injury. To make this claim you need to prove you are restricted from the physical requirements of your employment by written medical restrictions from your doctor and that those restrictions will result in lost work beyond the three year no-fault benefit.
If you were not employed and not actively looking for work, you may not be entitled to work loss benefits from your no-fault carrier. You should still have your treating doctor provide you with a list of physical limitations caused by your injury.
Accidents & Medical Expenses
Your insurance company will pay all “reasonable and necessary” medical expenses required because of your injury for your entire life. Your treating doctor must prove the medical expenses were for injuries you suffered in the accident. You must make a claim for no-fault benefits from your insurance carrier within one year from the date of the crash in which you were injured. Once you have made an “application for benefits” with your insurance carrier, you must then give your no-fault carrier the bill for any medical expenses you have because of your injury within one year from the day you were treated by that health care provider. Make and keep copies for your records of all letters, prescriptions, work restrictions, and medical bills sent to your insurance carrier and write the date you sent them to the insurance company on your copies.
Medical Benefits Include:
- Doctors, hospitals, ambulances, home health care, occupational and physical therapy, nursing homes, rehabilitation, etc.
- Medical and other equipment necessary for your care, recovery and rehabilitation.
- Mileage to and from the doctor, hospital, or clinic, such as physical therapy.
- Rehabilitation: Vocational, and if necessary, educational.
- Doctors, hospitals, ambulances, home health care, occupational and physical therapy, nursing homes, rehabilitation, etc.
- Medical and other equipment prescribed by your doctor as necessary for your care, recovery and rehabilitation.
- Mileage to and from the doctor, hospital, or clinic, and physical therapy appointments.
- Rehabilitation: Vocational, and if necessary, educational.
If you were the owner of an uninsured car, and you were injured in an accident in that car, you may not be entitled to No-fault Benefits.
The no-fault insurance company is responsible for working out any disputes with your health care providers (doctors, hospitals, etc.) the insurance company claims charged an “unreasonable” amount for their services. The insurance company may also try to claim some medical procedures or equipment are not “necessary” for your treatment or recovery. It is up to your doctor to provide support for the services or procedures required to treat your injuries.
Your no-fault insurance company will pay up to twenty ($20.00) dollars per day to have someone perform services for you or your family that you would have provided but cannot because of your injuries. These include such things as household chores, meal preparation, babysitting for minor children, transportation, and yard work. This benefit may be paid to anyone who performs these services for you, including family members. The $20 is a daily rate. For example, you cannot hire someone for $40 one day and nothing the next. Replacement service benefits are payable for up to three years from the date of the accident. You have one year from the date the service was performed for you to make the claim to your no-fault insurance company for reimbursement for these services.
Other Types of Coverage
Be careful, the Michigan Supreme Court has decided that the wording of the insurance policy itself controls when and how soon after the accident you must make your claim for these benefits. It most likely will not be the three years you would have to file your claim against an insured at-fault driver or owner. You may also be required by your insurance contract to go through an arbitration procedure for this claim. You should have the help of an experienced attorney to properly protect your rights and make these types of claims. Attorney Richard J. Stolcenberg has represented many people and their families with this type of claim.
Some no-fault insurance companies offer additional coverage called “underinsurance coverage.” If you bought “underinsurance” coverage in an amount that is more than the “at-fault” driver/owner’s liability coverage, and you or a loved one die or suffer a serious injury in a crash, you may file a claim with your own insurance carrier to make up the difference between the amount paid by the other driver’s insurance and the value of your losses or injuries. Your claim will be limited by the amount of “underinsurance” coverage you carry. For a relatively small amount of money, you can protect yourself and your family in amount that would more sufficiently address your (their) losses.
There are usually strict requirements for making underinsurance claims. If those procedures are not followed, you may be prevented from recovering anything from this part of your policy. Your no-fault carrier will require proof of the seriousness of your injuries and the inadequacy of the at-fault driver/owner’s liability insurance. Your insurance carrier must also consent to settlement with the at-fault party and generally receives a “credit” for all money you obtained from the at-fault driver/owner of the other vehicle. The provision may also not allow you to settle with the insurance carrier for the underinsured at-fault driver/owner unless your insurance carrier agrees or consents to the settlement.
Although you are dealing with your own no-fault insurance carrier in making an “underinsurance” claim, these are often difficult and complex claims. You should have help from an experienced attorney in making and supporting these types of claims.
Michigan No-Fault Law Highlights
All insurance companies are different. A few insurance companies try to pay all of the benefits to which you are entitled. Some insurance companies will not inform you of all of the no-fault benefits you may have coming to you or your family. Take pictures of your injuries and the damage to the vehicles in the crash. Keep the originals and give your insurance carrier copies if you are asked for them. Always get written medical restrictions from your treating doctor stating the limitations caused by your injuries. You may want to consult with an attorney to see if your company is paying you all of the benefits you are entitled to receive under Michigan Law. Often there is no charge for this service.
Owner of the At-Fault Vehicle:
Claims against the owner/driver of the vehicle that caused the accident if there was a death, serious impairment of an important body function or permanent serious disfigurement.
Your Own No-Fault Insurance Carrier:
No-fault benefits for “reasonable and necessary” medical treatment, services, accommodations and mileage from all medical appointments. Wage loss benefits and replacement service benefits for the first three years from the date of the crash.
Dramshop Claims if Alcohol was Involved:
Claims against liquor stores, bars, or restaurants that served alcohol to a visibly intoxicated person or a minor, who later caused an accident.
Some other types of claims that may be brought under some circumstances where a motor vehicle accident occurs causing death or serious injury include:
Product Liability Claims:
Claims against manufacturers/sellers of a defective product if it caused or contributed to the accident and your injuries. Examples include defective seat belts, improperly designed fuel systems, defective tires and vehicle rollover susceptibility.
Highway and Road safety claims:
Claims against a government agency that is responsible for the maintenance of the traveled portion of the road or highway.
These are only a few of the types of claims/lawsuits that may be brought. Each type of claim has specific legal requirements. You may wish to consult an attorney to investigate whether you have such a claim.
- No Insurance: A person who drives his own car and does not have insurance is not entitled to recover.
- Comparative Fault: Your damages will be reduced by your percentage of fault for the crash and your injuries. For example, if the other driver is 80% at fault and you were 20% at fault, you would recover only 80% of your damages.
- Limits on Your Recovery: If you were drinking or not wearing a seatbelt, your recovery may also be severely limited by percentages set by law.
- No Recovery: If you were more than 50% at fault, you generally cannot recover for your injuries.
All contracts with an attorney should be in writing and fully explained to you. You should not sign a contract unless you fully understand it.
There are procedures that must be followed to bring and settle a Wrongful Death claim.
If you received Workers’ Compensation benefits for your injury those benefits will be reimbursed from your settlement or lawsuit for things not covered by no-fault. Generally, you do not have to pay your no-fault carrier back for benefits it pays to you.
If a person is rendered mentally incapacitated because of an accident, a Guardian/Conservator/Personal Representative may need to be appointed by the Court.
Because additional claims may exist, all evidence, such as the car and seatbelts, should be preserved.
Photographs should always be taken of your injuries (casts, lacerations, bruises, etc.) to show the extent of the injuries. Pictures should also be taken of the damage to the vehicle and where the crash took place. You should take pictures to safeguard this information even if you do not think you want to make a claim or pursue an action.
No-fault tip: Examine the declarations page of your no-fault policy. If your policy says that you have coordinated or excess medical coverage, you may be at risk for an extreme hassle if you are injured in an automobile accident. Coordinated coverage means that you must first look to your health insurer for coverage for your injuries. Your auto insurance carrier will only cover auto related medical expenses that your health insurer will not cover. This creates a problem with who is required to provide what coverage. The result: a myriad of paperwork and requests to re-submit medical bills. Generally, you are better off have non-coordinated or full medical in your no-fault policy and the cost to change your policy to this type of “primary” coverage is minimum.