YOUR NO-FAULT RIGHTS The purpose of this document is to answer the basic questions most often asked about No- Fault. It is not intended to be legal advice, but rather to help you generally understand your rights. For specific questions or problems please contact us. Michigan s No-Fault law, adopted in 1973, can be confusing and complicated. The important thing to remember is that you must file a No-Fault application immediately and let us know if, after a reasonable period of time, you are experiencing any difficulties with the insurance company. 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. This document will attempt to answer questions if you have been injured in an accident involving a car, truck, bus or other motorized vehicle. Which insurance company pays for your benefits depends on a variety of circumstances, but the benefits themselves are the same regardless of which company pays. Most Important Goal: Your Rehabilitation and Recovery Regardless of whether someone else may be 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 circumstance, refuse to follow medical advice because it might help a lawsuit. Doing so is the worst thing you could do for yourself. Your full recovery and rehabilitation should be your primary goal after you are injured in an accident.
Anyone injured in a motor vehicle accident in Michigan is entitled to certain no-fault benefits, unless you were driving a car that you owned and that car was uninsured at he time of the accident. Pedestrians, bicyclist and sometimes motorcyclists are entitled to these benefits. These benefits, which will be fully described below, include medical expenses, wage loss, replacement services, attendant care, and medical mileage. Medical/Allowable Expenses: YOUR BENEFITS: A. Medical Bills & Medical Mileage: You are entitled to be reimbursed for all accident related medical expenses for the reminder of your life, even if you change insurance companies. This can include co-pays for doctor visits, prescription costs etc. You should keep a monthly list of expenses incurred and submit this list every month to your carrier. Medical mileage is payable indefinitely for any trips that are made for medical purposes as a result of the injuries from your accident. You should submit this form monthly, also. If you have coordinated medical no-fault coverage, and if you have health insurance, you must first submit your bills to your own health insurance company. Any amounts not paid by your health insurance company must then be submitted to and paid by your no-fault insurer. Note: there can be no coordination with medicare, medicaid or any other state or federal health insurance program.
If you have a coordinated policy you may have to submit, along with the outstanding bill, a copy of the Explanation of Benefits form (or EOB as it is commonly referred to ) that you receive from the health insurance carrier, this explains what the health insurance paid and what balance you may owe. B. Attendant Care/Nursing Services: If necessary, for your care, recovery and rehabilitation while you are disabled and unable to care for yourself. Some examples of this type of care include assistance bathing, grooming, getting dressed, administering medication, serving meals. Most insurance companies will; require a prescription from a doctor indicating that you need these services before they will pay. The hours spent by the person taking care of you must be logged on a record form and submitted monthly to the carrier. This reimbursement is owed regardless of who is performing the serves, including family members. We have Attendant care forms is you are in need of these services and we can assist you in filling out the same. C. Anything necessary for your care, recovery, or rehabilitation: Your entitlements are endless and can include, braces, wheel chairs, walker s recliners, tens units, vocational/occupational retraining, modifications to your home, transportation or modifications to a van, anything that is reasonable and necessary for your care or recovery.
Wage Loss: You are entitled to wage loss (85%) of your gross wages for the period(s) of missed work as a result of the injuries sustained in your accident. You may be entitled to receive wage loss benefits up to a maximum of 3 years following the accident. (Note: A physician s statement may be required by the carrier.) Replacement Services: These are services or things that you would normally do, but because of your injuries, cannot. Examples include cutting lawn, doing laundry, cleaning, etc., this benefit is limited to $20.00 per day and is payable for up to 3 years. These services can be performed by anyone including family members and a record should be kept for submission every month. We have replacement services forms for your use if you require said services and we would gladly assist you in filling out said forms. WHO PAYS MY BENEFITS: One rule that seems to perplex Clients is that even if you are not at fault for the accident, you still must make a claim against your own insurance company. If you do not have insurance do not worry, there is an effective system in place to ensure that you receive these significant, life saving benefits from another carrier.
If you, nor your spouse have insurance the next order of priority is the insurance carrier of a relative with whom you resided with on the date of the accident (even if that relative was not involved in the accident). If you did not reside with a resident relative you would potentially obtain no-fault benefits from the insurance carrier from the vehicle you were riding in or the owner of the vehicle you were riding in. If none of those individuals have insurance the state of Michigan has an Assigned Claims Unit which assigns your claim to a participating insurance Company. Thus, no matter what your predicament, there is insurance coverage somewhere that will provide you with these very valuable benefits. TIME LIMITATIONS: To secure these benefits, there are some important things that you must do. First of all, you must immediately file a No-Fault Application with the applicable insurance carrier. Nothing starts until you file this application. This application must be filed within twelve (12) months from the date of the accident, or you will forever lose any benefits to which you might be entitled. Secondly, if any particular item of reimbursable expenses is not paid by your insurance carrier, you must file a lawsuit for the particular item within twelve (12) months from the date that such expenses was incurred, If such a lawsuit is not filed within that twelve (12) month period, again, you will lose all rights to reimbursement for that particular item of expense. As a resident citizen of the State of Michigan, you have a right to collect no-fault benefits if you are injured in an automobile accident. These benefits should come to you without the need of hiring an attorney to collect them for you.
Because of this, our office will not be representing you for your no-fault benefits at this time. It will be your responsibility to file the No-Fault Application and to see that all necessary bills for reimbursable expenses are submitted to the insurance carrier. If we do not hear from you to the contrary, we will assume that everything is going smoothly and that your automobile insurance company is paying your benefits properly, as they should. HOWEVER, if you are experiencing any trouble with your insurance carrier, then be sure to call us so that we can discuss the necessary legal action to protect your rights to benefits, and to make sure that you do receive these benefits to which you are entitled to receive under the law. We are attaching some helpful tips for handling your OWN Michigan No-Fault Claim. Again, Please contact us here at Winston McGlynn if you have any questions or are uncertain about how to make a claim, whom to make the claim to, what you are entitled to, or if in the event your carrier is refusing to pay.
TIPS FOR HANDLING YOUR OWN NO-FAULT CLAIM: * Request an application for benefits from the no-fault insurance company. Typically all no-fault claims begin with an application for benefits. If your carrier fails to send you such an application we have provided one on our website that can be printed and completed. This application, along with the police report must be submitted within 1 year of the crash. * Complete the application for benefits form & Submit. Once you have completed the form and signed the medical authorization return it to the no-fault carrier promptly. Again, you must file the application for benefits within 1 year of your accident. You may want to send this application via certified mail or facsimile to insure that you have proof of receipt by the carrier. * REMEMBER the 1 Year Back Rule: In Michigan the insurance carrier is not liable for payment of claims submitted to them after one year of the bill being incurred. Therefore, you should promptly submit any expenses you incur to your carrier and be hyper vigilant in confirming said bills are paid within one year as well. * Keep Good Records: It is very important that you keep good records. In the event our office had to take over the handling of your no-fault case, we would request your records to see what has and has not been paid. The more documents you have to prove your claims the better. Insurance Carriers like the IRS require documentation, documentation, documentation. * Keep Copies Of Everything: Make a copy of all documents submitted to the carrier including the application, medical expenses, replacement service forms, medical mileage, etc. Additionally, keep all letters sent to you by the carrier. It is hard to determine what will be important later, thus keeping all documents is for your own protection later. Keep all of your paperwork together in a folder is what we have found the most helpful and it helps keep you organized as the paperwork accumulates.
* Keep Track of Submission Dates: The Michigan No-Fault Act Provides a carrier 30 days upon receipt of reasonable proof to pay the benefit. Thus, on your copy write the date that you mailed the information to the carrier. Then if the carrier delays in paying your benefits you are able to demand penalty interest if paid beyond 30 days. * 30 Days is 30 Days: Once the expense has been submitted, the carrier has 30 days to pay or deny the claim. If 30 days passes and no action is taken on the claim, contact the adjuster in writing (via Fax is good too) as to the status of your submission. Unless the carrier is claiming it did not have reasonable proof, 30 days is 30 days to pay the benefit. * Make Certain that All Bills Have Been Paid: When you receive payment on a claim, or proof of payment of a bill, write the date of the check and the amount paid on your copy. Make certain that all bills and benefits are paid within 1 year. Note that keeping proof of payments may help establish that the Carrier routinely delayed paying benefits. * You may have to forward payment to the appropriate medical providers if the insurance company sends you the payment. The above information is not meant to be comprehensive. Please contact the attorneys at WINSTON McGLYNN, P.L.L.C., for more detailed information specific to your claim.