No Fault Medical Benefits

Michigan car accident victims have access to medical insurance coverage through no-fault medical benefits. This is part of the state’s no-fault auto insurance requirements. According to the Michigan Health and Hospital Association, the law has guaranteed accident victims access to care they might not have otherwise received.

Recent changes to Michigan’s no-fault laws have left some accident victims struggling to understand the new processes. At Mike Morse Law Firm, we help accident victims navigate the no-fault medical benefits portion of insurance. After a free case review, we can assess whether you may be able to seek additional costs beyond your policy limits from another driver or his insurance policy.

What Are No-Fault Medical Benefits?

No-fault benefits, often called Personal Injury Protection insurance, pay for medical expenses related to car accidents regardless of who is at fault. They are required for all drivers under Michigan law. Historically, drivers were required to carry unlimited medical benefits insurance. However, recent changes to the law allowed a limited number of exceptions.

No-fault medical benefits are designed to pay for medical care for all listed individuals in the event of a car accident. This portion of an insurance policy is used for personal medical expenses regardless of who was driving when an accident happened or who was at fault. It also covers injuries sustained by a covered individual if they are struck by a vehicle as a pedestrian.

All household members are covered under a PIP policy, even if they are passengers in someone else’s car when an accident occurs or are struck as a pedestrian.

What Do They Cover?

No-fault medical coverage pays up to the listed maximums on the policy for:

• Medical care related to an auto, motorcycle or pedestrian accident
• At-home services for accident victims who need assistance with activities of daily living
• Lost wages resulting from an accident
• Other costs associated with recovery from an accident
• Death benefits in the case of fatal accidents

Drivers have the option to choose from several coverage limits. However, there are a few other limits that you should also be aware of, such as the amount of at-home attendant care you may receive. Additionally, lost wages are payable for the three years immediately following a covered accident.

What Isn’t Covered by No-Fault Benefits?

No-fault benefits offer comprehensive coverage for medical claims resulting from a car accident, regardless of who is at fault. However, they will not pay in certain situations, such as if your medical care exceeds your policy limit. Additionally, they do not cover:

• Personal property damage
• Injury to anyone else in the vehicle who is not listed on the policy
• Charges that are not considered reasonable and customary by an insurer
• Costs for care that are over the limits you choose for your policy

How Much Coverage Is Required?

Changes to the laws enacted in 2020 relaxed some no-fault medical benefits requirements. Drivers can now choose from several levels of coverage. The Michigan Department of Insurance and Financial Services outlines the following levels of coverage that any driver can purchase:

• Unlimited coverage
• $500,000 per person per accident
• $250,000 per person per accident

Additionally, the following coverage levels are available if drivers meet specific requirements:

$250,000 per person per accident with exclusions. This is available only if one or more of the following are met:

• The named insured has qualified (non-Medicare) health coverage or
• A related household member has qualified health coverage

$50,000 per person per accident. This is only available if the following conditions are met:

• The named insured is enrolled in Medicaid
• All related household members are enrolled in Medicaid, have qualified health insurance or are covered by another PIP policy

No medical PIP coverage. This option is only available if the following are met:

• The named insured has Medicare Parts A and B
• All related household members have qualified health coverage or coverage through another PIP policy

As part of a no-fault policy, drivers must also carry property protection insurance and residual liability insurance for bodily injury and property damage. These apply when a driver’s vehicle causes damage to stationary vehicles or personal property or under certain conditions when a driver is found legally responsible for an accident that results in injury or property damage.

When Are No-Fault Benefits Used?

Any Michigan driver involved in an auto accident uses their own no-fault medical benefits to pay for care for related injuries. Since all drivers must have coverage unless they meet specific exception criteria, all insured individuals will turn to their PIP coverage for medical care costs after an accident. This is true regardless of whether they were a driver, passenger, pedestrian or involved in some other way.

The most common situation preceding filing a PIP claim is someone getting injured as the driver or passenger of a car in an accident. However, it also pays for medical care in several other situations, including if someone is struck by a car and injured or killed while walking or riding a bicycle, motorcycle or off-road vehicle. Additionally, no-fault benefits provide a death benefit if someone is killed in a motor vehicle accident.

What Is the Process for Filing a No-Fault Claim?

You must file a claim with your insurance provider to receive no-fault benefits coverage. This application for benefits must be submitted within one year of the accident date. When filing, you should be prepared to provide proof of the accident, such as an accident report, and of your insurance coverage in effect when it occurred. Once filed, you must submit all expenses for reimbursement within one year of incurring them.

How Often Are No-Fault Benefits Used?

No-fault benefits are widely used. They are an insured driver or passenger’s first option to recover costs for medical care after any automobile accident. An initial assessment of the new regulations imposed in 2019 shows that the changes have effectively reduced insurance premiums without sacrificing use.

The Michigan State Polic Statewide Traffic Crash Data Year End Report for 2021 shows that there were:

• 282,640 total auto accidents in Michigan
• 51,666 Michigan auto crashes resulting in injury
• 71,246 injuries from auto accidents
• 1,068 fatal auto accidents in Michigan
• 1,131 fatalities reported from auto accidents
• 229,906 Michigan auto accidents resulting in property damage

Who Benefits From No-Fault Medical Coverage?

The drivers paying lower premiums for coverage are the biggest beneficiary of Michigan’s new no-fault laws. The changes have reduced premiums statewide by about 20% and appear to have reduced the number of uninsured drivers in the state. Additionally, because drivers file through their insurance carrier, there is no worry about other drivers not having sufficient coverage.

However, many drivers will now find themselves underinsured or unable to recover costs for care that insurance companies deem beyond the “reasonable and customary” range. If you have medical bills from a car accident that are beyond your policy limits or that your insurer has denied, it may be time to seek advice from an experienced personal injury attorney.

Does It Matter Who Was Responsible for an Auto Accident?

Michigan is a no-fault state. Therefore, in most cases, it does not matter who is responsible for an auto accident when filing for no-fault medical benefits. However, accidents should be reported to the police even if it does not affect filing an insurance claim. The Michigan Vehicle Code requires accidents to be immediately reported to the police if it results in any of the following:

• Property damage of at least $1,000
• A death
• an Injury

Does Using PIP Insurance Affect Legal Claims?

Filing a PIP claim with your insurance company does not ordinarily affect your ability to file a legal claim against another driver. It is not an admission of fault. Instead, it is an insurance benefit you pay for to get appropriate medical care after an accident.

Michigan’s no-fault laws protect drivers from lawsuits after accidents that cause minor injuries. Therefore, any legal claim for a minor injury will usually be dismissed. However, lawsuits for significant injuries or death are typically allowed.

If you are seriously injured in a Michigan auto accident where another driver was at fault, you may be entitled to compensation for injuries above what your PIP policy pays. You may also decide to file a suit for non-medical damages or pain and suffering. The first step to getting help is to schedule a free, no-obligation case review, during which one of our experienced personal injury attorneys will review your information and explain your options for seeking compensation.

Where Can I Get Help With No-Fault Medical Benefits? 

If you need help filing a no-fault claim or collecting benefits from your insurance company, the knowledgeable and experienced personal injury attorneys at the Mike Morse Law Firm are here to help. Our attorneys only handle personal injury cases, so we know the ins and outs of every facet of Michigan’s personal injury and insurance laws. Contact us online or call 855-MIKE-WINS to schedule a free case review. One of our team members will review your information and provide an unbiased opinion about the most practical next steps.