Making a Claim for No-Fault PIP Benefits
How to Make a No-Fault Claim
Although the actual filing of the claim is relatively straightforward, there are two principal requirements in which a victim of a Michigan crash must be ready to prove to establish his or her entitlement to these benefits.
The Reasonable Proof Requirement
A no-fault insurance company is not obligated to pay any benefits until a claimant provides an insurer with “reasonable proof” of the facts giving rise to the claim, and the amount of claim. This requirement is set forth in MCL 500.3142 of the no-fault act. Once the insurer is provided with that, the insurer must pay the claim within 30 days, or the benefits will be considered “overdue.”
Under the recent Michigan no-fault insurance reforms passed in 2019, when an insurer receives proof of claim more than 90 days after the service was rendered or expense incurred, the insurer has 90 days to issue payment, as opposed to the regular 30-day payment rule.
Unfortunately, the no-fault statute does not further define the concept of “reasonable proof.” However, the Michigan Court of Appeals has held that this a claimant is not required to “exact” proof. See Williams v AAA Michigan, 250 Mich App 249 (2002).
As it relates to the actual submission of reasonable proof, no-fault insurance companies ordinarily require claimants to submit claims by using several types of claim forms. Typically, these three forms are:
- an application for no-fault benefits;
- an attending physician’s report form; and
- an employer’s wage loss verification form.
It is advisable for the claimant to provide these forms to the no-fault insurance company so that the claimant cannot later be accused of failing to provide “reasonable proof.”
The Incurred Requirement
No-fault insurance companies have a legal obligation to pay claims for allowable expenses under MCL 500.3107(1)(a)and replacement service expenses under Subsection 3107(1)(c) only when the expense has been “incurred.” The statute does not define the word “incurred.” However, a number of Michigan appellate cases have held that to incur an expense, a person must have either paid for the expense or become legally obligated to pay the expense.
The incurred requirement has been very problematic for many patients, particularly those with catastrophic injuries who require products, services, and accommodations that are very expensive, e.g., handicapper housing, special vehicular transportation, residential facility admission, etc. Unless the injured person has “incurred” expenses for such items, the insurer has no legal responsibility to pay the expense.
There are several ways that patients can “incur” expenses other than by paying the full cost of the item in cash. These include entering into contracts to purchase the product, service, or accommodation or borrowing money to pay for the needed item. Also, patients can file a “declaratory judgment” lawsuit asking for a court to rule that an insurer will be liable to pay for the cost of certain specific products, services, and accommodations once the injured person has incurred the expense for such items.
If you think you need legal assistance following a crash, speak with one of Boyer Law Group for a free consultation. Our law firm represents injured persons throughout the State of Michigan.
No-Fault Insurance Medical Examinations (IMEs)
Many people injured in car accidents may receive correspondence from their auto no-fault insurance company requesting an “independent medical examination.” These are more accurately known as “insurance medical examinations.”
Common Questions Regarding No-Fault Insurance Medical Examinations
When a person receives notification of a request for an insurance medical examination, many are understandably concerned. Below are a few of the most common questions we receive regarding IMEs, as well as additional information we hope readers find helpful in answering their questions regarding these exams.
What is an insurance or “independent” medical examination?
First, the naming of such an exam is quite misleading. While auto insurance companies almost always refer to such exams as “independent medical examinations,” the fact that the insurer hand-selects the physician performing the exam is at odds with the term “independent.” Secondly, when auto insurance companies or their lawyers request an IME to be conducted by a doctor of their choosing, it is implied that the trusted and professional medical team that has been caring for the injured person is somehow not “independent.” Finally, a doctor who has never met or cared for the injured person and who is inserted into the case at the request of an insurance company is unlikely to be able to provide the kind of perspective that comes from the person’s own treating doctor.
Can a no-fault insurer request an injured person to undergo a medical exam?
Section 3151 of the No-Fault Act provides that when the mental or physical condition of a person is at issue, a no-fault insurance company can request to have the claimant undergo a “mental or physical examination by physicians.” This section does not give the insurer the right to send claimants to other types of non-physician practitioners, such as psychologists, neuropsychologists, or therapists.
What Are the Rules Pertaining to IMEs?
The specific rules pertaining to IMEs depend on the nature of the claim, as follows:
1. Claim for Auto No-Fault PIP Benefits
- There is a section of the Auto No-Fault Act that permits an auto insurance company to have the injured party examined. The specific statute reads as follows: “If the mental or physical condition of a person is material to a claim that has been or may be made for past or future benefits, at the request of an insurer, a person shall submit to a mental or physical examination by physicians.” Therefore, if a no-fault insurer can request an examination of a person claiming auto no-fault PIP benefits. Yet the following rules apply to those conducting the examination.
- The examination must be conducted by a physician licensed to practice medicine;
- The licensed physician must devote at least half of their time to the clinical practice of medicine or to teaching in a medical school or in an accredited residency or clinical research program for physicians; and
- If care is being provided to the person to be examined by a specialist, the examining physician must specialize in the same specialty as the physician providing the care, and if the physician providing the care is board certified in the specialty, the examining physician must be board certified in that specialty.
2. Claim for Auto Liability (i.e., Claim Against the Person Who Caused the Car Crash)
- The rules applicable to this type of claim differ from the rules applicable to a claim for no-fault benefits. First, if the injured person is not part of a lawsuit against the negligent driver, the auto insurer of the negligent driver has no way to require an insurance medical examination. However, when an injured party initiates a lawsuit and sues the at-fault driver, a provision in our Michigan Court rules permits one to request the other side to undergo a medical or psychological evaluation. The rule technically requires the party requesting the exam to show good cause for doing so. However, our trial courts typically permit these types of requests once a lawsuit has been filed.
What should an injured person do if requested to undergo an insurance medical exam?
Section 3152 of the No-Fault Act also states that a claimant who undergoes an insurance medical examination may request a copy of the report. Section 3153 of the Act provides that if a claimant refuses to submit to an independent medical examination, a court can issue orders that are appropriate under the circumstances, including prohibiting the claimant from introducing any evidence of his or her mental or physical condition. Therefore, claimants should never ignore a request from their insurer to appear for an independent medical examination, as an unjustified failure to appear could jeopardize the claim.
IME requests can oftentimes be confusing. As mentioned above, we always recommend taking them seriously but reading them thoroughly to make sure what will be included in the evaluation is permissible under the Michigan Auto No-Fault Act. Due to the complex nature of these notifications and language, a skilled Michigan auto accident attorney may be needed to ensure the injured party’s legal rights are protected.
Obtaining Compensation for Vehicle Damage Claims in Michigan
Most of us rely on a vehicle to get to work and back home again. So when you’re in a car accident, damage to your vehicle can derail you financially and for an extended period of time. It’s important to not only understand how vehicle damage claims in Michigan work but to also double check your insurance policy for additional coverages that may save you in the long run.
Michigan Car Accident Mini Tort Changes
With the 2019 Michigan No Fault reforms went into effect, Michigan car accident mini-tort changes were in the state’s future as well. Effective July 2020, Michigan’s mini-tort maximum for vehicle damages will increase from $1,000 to $3,000. It is important to note that fault is imperative in these types of cases. The party pursuing compensation for vehicle damage must prove that the other driver was at fault even under the reformed law. In cases of shared collision responsibility, damages are factored on that basis. For instance, if the person pursuing vehicle damage compensation was found to be 25% at-fault for the collision, they will only be able to obtain up to 75% from the other driver involved.
Who Pays Vehicle Damage Claims in Michigan
When your vehicle sustains damages in a collision, you can recover a maximum of $3,000 from the at-fault party. However, sometimes $3,000 won’t come close to repairing or replacing your vehicle. So where else do you turn to recover these damages? Additional coverages, such as comprehensive or collision, is where you obtain compensation for vehicle damages.
Comprehensive Versus Collision Coverage
Comprehensive coverage applies to all types of damage to your vehicle from car accidents to trees falling to deer-automobile collisions. Collision coverage only protects the car if it’s in an accident with another vehicle or on its own. These are optional coverages many people overlook. If you think you have PLPD insurance, chances are you don’t have these additional coverages.
It’s important to point out that collision coverage only pays for the value of the vehicle at the time of the accident, not what the owner still owes on that vehicle. Consumers purchasing a new vehicle who only put a small downpayment on a high-dollar loan may find themselves in the problematic situation of collision compensation in a far lower amount than what they still owe. The consumer must continue making payments on that vehicle despite no longer owning it.
If you’ve been in a car accident we are here to help you. Call and speak to Bill Boyer from the Boyer Law Group to Get the Boyer Promise!