Michigan First-Party Basics

SUMMARY
 

First-Party benefits under Michigan No-Fault automobile insurance law are "payable to anyone who suffers an injury arising out of the ownership, operation, maintenance or use of a motor vehicle as a motor vehicle."

You might ask "what does that mean?" That would be a good question. The issue of what injuries arise "arising out of the ownership, operation, maintenance or use of a motor vehicle as a motor vehicle" has been interpreted by the Michigan Court of Appeals and/or its Supreme Court.

Your lawyer can explain in detail what the courts have decided that you are entitled to recover if you are injured in an auto accident. By consulting with your attorney, you can make sure that your own insurance company is properly paying your "First Party benefits." in greater detail below.

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Michigan First-Party Order of Priority

Sometimes there are several insurance policies that could be available for coverage in the event of an auto accident. Even though your own insurance is first in line to pay if you’re involved in a Michigan automobile accident, sometimes an uninsured individual is an innocent passenger in a motor vehicle.  If that occurs, then determining which insurance company is responsible to pay Michigan No-Fault Benefits can be complex.

Some insurance companies may balk at payment. It’s essential, then, that you consult with your own attorney to make sure that your claim is being handled and paid by the proper insurance company. Michigan’s No-fault auto insurance laws explicitly regulate the legal and financial responsibility for economic loss caused by an auto accident. Remember that you have only one year from the date of your injury to resolve the payment issues or file a lawsuit. Contact Thompson, O'Neil & VanderVeen for more information

Driver or Passenger Order of Priority

No. 1:  The first in priority is your own    insurance policy, if none then...

No. 2:   2nd priority is to the insurance company of a resident relative (i.e. spouse, parent or sibling), if none then...

No. 3:   3rd priority is to the insurer of the owner of the vehicle occupied, if none then...

No. 4:   4th priority is to the insurer of the operator of the vehicle involved in the accident, if none then...

No. 5:   5th priority is to the Assigned Claims Facility.

Motorcycle Order of Priority

Motorcycles are not considered true vehicles under Michigan law. As a result, a more divergent order for receiving benefits exists if a person is involved in a car/motorcycle accident in Michigan.  In this situation, the priority would be as follows:

No. 1:  1st priority is to the insurer of the owner of the motor vehicle involved in the accident, if none then...

No. 2:   2nd priority is to the insurer of the operator of the motor vehicle involved in the accident, if none then...

No. 3:   3rd priority is to the motor vehicle insurer of the operator of the motorcycle involved in the accident, if none then...

No. 4:   4th priority is to the motor vehicle insurer of the owner of the motorcycle involved in the accident, if none then...

No. 5:   5th priority is to the Assigned Claims Facility.

The Michigan Assigned Claims Facility

The Michigan Assigned Claims Facility is a State Agency founded in 1973 and empowered to assign an insurance company to provide benefits if the injured party could not obtain benefits from other sources.

Remember that an uninsured driver, operating a vehicle they owned, does not qualify for Michigan Assigned Claim Facility assistance. For an application for Michigan Assigned Claims Benefits call the Michigan Assigned Claim Fund directly at 517-322-1875. 

Specific Michigan First-Party Benefits

Specific Michigan First-Party No-Fault Benefits that you should be entitled to from your own insurance company include:

Medical Bills for Life

If you are injured in an auto accident in Michigan, your auto insurance company should pay your medical bills. Auto insurance companies reimburse you for medical expenses that

(a)  are reasonable, both in cost and necessity,

(b)  are actually incurred, and

(c) are related to the accident. 

Auto insurance companies are not required to guarantee pre-payment of expenses due to an automobile accident. 

Strict Time Limitations

If your auto insurance company claims that a procedure ordered by your physician is unnecessary or disputes the amount billed by the doctor, call our office promptly so that your claim can be secured before the time limits expire.

A recent court decision in Michigan means that you have only one year from the date of your injury to either resolve the coverage issues with your insurer or to file a lawsuit to force your insurance carrier to pay your medical expenses. Contact the lawyers at Thompson, O'Neil & VanderVeen for more information about how to protect your rights.

Two Types of Benefits

There are two types of medical coverage in the event of an auto accident provided by auto insurance companies, un-coordinated benefits and coordinated benefits. The kind of benefits you will receive depends upon the terms of your policy. If you are entitled to uncoordinated benefits, the company pays benefits whether you have other health insurance or not.  If your policy provides for coordinated benefits, then your health insurance company, if you have one, must pay first. The auto insurance pays for expenses that the health insurance company doesn’t pay. 

Frequently, a primary health insurance policy and an automobile insurance policy may contain contradictory language about which company has the first obligation to pay medical bills. Because you might lose the right to have the auto insurance company pay expenses for which it is liable if the claim isn’t properly submitted within one year of the date a medical expense is incurred, you should call an attorney promptly if your insurance company is not taking care of your medical bills in a timely manner.

Contact the lawyers at Thompson, O'Neil & VanderVeen for more information about how to protect your rights.

Wage loss 

Under Michigan’s No-Fault auto insurance law, your auto insurance company is responsible to pay an injured person 85% of his or her salary if the individual has suffered injuries in an auto accident that cause him or her to be disabled from working. These benefits are owed for the first three years of disability. The money paid through no-fault wage loss reimbursement is tax free, and the 15% reduction takes normal taxes you would have paid into consideration.  

Wage loss claims are subject to many rules. There is also a cap on the maximum amount that an insurance company is obligated to pay an injured person per month. You should consult an attorney if you have any questions about a wage loss claim. Contact the lawyers at Thompson, O'Neil & VanderVeen for more information about how to protect your rights.

Attendant Care

Under Michigan No-fault auto insurance law, companies are required to provide nursing services or attendant care if a doctor says that they are medically necessary. If injuries are serious, doctors may order supervision and assistance for prolonged periods of time, sometimes around the clock. Problems with auto insurance companies paying for attendant care often arise because of a lack of firm guidelines indicating how much the insurance company must pay for these services. 

Other problems injured persons encounter relate to  the quality of care and ability to choose the care provider. If you have any questions or concerns about the attendant care benefits received for yourself or a loved one, contact the lawyers at Thompson, O'Neil & VanderVeen for more information about how to protect your rights.

Mileage Reimbursement

Under Michigan’s  No-Fault Law, your insurance company is obligated to reimburse you for mileage traveled to and from doctor's appointments.

Specific Michigan Third-Party Benefits

Your own Michigan No-Fault auto insurance company is responsible to pay the economic benefits described above. You are entitled to recover economic damages for pain and suffering, disfigurement, death, and wage loss in excess of 3 years from the driver of an automobile that injured you, or from the owner of that automobile. The only economic benefits you are entitled to in a Third-Party lawsuit are the wages you will lose on account of your injuries.

In Michigan, the injured party must prove that he or she has suffered what the law terms a threshold injury in order to prevail in a claim against the other driver for non-economic damages. A threshold injury is defined by statute as

(a)     a serious impairment of an important body function or

(b)  serious disfigurement/scarring, or death

Unfortunately, injured persons often have to fight with insurance company adjusters who claim that an injury is not a serious impairment of a body function.  Remember that the insurance adjuster works for the insurance company, not for you. You should contact our office to fight for the benefits you are entitled to if you have an injury to an important part of your body that is objectively shown and documents and that affects your life by preventing you from doing things that you were able to do prior to your accident.

Questions frequently arise about the legal definition of a "serious impairment of an important body function."  Basically, what it means is this: The injury must be serious and it must be objectively shown. Diagnostic tests or tools such as X rays, magnetic resonance imaging, CT scans, electromyograms, and other tests are used to "objectively show" the injury.

Sometimes an injury cannot be shown by sufficient objective evidence to allow a suit to be maintained – even hand, neck or back pain lasting for years. If a court determines that there is not sufficient objective evidence of a serious injury, it may dismiss a claim. In order to be sufficient to withstand a dismissal, the injury has to be serious, objectively manifested, affect an important body function, and affect a person's general ability to lead his or her normal life.

Thus, to prevail, you will need to prove that the other driver was more than 50% at fault in the accident, that you have a serious injury that a doctor has been able to document with an objective test or diagnostic tool, and that the injury affects an important body part and affects normal daily living. Evidence from family members, friends, treating medical providers, co-workers, and other persons might be able to corroborate before-and-after differences and help you assess and establish the impact that the injury has had on your life.

It’s important to consult with an attorney promptly if you are injured in an auto accident. Michigan law provides time limits within which you must file your claim in order to be entitled to sue an insurance company that refuses to comply with an obligation to pay damages. The time limit is called a Statute of Limitations. A person has to file a Third Party lawsuit no later than 3 years after the accident.  There are certain exceptions. For example, minors can sue if they file a claim within one year past their 18th birthday. There are other exceptions for military personnel and those judged mentally incompetent.

If you have any questions or concerns about whether you have a claim against the other driver involved in an auto accident, contact the lawyers at Thompson, O'Neil & VanderVeen for more information about how to protect your rights.

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