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.
________________________________
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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