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No-Fault Benefits

1. When are you entitled to No-Fault Benefits?

    A: If a “Motor Vehicle” (meaning a car, truck or van) is “involved” (contact not required) in the accident, the injured person is entitled to No-Fault Benefits which are also called First Party or PIP (Personal Injury Protection) benefits.

            There are exclusions to Michigan No-Fault Benefits.  The most common one is, if you are the driver and “owner” of an uninsured car, truck or van, you are excluded from receiving No-Fault Benefits. 

            Motorcycles are treated very differently in Michigan.  Please see www.motorcyclelawyermichigan.com

2. What are the No-Fault benefits?

     A: No-Fault Benefits include:

            1. Payment of medical treatment FOR LIFE, (medical bills);

            2. Wage loss: 85% maxing out at approximately $4,850 per month for as

                long as three years;

            3. Replacement services: household chores, a.k.a. essential services of

                up to $20.00 per day for as long as three years;

            4. Medical mileage and

            5. Attendant care: nursing type care which can be done by family

                members. 

These claims are made against a motor vehicle’s insurance company.

3. How do I set up a No-Fault claim, so I can submit bills for payment?

    A: Get an Application for Benefits Form from the appropriate Auto Insurance Company, fill it out and send it back.  Some companies don’t require completion of an Application for Benefits Form and just set up the claim over the phone by speaking to the victim.  The assigned No-Fault adjuster will call within days with the claim number, address and instructions for obtaining benefits. The claim must be filed within one year of the accident.

4. How do I know which vehicle insurance company is responsible for the No-Fault Benefits?

    A: The Michigan No Fault Act (MCLA 500.3101 et. seq.) sets forth the rules for determining which insurance company pays under different circumstances.  These rules are detailed on the following pages entitled No-Fault PIP Priorities.

            First you must determine if the victim is an Occupant of a motor vehicle, a non-occupant or a motorcyclist.  Then just follow the order of priority until you have an insurance company that fits.  See below. 

Important: This  is not a complete guide to the law.  There are many exceptions, special definitions and complex issues that cannot be explained in these limited pages. It is meant as a basic guide to determine which auto insurance company is liable for PIP benefits.

Many Myths & Misconceptions with Michigan's Motorcycle Law:

There are so many myths and misconceptions about Michigan's confusing and often illogical No-Fault Law.  Some include:

• Urban Myth: “No-Fault does not apply to motorcycles.”
• Answer: It depends.  If a car, truck, bus or van is “involved” in the crash, No-Fault Benefits may be paid.*

• Urban Myth: “Physical contact with my motorcycle and the other vehicle is required to qualify for No-Fault Benefits.”
• Answer: No, a car, truck, van or other “Motor Vehicle” (not motorcycle) only needs to be “involved” in the accident. You may be entitled to No-Fault benefits if you take evasive action to avoid a motor vehicle. * 

• Urban Myth: “Hit & Run cases: If a car hits me, takes off and is never found, there is no case.”
• Answer: It depends. If you have Uninsured Motorist Coverage, you may still obtain compensation for your injury.  No-Fault Benefits are also available.*

• Urban Myth: “If I have ‘full coverage’ on my bike, I’m covered for everything.”
• Answer: No.  There is no standard or legal definition of “full coverage.”  You need to specifically ask for the coverage you want.

• Urban Myth: “In Michigan I have three years to file claims and lawsuits.”
• Answer: No.  You do have three years to sue for a negligence case; however, some types of claims must be made within one year. 

• Urban Myth: “If I have collision coverage on my cycle, all my accessories and custom work is covered.”
• Answer: No. Ask your agent what ‘extras’ are covered.

*Exception: If you are riding your own uninsured motorcycle, you will NOT be paid wage loss, medical bills or other No-Fault Benefits.  Make sure you insure your bike.

There are many exceptions, special definitions and complex issues that cannot be explained in this material.  It is not intended to be a substitute for case specific legal advice.  Your legal rights greatly depend on the facts of your accident. 

The Law Offices of Jason A. Waechter

No-Win No-Fee     FREE Advice

Named to The Top 100 Trial Lawyers

No-Fault PIP Priorities

        Determining which auto insurance company is obligated to pay medical bills and other PIP benefits can be confusing.  To determine the auto insurance company that is responsible for paying benefits, answer the following questions:

1.  Was there an accidental injury that arose out of the ownership, operation, use or maintenance of a motor vehicle as a motor vehicle?     If answer is “Yes”, continue. 

      For an Insurance Company be obligated to pay under the No-Fault Law a “motor vehicle” has to be “involved.”  This typically means a car, van, truck, trailer or bus was somehow involved in the accident. 

      A motorcycle is not defined as a motor vehicle under the No-Fault Law.  If patient was injured in a single motorcycle accident (e.g. biker hits tree, deer, or other motorcycle), no PIP benefits are available.  However, if a car hit a biker or cut a biker off, a “motor vehicle” was “involved” and benefits would be available.

2.  Do any exclusions apply? If no exclusions apply, continue.
 
- If the patient is an owner and driver of an uninsured vehicle that was involved,
  he or she is not entitled to PIP.
- A patient that stole the accident vehicle is not entitled to PIP.
- A patient who is a resident of a different state in a car registered in a different state                      
  may be excluded from benefits.
- If the patient's injury occurs while performing his job, worker’s compensation      insurance may pay some of the benefits that would normally be paid by the  automobile insurance.
    
3.  Was the patient an “Occupant of a privately owned vehicle”, a  Non-Occupant (pedestrian, bicyclist, etc.) or a Motorcyclist?

The determination as to which auto insurance company is responsible for PIP benefits is different for an occupant, non-occupant and motorcyclist.  The next three pages explain the process for determining which company is responsible.

 
FINDING THE RIGHT INSURANCE COMPANY IN A NUT SHELL:
1.  A Motor Vehicle must be involved.
2.  You don’t get PIP if you stole the accident vehicle or are the owner and driver of an uninsured motor vehicle involved in the accident.
3.  You must figure out if the victim is an occupant, a non-occupant or a motorcyclist to ascertain which insurance company is responsible for paying PIP.

Occupants

1. Named Insured: If the patient has a Motor Vehicle with insurance, that insurance company pays.  If not, proceed to next level.

2. Spouse or Resident Relative:  Does the Patient live with a spouse or relative that has an insured Motor Vehicle?  If so, that company pays.  If not, proceed to next level.

3. Insurance Company of the Owner of the vehicle they were in:  The insurance on the Motor Vehicle occupied pays.  If none, proceed to next level.

4. Insurance Company of the Driver of the vehicle they were in:  If the driver borrowed a friend’s uninsured Motor Vehicle, the driver may have an insured Motor Vehicle.  If so, the driver’s insurance company pays.  If not, proceed to next level.

5. Assigned Claims Facility:  Michigan law requires every automobile insurance company that does business in Michigan to participate in the assigned claims plan.  If there is no insurance at any of the levels described above and there are no exclusions that would bar coverage, the assigned claims facility will assign the claim to an insurance company for the payment of benefits.

NON-OCCUPANTS
(Pedestrians, joggers, bicyclists, snowmobilers,
 Mopeds under 50cc’s, tractor drivers, but not motorcyclists)

1. Named Insured: If the patient has a Motor Vehicle with insurance that company pays.  If not, proceed to the next level.

2. Spouse or Resident Relative:  Does the Patient live with a spouse or relative that has an insured Motor Vehicle?  If so, that company pays.  If not, proceed to the next level.

3. Insurance Company of the Owner or person on the Registration of the vehicle involved: If none, proceed to the next level.

4. Insurance Company of the Driver of the vehicle involved:  If the driver borrowed a friend’s uninsured Motor Vehicle, the driver may have an insured Motor Vehicle.  If so, the driver’s insurance company pays.  If not, proceed to the next level.

5. Assigned Claims Facility:  Michigan law requires every automobile insurance  company that does business in Michigan to participate in the assigned claims plan.   If there is no insurance at any of the levels described above and there are no  exclusions that would bar coverage, the assigned claims facility will assign the  claim to an insurance company for the payment of benefits.

MOTORCYCLE  PRIORITIES
(Operators and passengers)

1. Insurance Company of the Owner or person on the Registration of the Motor Vehicle “involved”.  If none, proceed to the next level.

2. Insurance Company of the Operator of the Motor Vehicle (not motorcycle) “involved.”  If none, proceed to the next level.

3. Insurance Company of the Motor Vehicle (not motorcycle) of the operator of the motorcycle. If none, proceed to the next level.

4. Insurance Company of the Motor Vehicle (not motorcycle) of the Owner or person on the registration of the motorcycle. If none, proceed to the next level.

5. Spouse or Resident Relative:  Does the Patient live with a spouse or relative that has an insured Motor Vehicle?  If so, that company pays.  If not, proceed to the next level. 

6. Assigned Claims Facility:  Michigan law requires every automobile insurance company that does business in Michigan to participate in the assigned claims plan.  If there is no insurance at any of the levels described above and there are no exclusions that would bar coverage, the assigned claims facility will assign the claim to an insurance company for the payment of benefits.

You are entitled to PIP benefits, as long as: (1) no exclusions apply and (2) the accidental injuries “arise out of the ownership, operation, use or maintenance of a “motor vehicle.”  Therefore, you do not have to be in a “crash” to be entitled to benefits.  For example:

     The No-Fault Law is Not Always Logical or Fair:

• If a man is intoxicated, walks across a highway at night dressed in all black and is hit by a car, he is entitled to PIP.

Maintenance:

• A man that is working on his car when the car falls on him is entitled to PIP.
• A man that is watching someone open a radiator cap and is burned from steam is entitled to PIP.
• A man that is burned pouring oil in a van is entitled to PIP.
• A man that suffered an eye injury from a dropped flailing power wash hose when washing his car at self serve car wash is entitled to PIP.
• A man that suffered a burn injury when using a cutting torch to add on to his trailer is entitled PIP.
• A man that was injured when he attempted to start his car by warming the oil pan by burning charcoal under it is entitled to PIP.

Loading & Unloading:

• A man loading or unloading a motor vehicle usually is entitled to PIP.
• If patient is loading a heavy bag of salt in his trunk and injures his back, he may be entitled to PIP. 
• A man stacking boxes in back of a truck that is injured when a pallet falls on his head is entitled to PIP.
• Camper ladder collapses as a man carries a heavy cooler to roof – he is entitled to PIP.

Entering or Exiting (Slip & Fall):

• A patient that slips on ice, oil, etc. when getting into or out of his vehicle is usually entitled to PIP.
• If a patient fuels vehicle and falls after walking around to get back in -possible PIP coverage.
• A man that falls from the high step of truck after his hand slips off of door
  handle is entitled to PIP.

  Use of Motor Vehicle.

• A boy on an inner tube being pulled by a car down a snowy road hits a fence is entitled to PIP.
• A stove in motor home explodes causing burns – the occupants are entitled to PIP (there’s a dual use of this vehicle).
• A man partially asphyxiated by leaking propane when sleeping in camper -  entitled to PIP.  Vehicle has dual use.

SPECIAL SITUATIONS:

Vehicles for Hire: If patient is in a vehicle for hire (limousine, shuttle bus) the hired vehicle’s insurance company pays.  This does not include school buses, certain other buses or taxi cabs.

Company Car: If patient is injured and he has a car given to him or her to use by his or her employer, the only time that car’s insurance company pays is if the patient was actually in that vehicle at the time of injury. 

PASSENGERS AND PEDESTRIANS BILLS GET PAID

If a person was a passenger of a motor vehicle or a pedestrian hit by a motor vehicle, some auto insurance company must pay the medical bills and other PIP benefits.

AUTO INSURANCE OR MEDICARE/MEDICAID?

If an auto insurance company is available to pay PIP, you want auto insurance to pay instead of Medicare or Medicaid.  Auto insurance usually pays a much higher percentage of a medical bill.  Legally, where there is applicable auto insurance, the auto carrier should pay before these government programs.  If Medicare or Medicaid pays you will have to reimburse them from your personal injury proceeds or settlement, so make sure No-Fault is billed.

THE ASSIGNED CLAIMS FACILITY

The State of Michigan established the Assigned Claims Plan in 1973 to provide financial help to people injured by uninsured motorists.  The Assigned Claims Plan is administered by the Michigan Department of State under authority of the No-Fault Insurance Law.

If there is no available insurance, a dispute between insurance companies as to who should pay or the insurance company responsible for the claim is unable to pay (because of bankruptcy), the patient must make a claim to the Assigned Claims Facility.  The Assigned Claims Facility will then assign the claim to an insurance company for handling.

How do I file a Claim with the Assigned Claims Facility?

You must fill out an "Application for Bodily Injury Benefits" (NF-21).  You may obtain one at any Secretary of State branch office or by contacting:

    Assigned Claims Facility
    Michigan Department of State
    Lansing, MI 48918-1412
    (517) 322-1875

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