Michigan’s No-Fault insurance system is supposed to provide certain benefits after a motor-vehicle accident without requiring an injured person to first prove another driver caused the crash.
That does not mean every Personal Injury Protection (PIP) claim is simple.
Disputes can arise over which insurance company is responsible, whether treatment is related to the accident, whether wage-loss documentation is sufficient, whether attendant care is necessary, or whether important deadlines have been met.
Here are seven common problems that can complicate a Michigan No-Fault claim and what injured people should know about them.
1. You Don’t Know Which Insurance Company Should Pay Your PIP Benefits
One of the biggest misconceptions about Michigan No-Fault insurance is that an injured person simply submits everything to “their own insurance company.”
Determining the responsible PIP insurer can be more complicated.
Michigan uses statutory priority rules to determine which insurer is responsible for PIP benefits. The answer can depend on circumstances including the injured person’s insurance status, household coverage, whether the person was occupying a vehicle, and the type of vehicle involved.
Special rules can also apply to situations involving motorcycles, pedestrians, passengers, transportation businesses, and people who may qualify for benefits through the Michigan Assigned Claims Plan.
Submitting a claim to the wrong insurer can create unnecessary delay.
Our Michigan No-Fault Insurance Lawyer page explains PIP coverage and Michigan’s No-Fault system in greater detail.
2. The Insurance Company Delays or Refuses to Pay Medical Bills
Another common problem is an insurer questioning whether medical treatment should be covered.
Disputes may involve:
- Whether the injury resulted from the automobile accident
- Whether treatment was medically necessary
- Whether the provider supplied sufficient documentation
- Whether the charge is payable under Michigan’s No-Fault rules
- Whether the applicable PIP medical coverage has been exhausted
- Whether particular services qualify for payment
An unpaid bill does not automatically mean the injured person was not entitled to benefits.
The reason for the nonpayment matters.
If an insurer has already denied, reduced, delayed, or terminated PIP benefits, the dispute may require a more focused legal analysis of the insurer’s stated reason and the supporting evidence.
3. Your Wage-Loss Benefits Are Delayed or Disputed
A serious car accident can prevent an injured person from returning to work.
Michigan PIP benefits can include qualifying wage-loss benefits, subject to statutory requirements and limitations.
Problems often arise because the insurer wants documentation establishing both the amount of income lost and the connection between the inability to work and the accident-related injury.
Depending on the situation, documentation might include:
- Employer wage verification
- Recent pay records
- Tax or income records
- Medical work restrictions
- Disability documentation
- Information concerning missed work
Self-employed individuals, business owners, people with variable income, and workers whose compensation includes commissions, overtime, or bonuses may face additional documentation issues.
A delay in producing the necessary records can delay the wage-loss claim as well.
4. The Insurer Says Your Injuries Are Not Related to the Accident
An insurance company may dispute whether a medical condition was actually caused by the collision.
This issue frequently becomes more complicated when someone had a prior injury or medical condition affecting the same area of the body.
For example, an insurer may argue that back pain following a crash is attributable to an older back condition rather than the collision.
That does not automatically resolve the issue.
Medical records from both before and after the accident may become important in determining whether the crash caused a new injury or aggravated an existing condition.
Gaps in medical treatment can also create disputes because insurers may argue that a significant period without treatment undermines the claimed relationship between the collision and later symptoms.
For serious automobile injury claims involving questions about liability, compensation, and claims against an at-fault driver, see our Michigan Car Accident Lawyer resource.
5. Attendant Care or Replacement Services Are Poorly Documented
Some seriously injured people require help with activities they previously performed independently.
Depending on the circumstances and applicable Michigan law, No-Fault benefits can involve attendant care and replacement services.
These claims can become difficult when the services being provided are not adequately documented.
Records may need to identify information such as:
- Who provided the service
- What assistance was provided
- When it was provided
- How long it was provided
- Why the assistance was necessary because of the accident-related injury
The documentation required will depend on the particular benefit and circumstances.
Waiting months to reconstruct this information from memory can make the process significantly more difficult.
6. Your PIP Benefits Are Suddenly Reduced or Terminated
Sometimes an insurer initially pays benefits and later stops.
The insurer may claim that:
- The injured person has recovered
- Additional treatment is unnecessary
- The condition is no longer related to the accident
- Medical documentation does not support continued benefits
- Work restrictions are no longer justified
- Attendant care is no longer necessary
- Requested benefits are outside the applicable coverage
A termination can have immediate consequences when someone is still treating or unable to work.
The first step is to determine why the insurer stopped paying.
Review the insurer’s correspondence and preserve copies of denial letters, medical records, bills, wage documentation, and other communications concerning the claim.
A denial or termination letter represents the insurer’s position. It does not necessarily mean that position is legally correct.
7. You Wait Too Long to Address a No-Fault Problem
Michigan No-Fault claims have important statutory timing rules.
One of the most important is found in MCL 500.3145.
Generally, an action for PIP benefits cannot be commenced more than one year after the accident unless qualifying written notice of the injury was provided to the insurer within one year or the insurer previously made a PIP payment for the injury.
Michigan also has what is commonly called the one-year-back rule, which can restrict recovery of older unpaid losses. The statute contains additional provisions affecting how that period operates, including tolling involving certain claims submitted to and formally denied by an insurer.
Because of these rules, it can be dangerous to assume that a person can simply wait several years to address unpaid No-Fault benefits.
The legal deadline is also separate from a practical problem: evidence and documentation become harder to collect as time passes.
What Should You Do If Your Michigan No-Fault Claim Has a Problem?
Start by identifying the specific issue rather than assuming the entire claim has been denied.
Depending on the situation, useful steps can include:
- Obtain a copy of the applicable insurance policy
- Keep every letter from the insurer
- Save medical bills and explanation-of-benefits documents
- Maintain medical records and treatment information
- Preserve wage and employment documentation
- Keep accurate records of qualifying services being provided
- Document telephone conversations with the insurer
- Determine the stated reason for any denial or termination
- Pay attention to deadlines and requests for information
If the insurer has already denied or stopped benefits, legal review may help determine whether additional documentation, communication with the insurer, or litigation is appropriate.
Is a PIP Claim the Same as a Claim Against the Driver Who Caused the Accident?
No.
This distinction is important.
A Michigan automobile accident may involve No-Fault/PIP benefits as well as a separate potential claim against an at-fault driver.
PIP can address certain qualifying accident-related losses regardless of who caused the collision.
A claim against an at-fault driver involves a different legal analysis and may involve damages outside the PIP system when Michigan law permits recovery.
Our Michigan Car Accident Lawyer page explains the broader relationship between Michigan No-Fault benefits and claims against negligent drivers.
Can No-Fault Problems Make a Car Accident Case Take Longer?
Yes.
Insurance-priority disputes, disagreements over medical treatment, missing wage documentation, causation disputes, and denied benefits can all add time to an automobile injury claim.
But the No-Fault/PIP portion of a case and a liability claim against an at-fault driver do not necessarily proceed on identical timelines.
For a deeper explanation, read How Long Does a Car Accident Settlement Take in Michigan?.
Frequently Asked Questions About Michigan No-Fault Claim Problems
What does Michigan PIP insurance generally cover?
Depending on the applicable policy, eligibility and circumstances, PIP benefits can involve qualifying medical expenses, wage loss, replacement services, attendant care, rehabilitation and other benefits provided by Michigan law.
What if the insurance company says my treatment isn’t necessary?
The insurer may dispute medical necessity or whether the treatment relates to the automobile accident. Medical records, provider documentation and other evidence can become important in resolving the disagreement.
What if I didn’t own a car when I was injured?
Not owning a vehicle does not necessarily mean no PIP coverage is available. Michigan’s priority rules determine the potential source of benefits based on the particular circumstances.
Can an insurance company stop benefits after it already started paying them?
An insurer may reduce or terminate benefits if it believes they are no longer payable. Whether that decision is legally justified depends on the facts, applicable coverage and reason for the termination.
Can I still have a claim against the driver who caused my crash?
Potentially. Michigan No-Fault benefits and claims against negligent drivers are separate issues. Michigan law permits certain claims against at-fault drivers when its legal requirements are satisfied.
Should I wait to see whether the insurance company fixes the problem?
Be cautious about waiting. Michigan PIP claims are subject to statutory deadlines, and unpaid losses can be affected by timing rules. Evidence and documentation can also become more difficult to obtain as time passes.
Get Help With a Michigan No-Fault Insurance Problem
A No-Fault claim can become complicated quickly when an insurer disputes coverage, medical treatment, wage loss, attendant care, or responsibility for paying benefits.
Khamo Law Accident & Injury Lawyers represents people dealing with automobile insurance disputes throughout Michigan.
For a comprehensive explanation of PIP benefits, insurance priority, deadlines and No-Fault disputes, visit our Michigan No-Fault Insurance Lawyer page.
If your No-Fault problem arose after an automobile collision and you also have questions about a potential claim against the responsible driver, visit our Michigan Car Accident Lawyer page.
Call 248-466-0606 or contact Khamo Law online for a free consultation.