Michigan’s no-fault insurance system can become complicated quickly after a serious motor vehicle accident. Questions often arise about which insurance company is responsible for Personal Injury Protection benefits, what medical care is covered, whether wage-loss or attendant-care benefits are available, and what happens when an insurer delays or stops payments.
A Michigan no-fault insurance lawyer at Khamo Law can help injured people identify the insurance coverage that applies to their accident, pursue available PIP benefits, challenge improper denials, and evaluate whether additional claims may be available against an at-fault driver.
Michigan no-fault claims are not always as simple as sending bills to “your own insurance company.” Michigan law uses specific priority rules to determine which insurer is responsible in different situations, including special rules involving motorcycles, transportation businesses, household coverage, and other circumstances. Michigan Legislature — MCL 500.3114
For information about other injury claims involving negligence throughout the state, visit our Michigan Personal Injury Attorney resource.
If you were injured in a Michigan motor vehicle accident and need help understanding your no-fault benefits, call Khamo Law at (248) 466-0606 or contact us online for a free consultation.
What Is Michigan No-Fault Insurance?
Michigan’s no-fault system provides certain insurance benefits for people injured in motor vehicle accidents without requiring them to first prove that another driver caused the crash.
One of the primary no-fault coverages is Personal Injury Protection, commonly called PIP.
Depending on the circumstances and available coverage, PIP may provide benefits for accident-related medical care and rehabilitation, lost income, replacement services, and other qualifying expenses. Michigan law defines allowable expenses to include reasonable charges for reasonably necessary products, services, and accommodations for an injured person’s care, recovery, or rehabilitation. Michigan Legislature — MCL 500.3107
PIP benefits are separate from a potential lawsuit against a negligent driver for damages such as pain and suffering.
Which Insurance Company Is Responsible for PIP Benefits?
One of the first questions after a serious crash is which insurer must pay the no-fault claim.
The answer depends on the facts.
Michigan law generally looks first to policies covering the injured person, a spouse, or certain relatives living in the same household, but the statute contains important exceptions and separate priority rules for particular situations. Michigan Legislature — MCL 500.3114
Factors may include:
- Whether the injured person has an auto insurance policy
- Whether a spouse has applicable insurance
- Whether a qualifying resident relative has coverage
- Whether the injured person was driving or riding in a vehicle
- Whether the accident involved a motorcycle
- Whether the vehicle was being used to transport passengers
- Whether the injured person was occupying an employer-owned vehicle
- Whether another statutory priority rule applies
Submitting a PIP claim to the wrong carrier can lead to delays and disputes, so determining priority early can be important.
What Does Michigan PIP Medical Coverage Pay For?
PIP medical coverage may pay allowable expenses for reasonably necessary treatment, products, services, and accommodations related to the injured person’s care, recovery, or rehabilitation.
Depending on the injuries and available coverage, these expenses may involve:
- Emergency room treatment
- Hospitalization
- Surgery
- Physician visits
- Diagnostic testing
- Physical therapy
- Occupational therapy
- Rehabilitation
- Prescription medication
- Medical equipment
- Certain home-care services
- Other qualifying accident-related care
The medical expenses must still satisfy Michigan’s statutory requirements, and disputes can arise over whether treatment is related to the crash, medically necessary, or payable under the applicable policy.
Michigan PIP Medical Coverage Options
Michigan drivers can select from different levels of PIP medical coverage.
The Department of Insurance and Financial Services currently recognizes options including unlimited PIP medical coverage, $500,000 coverage, $250,000 coverage, certain $250,000 exclusions, a $50,000 option for qualifying Medicaid participants, and an opt-out option for certain Medicare participants. Eligibility requirements apply to several of the reduced or excluded options. Michigan DIFS — PIP Medical Coverage Selection
The selected limit can have a major effect after a catastrophic injury because PIP medical may pay for services that ordinary health insurance does not cover in the same way, including certain rehabilitation and attendant-care expenses.
That makes reviewing the actual auto policy an important part of evaluating a serious no-fault claim.
Wage-Loss Benefits After a Michigan Accident
An injured person who cannot work because of accident-related injuries may qualify for PIP work-loss benefits.
Michigan law provides benefits for income the injured person would have earned during the first three years after the accident if the injury had not occurred. The statute generally applies a 15% reduction reflecting the tax treatment of PIP work-loss benefits unless the claimant establishes a lower tax advantage. A monthly statutory maximum also applies and is adjusted periodically. Michigan Legislature — MCL 500.3107
Evidence supporting a work-loss claim may include:
- Pay stubs
- Tax returns
- Employer records
- Disability slips
- Medical work restrictions
- Proof of scheduled hours
- Records showing missed work
Insurance companies may dispute the amount of income lost, whether the inability to work resulted from the crash, or whether sufficient medical documentation supports the claim.
Replacement Services Benefits
Michigan PIP may also cover certain replacement services.
The statute allows qualifying expenses of up to $20 per day for ordinary and necessary services the injured person would have performed for themselves or their dependents if the accident had not occurred. These benefits are available during the first three years following the accident.
Examples may include help with ordinary household tasks that the injured person is medically unable to perform.
Maintaining records of who performed the services, when they were performed, and why they were necessary can help document the claim.
Attendant Care After a Serious Injury
Some motor vehicle injuries leave people unable to safely perform personal-care activities without assistance.
Qualifying attendant care may involve help with activities such as:
- Mobility
- Hygiene
- Dressing
- Medication
- Supervision
- Transfers
- Personal safety
- Other medically necessary care
Michigan law places specific limitations on certain in-home attendant care provided by relatives, members of the injured person’s household, and people with certain preexisting relationships. Michigan Legislature — MCL 500.3157
Attendant-care claims can become particularly important for people with traumatic brain injuries or spinal cord injuries.
Why Documentation Matters in a PIP Claim
Insurance companies typically evaluate PIP benefits based on documentation supporting both the existence and amount of the loss.
Depending on the type of claim, useful documentation may include:
- Medical records
- Physician referrals
- Medical bills
- Wage records
- Employer verification
- Replacement-services logs
- Attendant-care records
- Prescriptions
- Therapy notes
- Transportation records
- Correspondence with the insurer
Michigan law ties overdue-benefit rules to when the insurer receives reasonable proof of the fact and amount of the loss. Michigan Legislature — MCL 500.3142
Incomplete documentation can therefore create disputes about whether an insurer had enough information to evaluate or pay a particular benefit.
When Are Michigan PIP Benefits Overdue?
Michigan law generally provides that PIP benefits become overdue if they are not paid within 30 days after the insurer receives reasonable proof of the fact and amount of the loss, subject to statutory exceptions.
For certain medical bills submitted more than 90 days after the treatment or service was provided, the insurer receives an additional 60 days before the payment becomes overdue.
Michigan law provides 12% simple interest per year on overdue PIP payments. Michigan Legislature — MCL 500.3142
Whether a particular payment is legally overdue depends on what information was provided to the insurer and when.
What Happens When an Insurance Company Denies PIP Benefits?
Insurers may deny, reduce, or terminate benefits for many reasons.
Common disputes involve:
- Whether an injury resulted from the accident
- Whether treatment is medically necessary
- Whether a bill is properly documented
- Whether the claimant is entitled to PIP benefits
- Which insurance company has priority
- Whether the PIP medical limit has been reached
- Whether wage-loss documentation is sufficient
- Whether attendant care is necessary
- Whether a deadline was missed
- Whether the insurer believes the person has recovered
A denial letter does not necessarily mean the insurer’s position is correct.
If benefits have already been stopped, delayed, reduced, or denied, our Denied PIP Benefits in Michigan page explains those disputes in greater detail.
Can Attorney Fees Be Awarded in a Michigan PIP Case?
Michigan law allows a court to award a reasonable attorney fee against an insurer in certain PIP cases when the court finds that the insurer unreasonably refused to pay a claim or unreasonably delayed proper payment, subject to statutory restrictions. Michigan Legislature — MCL 500.3148
That does not mean attorney fees are automatically available whenever an insurer denies a claim.
The reasonableness of the insurer’s conduct and the particular benefits involved matter.
Michigan’s One-Year Notice Rule
Michigan no-fault claims are subject to important time limits.
Under MCL 500.3145, an action for PIP benefits generally cannot be started more than one year after the accident unless written notice of the injury was provided to the insurer within one year or the insurer previously made a PIP payment for that injury. Michigan Legislature — MCL 500.3145
The required notice must provide specified basic information about the claimant, injured person, accident, and injury.
Because these rules can affect whether benefits remain recoverable, a serious no-fault claim should not be allowed to sit unattended.
Michigan’s One-Year-Back Rule
Michigan also has what is commonly called the one-year-back rule.
When a PIP lawsuit is filed, the statute generally bars recovery for losses incurred more than one year before the date the action was commenced.
However, Michigan law now also provides tolling from the date a specific claim for payment is made until the date the insurer formally denies that claim, as long as the claimant pursues the matter with reasonable diligence.
For that reason, the law is more complicated than simply saying, “You only have one year.”
Insurance Medical Examinations and No-Fault Claims
During a disputed no-fault claim, an insurer may seek additional medical information or require an examination under applicable law and policy provisions.
These examinations can become important when an insurer questions:
- Whether treatment is still necessary
- Whether an injury was caused by the crash
- Whether the injured person remains disabled
- Whether attendant care is required
- Whether work restrictions remain appropriate
An insurer may later rely on medical opinions from its examination when deciding whether to continue or terminate benefits.
Because significant benefits may be at stake, injured people should understand the purpose of the examination and preserve their own treating medical records.
PIP Benefits for Passengers
Passengers injured in Michigan motor vehicle accidents may also qualify for PIP benefits.
However, the insurance company responsible for those benefits is determined by Michigan’s statutory priority rules rather than simply by whichever insurer covered the vehicle in which the person happened to be riding. MCL 500.3114 also contains special provisions involving vehicles operated in the business of transporting passengers.
This can become particularly important in rideshare, taxi, shuttle, or other transportation cases.
For crashes involving Uber or Lyft vehicles, see our Uber & Lyft Accident Lawyer in Michigan page.
PIP Benefits for Pedestrians and Bicyclists
Pedestrians and bicyclists injured in crashes involving motor vehicles can also face no-fault insurance questions.
Michigan law provides that, subject to certain existing policy coverage under MCL 500.3114(1), a person injured while not occupying a motor vehicle claims PIP benefits through the Michigan Assigned Claims Plan. Michigan Legislature — MCL 500.3115
The correct source of benefits depends on the person’s coverage situation.
Related resources include our Michigan Pedestrian Accident Attorney and Michigan Bicycle Accident Lawyer pages.
PIP Benefits After a Motorcycle Accident
Motorcycle crashes have their own no-fault priority rules.
When a motorcycle operator or passenger is injured in an accident involving a motor vehicle, MCL 500.3114 establishes a statutory order of priority that may look first to the insurer of the motor vehicle owner or registrant, then the motor vehicle operator, followed by certain motorcycle-related motor vehicle policies.
These claims should therefore not be analyzed exactly like an ordinary two-car collision.
For more information, visit our Motorcycle Accident Lawyer Michigan page.
What Is the Michigan Assigned Claims Plan?
The Michigan Assigned Claims Plan, often called the MACP, can provide a potential source of PIP benefits when a person is injured in an accident involving a motor vehicle but there is no applicable automobile insurance policy that pays under the ordinary priority rules. Michigan DIFS describes the Assigned Claims Plan as a program that may pay benefits in those circumstances.
It can become relevant for certain uninsured occupants, pedestrians, bicyclists, and others who lack an applicable source of PIP coverage.
Whether someone qualifies depends on the facts and Michigan’s statutory eligibility rules.
What Happens When Two Insurance Companies Dispute Priority?
In some cases, more than one insurer may argue that another carrier is responsible for the PIP claim.
Michigan’s priority statute addresses situations involving multiple insurers in the same order of priority and provides mechanisms for payment and later allocation between carriers.
For an injured person, a priority dispute can create unnecessary delays if the claim is not handled correctly.
A no-fault lawyer can review the insurance policies, household relationships, vehicle ownership, and circumstances of the crash to determine which carrier should receive the claim.
PIP Benefits After a Fatal Michigan Motor Vehicle Accident
Michigan no-fault law also provides certain survivor’s loss benefits when an insured person dies as a result of a motor vehicle accident.
Fatal crashes can involve several overlapping issues, including no-fault benefits, funeral expenses, lost financial support, and a possible wrongful-death claim against a negligent party.
Families dealing with a fatal crash can also review our Michigan Wrongful Death Lawyer page.
Can You Sue the At-Fault Driver in a Michigan No-Fault State?
Yes, in qualifying circumstances.
Michigan’s no-fault system does not eliminate all lawsuits against negligent drivers.
Michigan law permits recovery of noneconomic damages arising from a motor vehicle accident when the injured person suffers death, permanent serious disfigurement, or serious impairment of body function. Michigan Legislature — MCL 500.3135
That means a person may have both:
- A first-party PIP claim for no-fault benefits, and
- A separate third-party claim against the at-fault driver.
Our Michigan Car Accident Attorney page explains broader liability claims after Michigan crashes.
What Is a Serious Impairment of Body Function?
Michigan law defines a serious impairment of body function using three principal requirements.
The impairment must be:
- Objectively manifested
- An impairment of an important body function
- One that affects the injured person’s general ability to lead their normal life
Whether a particular injury meets that standard depends heavily on the medical evidence and how the injury has changed the person’s life.
Serious injuries such as brain injuries, spinal cord injuries, significant orthopedic injuries, and other disabling conditions may require detailed evidence showing the before-and-after impact of the accident.
How PIP and a Third-Party Injury Claim Work Together
PIP benefits and a claim against the at-fault driver serve different purposes.
A PIP claim may address qualifying medical treatment, wage loss, replacement services, and related benefits.
A third-party claim may address damages that are not compensated through PIP in the same way, including pain and suffering and certain economic losses beyond applicable no-fault benefits when Michigan law allows them.
A serious accident should therefore be evaluated as a whole rather than treating the no-fault claim and liability claim as completely unrelated matters.
What Should You Do After a Michigan Motor Vehicle Accident?
After a serious crash, protecting both your health and your insurance claim is important.
If possible:
- Report the collision to law enforcement
- Seek appropriate medical treatment
- Tell providers about all accident-related symptoms
- Photograph the vehicles and accident scene
- Collect witness information
- Keep insurance correspondence
- Save medical bills and records
- Document time missed from work
- Keep records of replacement services
- Document attendant-care assistance
- Obtain a copy of the accident report
- Avoid ignoring letters or requests from insurers
- Consider legal advice before providing detailed recorded statements
The earlier important evidence is preserved, the easier it may be to address later disputes about the crash, injuries, or benefits.
Common Mistakes That Can Hurt a No-Fault Claim
Problems sometimes arise because injured people understandably assume their insurer will automatically handle everything correctly.
Potential mistakes include:
- Failing to give timely notice
- Sending a claim to the wrong insurer
- Failing to document lost wages
- Failing to keep attendant-care records
- Ignoring medical appointments
- Allowing large gaps in treatment without explanation
- Failing to submit requested documentation
- Assuming every insurance deadline is the same
- Waiting too long after benefits are denied
- Signing documents without understanding their effect
A claim can become harder to resolve once deadlines pass or important evidence is unavailable.
How a Michigan No-Fault Insurance Lawyer Can Help
A serious PIP claim can require much more than simply forwarding bills to an insurance adjuster.
Khamo Law can help by:
- Reviewing applicable insurance policies
- Identifying the correct PIP insurer
- Investigating priority disputes
- Reviewing available PIP medical coverage
- Gathering medical documentation
- Pursuing qualifying wage-loss benefits
- Documenting replacement services
- Evaluating attendant-care claims
- Challenging denied or terminated benefits
- Reviewing no-fault deadlines
- Addressing overdue benefits
- Investigating the underlying accident
- Evaluating potential claims against negligent drivers
- Identifying other available insurance coverage
- Filing litigation when appropriate
For cases in which an insurer has already refused or stopped payment, visit our Denied PIP Benefits in Michigan page.
Why Choose Khamo Law for a Michigan No-Fault Claim?
Michigan no-fault cases may involve complex insurance priority rules, medical evidence, statutory deadlines, and disputes over the extent of an injured person’s losses.
Khamo Law represents people injured in motor vehicle accidents throughout Michigan.
Our related statewide practice areas include Michigan car accidents, Michigan truck accidents, Michigan bus accidents, Uber and Lyft accidents, Michigan pedestrian accidents, and Michigan bicycle accidents.
Khamo Law offers free consultations and handles personal injury matters on a contingency-fee basis.
Frequently Asked Questions About Michigan No-Fault Insurance
Does my own auto insurance always pay my PIP benefits?
No. A person’s own policy or qualifying household coverage often applies, but Michigan has specific statutory priority rules and exceptions that determine which insurer is responsible.
Does Michigan PIP only cover medical bills?
No. Depending on the circumstances, PIP may include allowable medical expenses, qualifying work loss, and replacement services.
How long can wage-loss benefits last?
Michigan’s statute provides qualifying work-loss benefits for income lost during the first three years after the accident, subject to statutory limits.
Does everyone have unlimited PIP medical coverage?
No. Michigan allows several PIP medical coverage selections, including unlimited and limited options, with eligibility requirements applying to certain choices.
What happens if my insurer stops paying?
The insurer’s reason for the denial or cutoff should be reviewed along with the medical records, policy, proof submitted, and statutory requirements. You can learn more on our Denied PIP Benefits in Michigan page.
How quickly must an insurer pay PIP benefits?
Generally, PIP benefits become overdue 30 days after the insurer receives reasonable proof of the fact and amount of the loss, although statutory exceptions apply.
Is interest available on overdue PIP benefits?
Michigan law provides 12% simple annual interest on qualifying overdue PIP payments.
Can an insurer be required to pay attorney fees?
In certain cases, a court may award reasonable attorney fees if it finds the insurer unreasonably refused to pay or unreasonably delayed proper payment, subject to statutory limitations.
What is the one-year-back rule?
Michigan generally prevents recovery of PIP losses incurred more than one year before the PIP lawsuit was filed, subject to the statute’s tolling provisions for specific claims that are formally denied.
Can I still sue the driver who caused my accident?
Potentially. Michigan permits certain claims against at-fault drivers, including claims involving death, permanent serious disfigurement, or serious impairment of body function.
What if I do not have my own auto insurance?
You may still have a potential source of PIP benefits depending on household coverage, statutory priority rules, and possible eligibility for the Michigan Assigned Claims Plan.
Do pedestrians get Michigan no-fault benefits?
They may. Michigan has specific rules governing PIP benefits for people injured while not occupying a motor vehicle.
Are motorcycle PIP rules different?
Yes. Michigan uses a separate statutory priority order for motorcycle operators and passengers injured in accidents involving motor vehicles.
How much does it cost to hire Khamo Law?
Khamo Law offers a free consultation and handles personal injury matters on a contingency-fee basis, meaning attorney fees are generally tied to the recovery obtained rather than charged upfront.
Michigan No-Fault Insurance Lawyers Serving Clients Statewide
Khamo Law represents people dealing with no-fault insurance issues throughout Michigan.
This page serves as the firm’s broad statewide no-fault resource. People dealing specifically with benefits that have already been denied, delayed, reduced, or terminated can visit our Denied PIP Benefits in Michigan page.
Contact a Michigan No-Fault Insurance Lawyer
If you were injured in a Michigan motor vehicle accident and have questions about PIP benefits, insurance priority, medical coverage, wage loss, attendant care, denied benefits, or a potential claim against the negligent driver, Khamo Law can review your situation.
Call (248) 466-0606 or contact Khamo Law online for a free consultation.