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MICHIGAN NO-FAULT BENEFITS

NO-FAULT BENEFITS

Application for No-Fault Benefits

The law requires that certain information be supplied to the no-fault carrier within one year of the accident. Generally, the law requires an identification of where, when, and who was injured; a description of the nature of the injury; and a claim for no-fault benefits. A standard application for benefits form (which can be obtained through the  Department of Insurance and Financial Information or through any insurance company) can be used to apply for benefits. The form requests all of the factual information required by statute to be provided to the no-fault insurer. If the application for benefits with the appropriate information is not submitted to the insurer within one year of the date of the accident, the individual’s claim for no-fault benefits is forever barred. If a question arises regarding who should receive the no-fault application for benefits, a claimant is well advised to give the written application for benefits to each insurance company that may be responsible to pay no-fault benefits. 

WHO PAYS FOR BENEFITS

Under the No-Fault Act, the no-fault insurer pays all reasonable charges for necessary products, services, and accommodations for an injured person’s care, recovery, or rehabilitation arising out of a motor vehicle accident.  This means the no-fault insurer may be obligated to pay for medical benefits/expenses. This includes, but is not limited to, things such as hospital bills, doctor visits, medical tests, physical therapy, prescriptions, fees for a guardian or conservator, medical devices, transportation to and from medical care, vans, wheelchairs, home modifications, and attendant or replacement services, including attendant care and replacement services  provided by family members. However, starting July 1, 2020. what  the no-fault insurer is required to pay depends on the type of coverage you purchased.

COORDINATED BENEFITS

No-fault insurance companies can sell coordinated policies. Usually, this comes with a reduced premium.  If you purchased a coordinated policy, your no-fault carrier is no longer the primary source of benefits, and you must look to your health care insurance first if the service is available.  The no-fault insurer will pay for care that is not covered by your health insurance or in excess of your health insurance coverages.  The  no-fault insurer will require proof that the bills were submitted to your health Insurance for payment first, and that your health Insurance rejected the claim or made partial payment, before the no-fault insurance will pay. 

MEDICAL BENEFITS

If you are injured in a motor vehicle accident, your own auto insurance policy would cover your no-fault benefits. If no policy applies, then you would look  to the policy of your spouse. If no policy applies, then you would look to the policy  of a relative residing in the same household. If no policies apply, you would have to go to Michigan Assigned Claims Plan (MACP), and they will assign and insurer to cover your no-fault benefits. 

WAGE LOSS

The No-fault Act provides benefits for wage loss that are payable for three years from the date of the accident. The wage loss benefits may be up to 85 percent of a person’s wage and salary or the current monthly maximum amount, which is approximately $5,700 per month, whichever is less. The monthly maximum in effect at the time of the accident is the maximum for that injured person for the next three-year period. However, the no-fault wage loss maximum is adjusted annually for inflation. The income that is recoverable is what you would have earned, not what you could have earned. It is also not based necessarily on the last year or even the last month’s earnings. A new job, a promotion, and a new wage rate (if provable) is recoverable under no-fault insurance. No-fault wage loss benefits are paid at the 85 percent rate since the statute assumes a 15 percent tax

REPLACEMENT SERVICES

Under the No-fault Act, an injured person or the survivor of a deceased may recover replacement services. The no-fault law provides for the payment of up $20 per day for the loss of services that the injured or deceased person would have provided for himself or herself (if the person is surviving) and for dependents. The replacement services are only payable for the first three years after the accident. Typical replacement services include such things as housecleaning, washing dishes, yard work, home maintenance, babysitting, child transportation, etc. The service can be hired and paid to non-family members or provided by family members with a payment or promise to pay by the injured person. Benefits for replacement services are not adjusted for inflation and have not been increased since the act was enacted in 1973. 

ATTENDANT SERVICE

The statute allows for nursing service relating to the patient’s care, recovery, and rehabilitation. These services are typically referred to as attendant care services. These services include taking patient to their doctor’s appointments, bathing, dressing, exercising, walking, grooming, using the bathroom, planning patient’s diet in accordance with the doctor’s instruction, administering medication, etc.   The no-fault law provides that payment for attendant care services are limited to 56 hours per week if the person is related to you, lives in the some home as you,  or if you had a business or social relationship with them before the injury.

MEDICAL MILEAGE

Medical mileage benefits include mileage to and from medical care. Keep records of the mileage expenses by date and miles for submission to the no-fault carrier. The state premium rate of mileage is approximately $.58 per mile at the present time. The IRS mileage rates are approximately $.58 per mile for business and $.20 per mile for medical. The amount paid by insurers varies from about $.30 per mile to $.57 per mile.

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