Your First Party claim deals with economic losses, or actual monetary costs in terms of dollars spent or lost because of the accident.  These claims can also be called a PIP claim (Personal Injury Protection), and they include No-Fault benefits.

Michigan’s No-Fault Act, which makes this claim possible, states that your No Fault benefits can include but are not limited to

Each of these items is explained in detail below.

A.  Wage Loss - The No-Fault Act says that if you cannot work because of the accident, you can still be paid 85% of your normal wages for up to three years following the accident. To qualify for this benefit you will need at least these three things:

  1. A letter from your physician, or a prescription, stating that you are unable to perform your work duties because of injuries from the accident. This is often called a disability slip.
  2. Verification of your employment (usually a letter from your employer)
  3. Proof of your lost wages (for example, a tax returns or paystubs). 

Note: The No-Fault law only provides for three years of wage loss from the date of loss. If a person remains disabled and unable to work beyond the three years, then the wage loss claim becomes an excess economic claim in the third party case against the at fault driver. See Third Party Claims.

B.  Medical Services, Bills – Medical providers can submit your medical bills for your care, recovery or rehabilitation directly to the No Fault insurance carrier for payment. Depending on your coverage, either your health insurance carrier pays these expenses, or your automobile/No Fault insurance carrier pays them. Sometimes each carrier pays part of the cost. In most cases, the injured party should not pay out-of-pocket for these services

C.  Household Services – When the injury prevents you from doing your usual household chores, you can receive up to $20 a day to pay for help with those chores. Examples of covered household services include: cooking, doing the dishes, taking out garbage, snow shoveling, changing linens, grocery shopping, doing laundry, raking leaves, cleaning bathtubs, etc.

DPrescriptions – Your automobile insurance carrier pays for prescription medications that help treat the injuries you suffered in the automobile accident.

E.  Mileage – You may be reimbursed (paid back) for the miles you drive (mileage) to and from doctor appointments, physical therapy, hospital visits, and medical tests.

F.   Attendant Care – Some people need extra help at home beyond chores. For example, if you have a severe injury you may not be able to bathe yourself, take your medications, clean wounded areas, dress yourself, or do other activities. In a hospital setting, a nurse might provide these services. To have them paid for at home, they must be prescribed by a doctor.

Skilled Attendant Care – When you need care at home that can only be provided by someone with special skills, such as a registered nurse or a skilled home health aide.  Generally speaking, the hourly rate paid to a person with medical training is higher than for family provided attendant care (as described below) or other non-skilled attendant care.

Family Provided Attendant Care- On occasion, attendant care can be provided by members of your own family, and they can receive payment for providing those services.  For example, if your doctor says that because of an accident, you cannot be left alone and you need someone at home with you 24-hours a day, you may prefer to have a family member do that for you. Automobile insurance companies will pay an hourly rate for family provided attendant care. This rate, however, will be paid as unskilled labor so it will likely be lower than for a trained health worker. 

G.  Home Modification – If you require a wheelchair, cane or walker because of an accident, and have trouble getting in and out of your home, the automobile insurance carrier can pay for your home to be modified. This might mean wheelchair ramps or other aids. If the home cannot be modified, the insurance company may pay for a home that is accessible, such as ranch-style home.

K.  Vehicle Modification - An injured person may require a van with a lift to allow for a wheelchair. Or if you lose the use of your legs, you may require a vehicle that allows you to drive using just your hands (no pedals or brakes). The automobile insurance carrier will pay for the vehicle modifications and sometimes the vehicle.

L.   Order of Priorities - Once you are involved in an automobile accident with another vehicle (a collision), you will have to determine which No-Fault insurance carrier is responsible. The statute (state law) MCL 500.3114 covers the order of priorities. The first place to look is the No-Fault coverage from your own automobile insurance carrier. After that, it becomes complicated. An attorney is a great resource to help you determine the order of priorities for a No-Fault claim.

Beginning the No-Fault Claim or What to Expect from Automobile Insurance

Application for Benefits - When a No-Fault claim is made, the insurance carrier may require the person to complete an application for benefits. This application will ask for vital information such as the person’s name, their injury, the date the injury occurred, their employer, if they are claiming loss of wages, and the names of their treating physicians. Click here for an example of an application for benefits.

Examination Under Oath - In addition to a medical examination, some automobile insurance companies ask for an examination under oath (EUO). This may be done because the insurance company believes there is a problem with the No-Fault claim, For example, they may believe that the person is living at a different address than is listed on their insurance. This could constitute fraud.

If the insurance company contacts you and requests an examination under oath, contact an attorney immediately.

Termination of No-Fault Benefits

Independent Medical Examination (IME) - The automobile insurance carrier often asks the injured person to submit to an independent medical examination (IME), or possibly several exams. The plaintiff’s attorney may also call it a defense medical examination (DME).
           
The doctor who conducts the exam may determine that the injured person has reached maximum medical improvement, no longer requires any further medical treatment or therapy, and can return to work. At this point, the automobile insurance carrier usually sends a cut-off letter to the injured party.

Cut-off letter - The No-Fault law was designed to provide benefits to an injured person so they could maintain their home and take care of their family while they were unable to work.  An automobile insurance company should pay the No-Fault benefits until they send a cut-off letter.  The cut-off letter must be based on evidence, such as an independent medical examination (IME) as described above. The only way to recover No- Fault benefits after they have been cut off is to file a lawsuit.

Dog Bites

An injured person may receive financial compensation (i.e., recover) for scarring and emotional damages caused by a dog bite.

Michigan law MCL 287.351 states that dog owners are strictly liable (legally responsible) for damage caused by their dog if the dog bites someone. The injured person may recover damages if a) the person did not provoke the dog; and b) the person was on public property or lawfully on private property.

Strictly liable means that the dog owner is liable for damages suffered by the bitten person regardless of the dog’s prior vicious acts or the owner’s knowledge of such viciousness.

In addition to strict liability, the dog owner may be responsible for common law damages if that owner knew the dog had a history of viciousness and did not take any safety precautions.  Dog bites often leave significant and severe scars.  If a child is bit by a dog, he or she may suffer permanent scarring that they will have throughout the rest of their lives.

Worker’s Compensation

A person injured while working cannot sue their employer or co-workers for their injuries. Instead, an administrative remedy, called Worker’s Compensation, provides payment of lost wages and medical expenses caused by an injury on the job.

If the injury involves a person who was operating a vehicle as part of his or her job (a FedEx driver, for example), then that person may have a claim for worker’s compensation as well as a third-party claim against the at-fault driver.

Note: Contact a lawyer to help you determine which claims to file — No-Fault, Third-Party and/or Worker’s Compensation.

Social Security Disability

Sometimes an injury may permanently disable a person, and that disability may prevent that person from going back to work. In that case, they can apply for Social Security Disability benefits. The State will have to verify that the disability prevents them from working. 

Note: You do not need a lawyer to apply for these benefits. You can apply on your own. If benefits are denied, an attorney can help you appeal the decision to the Social Security Disability Board.

Insurance Coverage – Protecting Yourself

There are many types of automobile insurance coverage. Most fall into one of four categories: collision, property, liability or medical. Those may also be broken down further. For your convenience, they are explained in detail below.

A. Collision

  • Full
  • Broad Form
  • None

B. Property

C. Liability

  • Underinsured
  • Uninsured

D. Medical Coverage

  • Coordinated
  • Full Medical

You can find out how much coverage you have from your Insurance Declaration Sheet. This is a page that details the coverage you have. It usually includes the following information.

  • Name of insurance company – the insurer.
  • Policy number – used to reference the policy.
  • Policy periods – effective date and expiration date.
  • Named insured and address – the policyholder.
  • Description of included vehicles – year make and model of listed vehicles.
  • Coverage for each vehicle – type and limits of coverage.
  • Premium for each vehicle – the cost breakdown for each vehicle and each coverage.
  • Loss Payee, Lien Holder, Additional Interest or Additional Insured – the finance or leasing company or person listed as owning the interest of the vehicle.
  • Endorsements – changes made to the policy or special conditions.

 

Click here to see an example of a Declaration or “dec” sheet.

Here is an explanation of the different kinds of coverage in detail.

A. Collision – Michigan’s No-Fault law says that when there is an automobile collision or accident, each person’s own automobile insurance carrier pays for the repairs to his or her own vehicle. 

Most automobile policies have a $500 deductible (or more). This means that the policy holder pays the first $500 of the repairs; they are not the responsibility of the insurance carrier. If you have broad form insurance, your own automobile insurance carrier pays for the repairs to your vehicle without a deductible. 

Mini tort - The at-fault driver in the accident may be responsible for paying the $500 deductible/mini tort of the other driver. This could occur when both autos are covered.

No Collision Coverage (PLPD or Personal Liability and Property Damage only) - Some people choose not to carry collision coverage. Usually it is because their vehicle is so old that the replacement cost of the vehicle is less than the cost of the collision coverage. The risk, however, is if you are the at-fault driver (that is, your actions cause the accident), and neither vehicle has collision coverage, you can be sued in small claims court for the value of the other car damaged by your negligence.

There are exceptions, however, such as a parked car exception or if neither vehicle has the required automobile insurance. In this case, there may be a Small Claims Court case. You do not need an attorney to file a claim in Small Claims Court.

B. Property – Most automobile insurance policies include property damage protection. This is important when, for example, a person loses control of a vehicle and drives into a gas station or store.  If the person has property damage protection, the repairs to the property would be paid for by the automobile insurance carrier.

To determine whether you have this coverage, ask your insurance carrier for a declaration sheet for your account.

Declaration Sheet - Click here for a link to an example of a declaration sheet.

C. Liability Coverage – Under liability coverage there are three kinds of protection available:

- Liability Coverage
- Uninsured motorist coverage
- Underinsured motorist coverage

  • 1. Liability Coverage of the Defendant is usually listed as two amounts, as in $20,000/$40,000, $50,000/$100,000, $100,000/$300,000, $250,000/$500,000 or $500,000/$1,000,000. The first number is the maximum amount of money the insurance company will pay for one person’s injuries. For example, with a $50,000/$100,000 policy, the maximum amount an injured person can collect through the defendant’s automobile insurance carrier is $50,000.
  • The second number is the total amount of money the automobile insurance will pay to all injured victims in a single automobile accident. For example, with a $50,000/$100,000 policy, the total available is $100,000, no matter how many people or how badly they are injured. So if four people were injured when the car they were in was struck head-on by a drunk driver, the insurance company will pay only $100,000 total. The four people would have to divide that money between them and each might only get $25,000.
  • To find out how much liability coverage there is, you must get a copy of the defendant’s declaration sheet by requesting it from the defendant’s insurance company. If you file a law suit, the insurance company is required to provide this information. Before a suit is filed, however, the insurance company my refuse to comply with your request. Click here for example declaration sheet.
  • 2. Uninsured Motorist Coverage - Many Michigan drivers do not have automobile insurance for their vehicle.  If you are injured in an accident, and the at-fault driver does not have automobile insurance, you may still be protected if you have uninsured motorist coverage on your own automobile insurance policy. This coverage is listed on your declaration sheet as UM coverage. (Click here for an explanation of a declaration sheet)
  • Here is an example of when a person would need UM coverage: If a car is struck by a drunk driver that crossed the centerline, and the drunk driver did not have any automobile insurance coverage, then the injured party could not collect from the drunk driver. They would have to look to their own automobile insurance coverage for uninsured motorist coverage.
  • 3. Underinsured Motorist Coverage - Having this coverage is important if the defendant, or at-fault driver, has automobile insurance coverage, but not enough to pay for all of the plaintiff’s injuries. 
  • Many people choose to pay only for $20,000 liability coverage – that’s the minimum required to be able to renew a license and get license plate tabs (stickers) from the Secretary of State.
  • But what if a person with this minimal coverage causes an accident and significant injury to another person? The injured person’s third party claim for pain and suffering is likely to exceed the $20,000 in liability coverage carried by the defendant. If the plaintiff (the injured person) has underinsured motorist coverage, the plaintiff could turn to their own automobile insurance coverage for additional reimbursement.

  • For another example, if a person suffers an extreme injury where they break both legs, they may be off work for the rest of their life. If they have a job in manufacturing, their legs may never be stable enough to allow the person to stand for eight hours a day and perform their job. 
  • The at-fault driver may only have an automobile insurance policy with the minimum requirement of $20,000 in liability coverage. If the injured person has underinsured motorist coverage in the amount of $250,000, then that person would have an additional $230,000 in coverage ($250,000 underinsured motorist coverage minus the $20,000 from the at-fault driver). 
  • Note: Uninsured Motorist coverage is the best coverage money can buy, and we highly recommended.

D. Medical No-Fault Insurance Coverage – This may include coordinated coverage and/or full medical coverage.

  • 1. Coordinated Coverage - Coordinated coverage is a term you may hear, but it really means something else. Coordinated coverage means that your health insurance policy is the primary (first) payer of medical bills related to an automobile collision.  For example, the health insurance provider may pay 80% of your medical bills, leaving the remaining 20% the responsibility of the injured party.
  • The injured person then must submit the bills for the 20% to their automobile insurance carrier for reimbursement. Often, payment of the 20% takes a long time, and medical providers expect to receive it in a timely manner. If it takes too long, collection agencies may start calling on the injured person for payment.
  • Note: Your insurance agent may ask if you have health insurance, and may tell you that you can save money on your automobile insurance coverage by making your health insurance primary coverage. This may not be the best option, even if it saves a little money up front. 
  • 2. Full Medical Coverage - This makes the automobile insurance carrier the primary payer for any medical bills that result from an automobile collision.  The No-Fault law was designed to provide prompt payment of medical bills submitted, with reasonable proof, within 30 days of submission to the automobile insurance carrier.  See MCL 500.3142 for more information.