Medical coverage for doctors’ and hospital bills is a massive feature of the Michigan No-Fault Law. When a person purchases an auto policy, almost all contain personal injury protection (PIP) benefits. These benefits include the auto insurance carrier’s payment of accident-related medical expenses following a crash. The medical benefit amount is quite extensive.
What Is the PIP Medical Coverage Options?
There are now different levels of PIP medical coverage. Coverage levels from auto insurance carriers after July 1, 2020, include:
- Unlimited PIP coverage;
- $500,000 PIP coverage;
- $250,000 PIP coverage;
- $50,000 PIP coverage – only for Medicaid beneficiaries whose family members live in the same household and have qualified coverage or are covered by another auto policy;
- No PIP coverage – only for proper Medicare beneficiaries or individuals whose private health insurance pays for all auto accident-related treatment.
Under Michigan car accident law, negligent drivers are at the mercy of the no-fault coverage the person they injured maintained. Once the injured person exhausts their own medical PIP coverage, whether it is $50,000 or $250,000, the injured person can turn to the negligent driver and vehicle owner for payment of excess medical bills.
What Medical Expenses Does PIP Pay For?
Personal injury protection coverage pays for all “allowable expenses” for an injured person’s care, recovery, or rehabilitation. MCL 500.3107(1)(a). Medical bills fall within allowable expenses. Examples of medical expenses covered by PIP include:
- Hospital bills
- Physical therapy and rehabilitation
- Surgery
- Long-Term care
- Medications
- Home modifications
- Durable medical equipment
How Much Time Do I Have to Make a Medical Claim?
Under Michigan law, specifically MCL 500.3145, a person must file a claim for no-fault medical benefits within one (1) year of the accident. The notice must be in writing, and the name and address of the claimant must be given. The notice must also indicate the person injured’s name and the injury’s time, place, and nature.
Which Car Insurance Company Pays Medical Expenses?
This is an important question. An injured person must file a first-party claim against the correct auto insurance carrier. Failing to do so can result in the loss of all no-fault benefits.
There is an order of priority to determine which insurance carrier is responsible. After the significant 2019 reforms, the order of priority changed drastically. The current order is the following:
- Your own auto insurance – if you have car insurance, your car insurance company is responsible for paying PIP benefits. This is true even if your vehicle or vehicles had nothing to do with the accident. If you are a named insured on the policy, your auto insurance must pay all first-party benefits.
- The auto insurance company of a resident relative – this includes a spouse, sibling, child, parent, and possibly other relatives. Again, it doesn’t matter if their car had nothing to do with the crash. That insurance carrier must step up and pay all first-party benefits.
- The Michigan Assigned Claims Plan (MACP) – If an injured person does not have auto insurance and does not live with a relative who has car insurance, then they MUST turn to the Michigan Assigned Claims Plan or the MACP. The MACP is run by the Michigan Automobile Insurance Placement Facility.
How Do I Get Medical Bills Paid?
Insurance carriers will pay medical bills related to the accident. But they must receive “reasonable proof” of the medical bill and the “amount of loss sustained.” This means it is important to get the auto insurance company’s medical records showing the medical treatment incurred and how it was related to the crash. In addition, submitting an itemized medical bill to the insurance adjuster is necessary.
How Long Does the Insurance Company Have to Pay My Benefits?
Your car insurance company must pay outstanding medical bills within 30 days of receiving “reasonable proof” of the benefit and the amount sustained. However, if you provide proof of outstanding medical expenses more than 90 days after the treatment was provided, then the car insurer has an extra 60 days to pay the benefit(s). MCL 500.3142(3).
The benefit is considered overdue if the car insurance company fails to pay within this time frame. The insurer must pay a penalty interest of 12% on overdue payments.
What Happens If Auto Insurance Refuses to Pay My Medical Bills?
A lawsuit is necessary if the auto insurance carrier denies your claim or refuses to pay any medical expenses. Insurance companies will deny claims for different reasons.
Sometimes, it is because they sent the injured person to an “independent medical examination,” and the doctor wrote a report stating that no more medical treatment was necessary. IMEs are a significant reason for denying payment in Michigan no-fault cases.
Another excuse is the insurance company accusing the claimant of fraud or material misrepresentation.
A Michigan personal injury lawyer will file the lawsuit against the insurance company. The lawsuit will ask to pay all medical bills and other outstanding benefits. Most lawsuits are settled before going to a jury trial. However, sometimes a jury trial is necessary. Having an experienced and aggressive Michigan car accident law firm on your side is important.
Injured in a Car Accident and Need Help Getting Medical Bills Paid? Call the Lee Steinberg Law Firm to Get Results
The legal experts at the Lee Steinberg Law Firm have been handling first-party claims for over 50 years. Our team of tough and aggressive Michigan car accident lawyers knows what it takes to get you the benefits you paid for and deserve.
Call us at 1-800-LEE-FREE (1-866-696-9146) for a free consultation. We can answer your questions. Our office will go after the insurance company for your unpaid medical bills. There is never a fee until we win your case.