Michigan No-Fault Benefits

Michigan’s no-fault system is written into Chapter 31 of the Michigan Insurance Code, MCL 500.3101 and the sections that follow. The core benefits provision is MCL 500.3107, which requires insurers to pay “allowable expenses consisting of reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person’s care, recovery, or rehabilitation,” along with work loss and replacement services. Survivors’ benefits after a fatal crash are governed by the neighboring section, MCL 500.3108.

These sections were amended significantly by the 2019 reform legislation, which the Michigan Legislature passed in stages: new IME rules and out-of-state resident restrictions took effect June 11, 2019, the tiered PIP medical coverage options and higher bodily injury liability minimums took effect July 1, 2020, and the medical provider fee schedule and attendant care limits took effect July 1, 2021. Together, these remain the current framework years later.

The state’s insurance regulator, the Department of Insurance and Financial Services, maintains a plain-language consumer FAQ on Michigan no-fault insurance that is useful for policy questions. What the statute and the FAQ cannot tell you is how the law applies to your specific claim, which is where a firm that handles PIP disputes every day earns its place.

Priority Of Insurance Policies After a Michigan Car Accident

Anyone who is involved in an accident in Michigan is entitled to No-fault benefits. The trick is determining the appropriate company to pay those benefits to you. Whether you are a driver, passenger or pedestrian, and even if you are NOT at fault, your Michigan No-fault benefits will be paid by your own auto insurance company. If you do not own a car, the benefits will be paid by the auto insurance of a relative you live with. If you do not live with a relative who has car insurance, the priority shifts depending on whether you were a driver, passenger, pedestrian or on a motorcycle.

It is extremely important that you make a claim for No-fault benefits with the appropriate company. Every owner of a car must buy certain basic coverages in order to get license plates. It is against the law to drive or let your car be driven without no-fault insurance. Your basic no-fault insurance does NOT pay for repairs to your car. This is a very confusing area of the law! We can help you figure out who is the responsible insurer.

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Types of Benefits Explained

Work Loss Benefits: In the state of Michigan, if you are hurt in an automobile accident and unable to work, you may qualify to receive benefits to help compensate for your lost wages. Michigan no-fault wage-loss benefits do not include potential earning capacity or fringe benefits such as those that may be received from anticipated raises, premiums, a 401K, or health insurance benefits, for example. Qualifying wage-loss benefits are payable to an injured person for three years following an accident, covering 85% of the gross lost wages. In accordance with the policies of Personal Injury Protection Insurance (PIP), the maximum allowable monthly benefit is raised October 1st of each year.

A doctor’s disability slip and proof that you were earning a wage are required. If you were receiving cash as payment during your employment at the time of your Michigan automobile accident, or perhaps didn’t otherwise file an income tax form, you may still qualify for the No-Fault Lost Wages benefit. Even if you were looking for work or were “temporarily unemployed” at the time of an accident, you will still be able to receive benefits. If your earnings exceed the statutory maximum, then additional wages lost can often be collected from the negligent driver’s automobile insurer by making an excess wage loss claim.

Replacement Services Benefits: Replacement services are “ordinary and necessary” services that a person must hire someone else to do because they can no longer do the job themselves. In most cases family members of the injured party provide replacement services. To qualify, Michigan accident victims must demonstrate proof of disability. This is provided in the form of a physician-issued replacement service disability certificate. A household services statement must also be submitted to identify the tasks now being performed by someone else.

Paid by the no-fault insurance provider, an automobile accident victim may obtain up to $20.00 per day in household replacement services. (The amount of this compensation has not increased since 1973.) Typical household replacement services include cleaning, laundry, snow removal, lawn mowing and yard work, babysitting, grocery shopping, running errands, preparing meals, home repairs, car repairs, or anything around the home that the injured person used to do, but can no longer do because of the accident. This benefit is paid during the first three years after the date of the accident.

No-fault Medical Benefits: The Michigan No-Fault Act allows Michigan car accident victims to receive up to lifetime payment, if the injured person’s chosen PIP tier is unlimited coverage, of medical bills “for reasonably necessary products, services and accommodations” required for the victim’s care, recovery or rehabilitation. Allowable medical expenses include doctor bills, hospital bills, medication, medical equipment and rehabilitation expenses. Certain criteria must be met before coverage will be allowed for treatments which are considered experimental. Just because an injured subject believes an experimental treatment is necessary doesn’t mean that it will be viewed the same way by the insurance company or the court.

Since a 2020 reform to the No-Fault Act, drivers can choose varying levels of medical coverage through their insurance policies. These levels range from no coverage whatsoever for certain individuals covered by Medicaid to unlimited coverage as provided before the changes. Although the changes were instituted to reduce the cost of insurance for Michigan drivers, any savings related to decreased coverage is minimal. Consumers should still strongly consider unlimited coverage in most circumstances to afford themselves the greatest protection should they suffer injuries in a car accident.

A person who is seriously injured, such as a quadriplegic or paraplegic, may be entitled to additional benefits including modifications to a home or van for wheelchair accessibility.

Attendant Care Benefits: Attendant Care Benefits are available for people who have suffered a significant injury related to a Michigan car accident, motorcycle accident, or semi-truck accident. When someone cannot take care of themselves ( needing personal hygiene, getting dressed, changing bandages, toileting, feeding, taking medications, assistance in walking, needing supervision, or someone just being “on-call”) the No-Fault insurance company will pay to have another person perform these services for the injured person. Often, these situations occur when the injured person has required some type of surgery, spinal cord injury, or traumatic brain injury. If an accident victim is unable to adequately care for themselves, a third-party assistant may be hired to help during the injured party’s time of need. The assistant chosen can be a husband or wife, child, neighbor, friend or professional.

The No-Fault Insurance Company is financially responsible to pay the assistant at an hourly rate. The rate is based on the skill level required for the services needed by the injured person. The level starts at unskilled or supervision attendant care and escalates to highly skilled or registered nursing level care. You will need a doctor’s note and an affidavit from your caregiver to receive this benefit. Attendant care services can last anywhere from a day to a lifetime. Michigan case law has held that a person is entitled to be paid for providing attendant care even while sleeping or doing chores. Merely supervising an injured person is enough to get paid for attendant care benefits.

As of July 2, 2021, No-Fault auto insurance companies are required to pay for no more than 56 hours per week of in-home, friend- or family-provided attendant care. This limitation, of course, only affects those in need of attendant care to be covered by auto insurance. If you or your loved one was not injured in an auto accident, this law may not apply to you. These limits also do not apply to services provided by a medical facility or a commercial entity. What’s more, the new law does not prevent auto insurance providers from contracting to cover more than 56 hours of attendant care services per week.

The Michigan Supreme Court settled this question in Andary v. USAA (July 2023): the 56-hour cap and the associated fee schedules do not apply retroactively. If you or your loved one was injured before June 11, 2019, these limits do not reduce or cap the attendant care benefits you are owed, regardless of when the care is provided. The amount of PIP coverage your insurer provides may still affect your total coverage, and how the ruling applies can depend on the specifics of who is caring for you. To find out how Andary applies to your claim, please contact an attorney.

The experienced attorneys at Mike Morse Law Firm will personally help you negotiate the highest rate for the services performed. If a family member cannot perform the services, then Mike Morse Law Firm will help find the perfect agency to help fill the needs of the injured person at no charge to the family. Have more questions? Contact our experienced staff of Michigan car accident lawyers and ask them for free by dialing 855-MIKE-WINS or e-mail us at mike@855mikewins.com. Remember, no fee unless your case is won.

Home Modifications: Pursuant to the Michigan No-Fault Act, you may be entitled to have home modifications paid for by your insurance company to make your home more accessible for the injured person. This requires a prescription from your physician indicating what type of modifications you would need. Occupational Therapists and architects, knowledgeable in these types of cases, are very useful in determining what can be done to an existing home or apartment. Our legal experts will help negotiate with the insurance company or file a lawsuit against the insurance company to pay for home modifications.

Vehicles and Vehicle Modification: If, because of your auto accident injury, your doctor feels that you need a special van or vehicle, the No-Fault Act requires your insurance company to pay for it. Mike Morse Law Firm negotiates with insurance companies for persons suffering from spinal cord injuries who require vans with lift devices and other special needs. When a special vehicle is needed, many issues can arise, such as vehicle ownership, who pays the insurance, gas, damage, and routine maintenance? Let Mike Morse, an experienced Michigan personal injury attorney, help you. There is no cost for hiring a personal injury lawyer to help you with this very important step in your rehabilitation process.

Medical Transportation Benefits: Michigan law allows accident victims to be reimbursed by the insurance companies for transportation expenses related to obtaining necessary medical treatment for the care and rehabilitation of their accident-related injury. These transportation costs may potentially include mileage, parking fees, tolls, gas, oil, or bus and taxi fare.

Reimbursement rates vary by carrier and are often benchmarked against the IRS standard mileage rate, which is adjusted periodically and currently sits at 76 cents a mile for business use. Not all insurance companies consistently reimburse at that rate. By working with the Mike Morse Law Firm, you can be assisted in pursuing the strongest rate available. Medical mileage reimbursement is a lifetime benefit but you must file a mileage claim with the appropriate insurance carrier within one year from the date the mileage expense is incurred.

To access the Michigan no-fault mileage benefit, a Medical Mileage Benefit Claim must be submitted. It’s very important to keep detailed records of your appointment dates, the name and address of medical providers, and the distance to and from your home. Our office provides free forms to help you keep track of your mileage and reimbursement. We will fax or mail these forms to you free of charge.

Survivors’ Loss Benefits: The Michigan No-Fault Law (MCL 500.3108) guarantees that dependents of a Michigan accident victim are entitled to benefits when that loved one dies due to injuries sustained in an automobile accident. It doesn’t matter if they were a pedestrian, on a bicycle, a motorcycle, or in a car or truck, or whether the deceased was at fault. A no-fault policy maintained by one person includes all family members living in the same residence.

The maximum monthly payment for survivor loss benefits changes annually, to reflect the cost of living. No-fault survivor benefits are determined by the decedent’s post-tax income, financial fringe benefits, and other “contributions of tangible things of economic value” of the deceased that dependents would have received for their support if the victim had not been killed. (Even if the deceased was unemployed at the time of the accident, it may be possible for the survivor to demonstrate that the deceased would have accepted an employment opportunity within three years of the accident). Under the law, financial compensation may be based on resources such as:

• lost wages
• social security benefits
• annuity income
• disability coverage
• worker’s compensation benefits
• pension benefits
• medical insurance premiums
• fringe benefits
• hospital/medical insurance premiums
• investment income

Michigan no-fault benefits can be paid to surviving dependents for up to three years after the accident. Dependents are typically spouses and children under the age of 18 but may include children over 18 if the children are physically or mentally disabled at the time of the parent’s death. Funeral expenses are also payable in the amount specified in the decedent’s no-fault insurance policy. Funeral and burial expense benefits may not exceed $5,000.

Working with an experienced Michigan accident attorney to submit your claim for survivor loss benefits correctly and quickly is key. Claims not submitted within one year of the accident will be permanently denied. Because insurance companies are notorious for denying claims, it is imperative that you contact the Mike Morse Law Firm as soon as possible after a Michigan accident, to ensure you receive all the benefits that you deserve.

What Are the PIP Options for No-Fault Claims?

Since July 1, 2020, every Michigan driver chooses a PIP medical coverage level when buying or renewing a policy, and that choice controls how much the insurer must pay if a crash happens. There are six options.

Unlimited coverage pays all allowable expenses for the injured person’s lifetime, as every Michigan policy did before the reform. Three capped tiers follow: $500,000 per person per accident, $250,000, and a $250,000 option that lets named household members with qualifying non-Medicare health insurance be excluded from PIP medical coverage. A $50,000 option is available only where the named insured is enrolled in Medicaid and the rest of the household has other qualifying coverage. Finally, drivers with Medicare Parts A and B whose household members have their own qualifying coverage may opt out of PIP medical coverage entirely.

The caps apply per person, per accident, and wage loss and replacement services sit outside the capped amounts. Our recommendation has not changed since the reform passed: choose unlimited coverage. A serious injury exhausts a $250,000 cap quickly, and the premium savings on the lower tiers are modest because the mandated reductions only ever applied to the PIP portion of the bill. Your coverage choice also reaches beyond your own household, since an injured motorcyclist’s benefits are capped at the level chosen on the involved car or truck’s policy.

Choosing a Michigan Firm for a No-Fault Claim

No-fault work is its own discipline within injury law, with statutory deadlines, priority rules and case law that change how a claim should be run from day one. Before hiring a firm, ask three questions. Does the firm handle PIP disputes routinely, or mainly general injury cases? Can it name the attorneys who will actually work on your file? And is its track record built in Michigan, where the No-Fault Act and the court decisions interpreting it control the outcome?

Mike Morse has spent his career representing Michigan crash victims, and the firm he founded has grown into Michigan’s largest personal injury firm. PIP denial and cutoff disputes make up a substantial share of the firm’s caseload, and every no-fault matter is handled on a contingency basis, so you pay nothing unless your case is won.

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