Michigan Automobile Accident Lawyer

Under personal protection insurance (PIP), your insurance company is liable to pay benefits for accidental bodily injury arising out of the ownership, operating, maintenance or use of a motor vehicle as a motor vehicle, without regard to fault.  MCL 500.3105.  Your auto insurance must pay for “allowable expenses” consisting of all reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person’s care, recovery, or rehabilitation.  The following are benefits that are covered by your auto insurance:

A) Work Loss: Work loss is paid for up to 3 years from the date of your accident.  Work loss is loss of income from work that you would have performed during the first 3 years after the date of the accident.  Work loss does not include any loss after the date on which the injured person dies.  Since this benefit is not taxable income, your insurance company will reduce the payment 15% (which makes up for the taxes you would have paid).  You are paid work loss every 30 days.  Work loss for a single 30 day period shall not exceed $5,189.  This amount is adjusted annually to reflect changes in the cost of living. If your insurance company fails to pay and payment is overdue by more than 30 days, you can sue for the amount due including attorney fees and penalty interest.

B) Allowable Expenses: Rehabilitation, nursing care, attendant care, accommodations, occupational therapy, physical therapy, vocational therapy, prescriptions, hospital bills, transportation and/or mileage to and from doctor’s appointments, and medical equipment and supplies, are some of the expenses that are covered by insurance.  For these types of services and expenses to be covered by your insurance company, the claimed benefits must be causally connected to the accidental bodily injury and the injury must be causally connected to the automobile accident.  See Griffith v State Farm Mut Auto Ins, 472 Mich 521 (2005). This is a fancy way of saying that your injury has to be a result or caused by the automobile accident or at least casually related.  For example, if you broke your leg in an auto accident and years later you fall on ice and break that same leg, you would not be able to get your auto insurance to pay for the leg again.

• Rehabilitation, special training, physical therapy, vocational therapy and/or occupational therapy:  these are services in which your insurance company is obligated to pay.  Your doctor writes you a prescription for the specific service(s) and the duration in which you are to attend.  In some circumstances, you may be admitted into a rehab facility for a period of time and, once you have made the necessary progress, then released to your home for in-home care and therapy.
• Attendant Care and/or Nursing Care:  If you suffered a serious injury and you are unable to care for yourself or have special needs that only a nurse can perform, you may be ordered attendant care or nursing care.  Attendant care allows you to return to your home instead of being lodged in a rehab facility.  Sometimes, family members can provide the attendant care.  Of course, when this happens the amount of pay that that family member is paid is usually an issue with the insurance company.  For some reason, insurance companies think that family members should be paid far less than a skilled attendant care provider who performs the same tasks.  When attendant care is ordered by your doctor, the decision becomes whether a family member is available to perform the attendant care or whether an outside company/person is hired to come into the home and provide attendant care.  Attendant care can be ordered for just a few hours to 24/7.  Most often, an insurance company will argue that the injured person does not need attendant care while they are asleep.  However, if you suffered a catastrophic injury, you may not be able to be left alone in which case you would need 24/7 in the event say you wake up at night and have to use the bathroom.  Examples of services that may be provided by attendant care are dressing, assisting with transfers from bed to wheelchair or wheelchair to bathroom, bathing, dressing, preparing and eating meals, personal hygiene, giving you medications, driving you to doctor’s appointments, assisting with in-home therapy.  Attendant care is very important if you are seriously injured in an automobile accident and is available to you for life.
• Accommodations:  Accommodations is another expense that may require your insurance company to pay for renovations to your home to make it handicap assessable.  In some cases (catastrophic injuries), the insurance company may be obligated to build you a new residence.
• New vehicle:  In some cases, your insurance company may be required to buy you a wheelchair assessable van or make modifications to your existing vehicle.  Again, which one you get depends on what is “reasonably necessary” for your care, recovery or rehabilitation.
• Mileage:  is paid to travel to and from doctor’s appointments.  In addition, travel arrangements may be made.  For instance, if you are unable to travel in a motor vehicle, your insurance company will pay for an ambulance to move you back and forth.

C) Replacement Services: Replacement services are paid to someone who has to do “chores” for you.  The amount is not to exceed $20 per day and must be reasonably incurred in obtaining ordinary and necessary services in lieu of those that, if you had not been injured, you would have performed yourself.  Replacement services are available for up to 3 years from the date of the accident.  Examples of replacement services are mowing the lawn, doing laundry, cleaning the house, doing dishes, cooking, etc. and are things that you can no longer perform do to your injuries and that you did perform prior to the accident or injuries.

D) Survivor’s Benefits: if the accident resulted in the death of your loved one, you are entitled to “survivor’s benefits”.  The benefits include the same type of benefits your loved one would have received had he not died, which include after tax work loss, the value of any benefits he received at work such as fringe benefits, replacement services (up to $20.00/day) and other contributions of tangible things of economic value.  If the motor vehicle in which the deceased owned and operated was uninsured, you and his dependents will not be entitled to survivor’s benefits.

If your insurance company fails to pay any of the allowable expenses (i.e. work loss) and payment is overdue by more than 30 days, you can sue for the amount due, including attorney fees and penalty interest.  The hospital or health care facility that provided medical treatment to you for injuries sustained in an automobile accident, can sue your auto insurance company for PIP benefits under the no-fault act if it fails to pay your medical bills.  When a health care provider submits a claim for payment under the no-fault act, the healthcare provider can also enforce payment of penalty interest and attorney fees of the no-fault act.  See  Wyoming Chiropractic Health Clinic v Auto-Owners, Court of Appeals, 2014 WL 6909637 (Dec. 9, 2014).

Michigan law requires No-Fault insurance and it is a misdemeanor to operate a motor vehicle without the required insurance.  If you or a family member is injured in an auto accident, your auto insurance pays for PIP benefits including medical and rehabilitation expenses for life, work loss and replacement services for up to 3 years.  If you do not have the required insurance and you are in a serious automobile accident, medical expenses can exceed $100,000 within a day of hospitalization.  You would not have the benefit of PIP benefits if you fail to insure your vehicle.  Further, you can be exposed to personal liability for all damages to which an injured victim may be entitled should you injure or kill another person.  The current minimum insurance coverage that is required in Michigan is $20,000 per person who is hurt or killed in an accident, $40,000 for each accident if several people are hurt or killed, and up to $10,000 for property damage or 20/40/10.  You should purchase higher limits, and also purchase uninsured and underinsured coverage as well.  As you can see, should the at-fault driver only carry the minimum insurance, it would not be enough if you or a family member were seriously injured.  Uninsured and underinsured (UIM) is very inexpensive and I would recommend a minimum of $250,000 for each.

If you are injured while working in the course of your employment by a motor vehilcle, then worker’s compensation will pay the medicals, rehab, work loss, etc. that you would otherwise receive from your auto insurance company.  If worker’s compensation pays for any work loss during the first 3 years following the automobile accident, worker’s compensation does not have a right to subrogation for that amount paid.  However, after 3 years, worker’s compensation will have a lien on future wage losses.  The amount of the lien is determined by the amount that you recover from the at-fault driver.  Workers’ compensation will take the total recovery which includes both past and future non-economic damages (i.e. past/future pain and suffering, embarrassment, shock, distress, etc.) and economic losses (work loss, excess replacement services) and utilizing what is referred to as the “Franges Formula” will determine the monthly amount that you are entitled to receive following the 3 years after the accident.  An example of how this could work on a case that settles for $1,000,000: 

Example:  $1,000,000.00 settlement:  The entire $1,000,000.00 settlement, along with current worker’s compensation payment ($391.00/week) is entered into the Franges worksheet.  The estimated total W/C benefits paid is $200,000.  Based upon this scenario, your workers compensation work loss amount would be reduced from $391/week to $204/week.

These numbers can vary drastically, even so far as giving you $0.00 per week depending on the amount of settlement, amount of benefits paid, etc.
In addition to work loss, worker’s compensation will also pay for the medical bills and rehabilitation.  Normally, your auto insurance would pay for these expenses.  However, if you are seriously injured in a motor vehicle accident while you are working within the scope of your employment or you are struck by a car while you are working within the scope of your employment (i.e. working in road construction and a car hits you), your worker’s compensation pays for the medical treatment.  When worker’s compensation pays for these expenses which would be compensable under the no-fault insurance act, there is no right to reimbursement for such payments.  See Great American Insurance Co. v Queen, 410 Mich 73 (1980).

A)    Your vehicle:  If your motor vehicle is involved in an accident, your auto insurance company pays for work loss, medicals, rehabilitation, and replacement services for you, your spouse and a relative of either you or your spouse who is living in your house (i.e. your kid).  If applicable, your insurance company also pays for survivor’s benefits and up to $5,000 in burial fees.

B)    Employer/Employee: If you are an employee and you are driving your employer’s vehicle and you are in an accident – the employer’s auto insurance pays for PIP benefits (work loss, medicals, replacement services and survivor’s benefits).

C)    I suffered accidental bodily injury while a pedestrian and, therefore, was not an occupant of a motor vehicle – who pays PIP benefits:  If you are not an occupant (in or upon) a motor vehicle but you are hit by a motor vehicle, the order of priority is as follows (MCL 500.3115):

• Insurers of owners or registrants of motor vehicles involved in the accident (owner).
• Insurers of operators of motor vehicle involved in the accident (driver).

D)    Motorcycles:  You are an operator or passenger on a motorcycle and you are involved in a crash with a motor vehicle and suffer injury.  Who pays your PIP benefits (work loss, medicals, replacement services):  According to MCL 500.3114, the priority is as follows:

• The insurer of the owner or registrant of the motor vehicle involved in the crash (the owner or registrant of the car involved in the crash).
• The insurer of the operator of the motor vehicle involved in the crash (the driver of the car that was involved in the crash).
• The motor vehicle insurer of the operator of the motorcycle involved in the accident (the motorcycle driver’s auto insurance).
• The motor vehicle insurer of the owner or registrant of the motorcycle involved in the accident (the motorcycle owner or registrant’s auto insurance).

E) Miscellaneous coverages for Passengers:  A person suffering accidental bodily injury while an operator or a passenger of a motor vehicle operated in the business of transporting passengers shall receive PIP benefits to which he/she is entitled from the insurer of the motor vehicle.  This does not apply to a passenger in the following, unless that passenger is not entitled to PIP benefits under any other policy:

• taxi cab
• school bus
• bus operated under a government sponsored transportation program
• bus operated by or providing service to a nonprofit organization
• bus operated by a canoe, watercraft, bicycle or horse livery used only to transport passengers to or from a destination.

F) I suffered accidental bodily injury, but I do not have auto insurance nor does any of the vehicles involved in the accident:  You could be eligible for PIP benefits through the Assigned Claims Facility of the Michigan Department of State for no-fault benefits.   Once you file your claim, the Assigned Claims Facility will assign your case to an insurance company to handle the claim.

Pursuant to MCL 500.3113, the following persons are not entitled to be paid personal protection insurance benefits for accidental bodily injury if at the time of the accident any of the following is present:

a)    You were operating a motor vehicle or motorcycle that you took unlawfully (stolen car) – unless you reasonably believed that you could take and use the vehicle or motorcycle;

b)    You are the owner or registrant of the motor vehicle or motorcycle involved in the accident, and you did not have the required Michigan auto insurance in place at the time of the accident.

c)    At the time of the accident, you were not a resident of Michigan, you were an occupant of a motor vehicle or motorcycle that was not registered in Michigan, AND you were not insured by an insurance company that filed a certification of compliance.  The list of insurance companies that are licensed to write auto insurance in Michigan can be found here.

When you are in an auto accident that is caused by another driver’s negligence, the first thing you should do is seek the necessary medical attention that you need.  You must follow doctor’s orders and make all the follow-up treatments.  Taking care of yourself and getting better should be your first priority.  You should report the accident to your automobile insurance and then contact an attorney who has experience with auto negligence cases.  Some insurance companies will want to take your recorded statement.  You may even get a call from the at-fault driver’s insurance company asking for a recorded statement about the accident.  You should not give a recorded statement (or any statement) to an insurance company without first contacting an attorney.  Your insurance company will ask you to fill out PIP paperwork.  This is okay, since it will start up the payment of benefits that you are entitled to through your automobile insurance.  After an accident that causes serious injuries to you or a loved one, it is wise to contact an attorney who regularly practices in the area of auto negligence.

When you are in an automobile accident that causes serious injuries, there are generally two separate claims – First Party Claim and Third Party Claim.  The First Party Claim is with your auto insurance.  Generally, the main expenses that are paid by your insurance company are lost wages, hospital expenses, rehabilitation expenses, attendant care and replacement expenses.  Your insurance company may also be responsible to make improvements to your home to make it handicap assessable or in some cases provide a new home if your existing home is unable to be remodeled to accommodate your specific needs.  Further, if you are confined to a wheelchair because of a serious injury, your insurance company should either make modifications to your existing vehicle to make it wheelchair accessible or buy you a new vehicle such as a handicap van.  A more thorough discussion of First Party Claims is found in my section called First Party Claims.  The Third Party Claim is against the at-fault driver.  In reality, it is his/her insurance company who pays the money for pain and suffering, excess wage loss, etc.    In a Third Party claim, you may recover money for things such as pain and suffering, embarrassment, permanent serious disfigurement, loss of society and social pleasures, loss of quality of life enjoyed prior to the accident versus your quality of life have the accident.  

The at-fault driver’s insurance company is responsible to pay for what is called, Non-Economic Damages and Economic Damages.  In Michigan, you must suffer a “threshold injury” in order to recover economic such as excess wage loss and non-economic damages such as pain and suffering, permanent serious disfigurement, loss of society, social pleasures, etc.  A threshold injury consists of death, serious impairment of body function and/or serious permanent disfigurement.    What constitutes a “serious impairment of body function” or “permanent serious disfigurement” is discussed more in depth below.  But know that just because you are not rushed to the emergency room via ambulance does not mean you will fail to meet a threshold injury. 

Non-economic damages are generally those damages for pain and suffering, permanent serious disfigurement, loss of social pleasures, and loss of a quality of life that you now have because of the accident.  In Michigan, a person remains subject to tort liability for non-economic loss caused by his or her ownership, maintenance, or use of a motor vehicle only if the person has suffered death, serious impairment of body function, or permanent serious disfigurement.  MCL 500.3135.  Whether you have suffered serious impairment of body function or permanent serious disfigurement are questions that the judge decides.  If you suffered a closed head injury, you need to only provide an affidavit from a doctor who regularly diagnoses or treats closed head injury (i.e. neurosurgeon) stating that you may have a serious neurological injury.

The definition of “serious impairment of body function” is an objectively manifested impairment of an important body function that affects the person’s general ability to lead his or her normal life.  (MCL 500.3135(5)). 

i.    Objectively manifested impairment:  The “objectively manifested impairment” element is an impairment that is evidenced by actual symptoms or conditions that someone other than the injured person can observe or perceive on an X-ray or MRI for instance. 

ii.    Important body function:  An “important body function” element is subjective and depends on the person.  For instance, a pinkie finger would be more “important” for a famous pianist vs an accountant.  Being able to do the golf swing would be more important for a professional golfer vs someone that places once or twice a year.

iii.    General ability to lead his/her normal life:  Whether or not the injured person’s general ability to lead his/her normal life is affected is subjective and is determined case-by-case.  This element requires an actual comparison of the injured person’s life prior to the accident versus after the accident.  What could you do before the accident that you no longer can do (or you do it with pain or difficulty)?

A person that suffers a serious injury can recover from the at-fault driver those expenses that are in excess of the 3-year statute of limitations found under the First Party Claim.  The most common excess economic damages is excess work loss.  Your own auto insurance will pay for lost wages up to 3 years. However, after those 3 years, you can look at the at-fault driver’s insurance company for work loss that you suffer that goes beyond the 3 years.  Further, you can recover excess survivor’s loss and excess allowable expenses.

Comparative Fault:  Money including those that would be paid to you for pain and suffering, will not be paid to you if you are found to be more than 50% at fault for your injuries.

No insurance at time of accident:  Money will not be assessed in your favor if you were operating your own vehicle and at the time of the accident or injury you did not have the required auto insurance on your vehicle.  (MCL 500.3135(4)(e).  In other words, you are barred from getting money for things such as pain and suffering, excess wage loss, etc. against the at-fault driver if you failed to have in place auto insurance on your vehicle at the time of the accident. 

If you are injured at work while using an automobile or the accident involves an automobile, your worker’s compensation may pay the medical bills, which would otherwise have been paid by the First Party insurance company.  When worker’s comp pays a benefit that would otherwise be compensable under no-fault insurance act, the workers compensation company does not have a right to be reimbursed for those benefits it paid.  For instance, if worker’s comp pays for your medical bills.  These bills would otherwise be paid by the no-fault insurance (commonly, your automobile insurance).  Since the no-fault insurance would have had paid them, worker’s comp is not allowed a lien against a settlement in your Third Party case.  Same thing for lost wages for those first 3 years.  The only time worker’s comp can place a lien against any settlement is when it pays for things such as excess wage losses and those benefits paid that no-fault insurance is not responsible to pay.

Usually, the insurance company will not give this information to you.  In some cases, however, if the value of your injury far exceeds the policy limits, then the insurance company will typically tell you the policy limits.  For instance, if a loved one suffered death as a result of the automobile accident and the policy limit is only $50,000, then most likely the insurance company will divulge the limits.  Otherwise, if an insurance company will not provide the policy limits, you may have to file a lawsuit and conduct discovery.