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.