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News & Case Results


Matz & Pietsch Blog

  • Dec

    02

    2014

    Coordination of Benefits

    “I have medical insurance through work, and no-fault insurance on my car. If I am hurt in an accident, which policy pays?”

    This is both one of the most common questions we hear, and one that does not have a single answer that fits all situations. When you have both medical insurance and car insurance in Michigan, you have to look at the “coordination of benefits” and “exclusions” sections in each policy to decide which pays for auto-related injuries.

    All no-fault car insurance policies in Michigan have medical coverage. If you have “PL/PD” on your vehicle, you have medical benefits, too. If your no-fault benefits are “coordinated” or “excess,” that means your health insurance has to pay the bill first. It is possible that your car insurance will pay amounts over and above what the health insurance pays, but the health insurance is “primary.”

    If your health insurance has an exclusion for auto-related claims, that makes it easy. Your car insurance pays the bills.

    If both your health plan and auto insurance are coordinated (that is, each policy says the other policy is primary), the health insurance pays first.

    If you pay extra and buy “full” medical coverage on your car insurance, both the medical insurance and car insurance may pay. This means you might be able keep the check your no-fault company sends you to pay the medical that was already covered by your health insurance (this is called “double dipping.”) That is perfectly acceptable to do, because you paid extra for the auto coverage to allow that. But be careful—if you misinterpret the language in either your health insurance or auto policies, you could be responsible to pay the medical bills yourself from the check your auto carrier sends you.

    Lastly, be aware that certain kinds of employer health plans are organized under a federal law called ERISA. That type of health plan may have the responsibility to pay your accident-related medical bills, but may also demand that you repay the health plan for the money it spent if you get compensation from another driver who caused the accident.

    As you can imagine, the issue of coordination of benefits is a topic that even specialist lawyers are constantly debating and studying. A judge once remarked: “The only thing worse than having no insurance policy in an auto accident is having two policies.”

    Source: 450 F3d 643


  • Nov

    26

    2014

    Chronic ailments and No-Fault Benefits

    “Can I get no-fault benefits if an auto accident makes an “old” injury worse?”

    Yes, but you have to prove to your auto insurance company that the accident, as opposed to the pre-existing injury, is what is causing your need for treatment and any disability you claim.

    We see many cases where, for example, someone with a history of back or neck pain gets into an auto accident that seems to make the old problems worse. It can be difficult for your doctor (and later, your lawyer) to prove that the recent trauma from the accident has made you feel worse. One way this is done is to compare your medical records from before the accident to what your records say now. There might be an old MRI or “CAT” Scan that was taken when you started having problems years ago. This could be compared to updated studies taken since the accident. If you had been doing fairly well before the accident, despite having underlying problems, and now your new studies show worsening of your condition, it seems reasonable to suggest that the accident made your old problems worse.

    As we have said in previous parts of this series of articles, you can expect your insurance company to ask the same questions, because the insurance company may be responsible to pay for your medical care, work time lost, and other benefits that are provided under No-Fault. The company may send you for an evaluation by a doctor it chooses, who will usually say that the accident had nothing to do with your complaints. That takes the insurance company “off the hook” for paying your expenses. You probably will need a lawyer to fight that battle for you, since the law gives the insurance company the right to do that—you have to prove they are wrong!

    One more thought to keep in mind: you have to be able to show that a single auto-related incident caused your problems. Claiming that years of climbing in and out of your truck caused you to have sore knees, for example, is not the kind of case that no-fault benefits were designed to cover.

    Source: MCL 500.3105; 125 Mich App 123


  • Nov

    24

    2014

    Why doesn’t the other driver’s insurance cover my medical expenses?

    “Why should my car insurance have to pay my medical and wage loss expenses if the other driver caused the accident?”

    This is probably one of the most common questions we have heard in more than 35 years of practicing auto law in Michigan. It is certainly reasonable to assume that the person who caused the accident between vehicles should pay the medical and economic expenses that the innocent parties incur. In fact, that’s the way it is in most states.

    However, Michigan is one of about 15 states that have some form of no-fault system. The idea is that it is cheaper for the insurance system in the long run if each of us insures ourselves for medical and wage losses from an accident. That way, the idea goes, if you get into a collision, your insurances steps up and takes care of you right away, and the other person’s insurance does the same for him or her. No need to sue, or to worry about whether the other driver even had insurance in the first place. That is supposed to make the system easier to use, and therefore cheaper for all of us.

    So if you are in a collision with another driver, the other person’s insurance is not responsible for your medical, wage loss or a couple of other benefits that are provided by law (there are a few exceptions that apply to pedestrians and motorcyclists, and that apply to the amount of wage loss you suffer). Remember: you may have health insurance or disability plans through work that might play into this, too.

    If you are still thinking that this sort of system sounds strange, you are right to be skeptical. The fact is that there are so many loopholes and interpretations to the no-fault system that even attorneys who do this kind of work for a living have to argue cases about it all the time!

    But the general rule is: your insurance pays your medical expenses and wage losses, and the other driver’s pays his or hers.

    Source: MCL 500.3114, 500.3115.


  • Nov

    22

    2014

    Can an illegal alien receive Michigan No-Fault benefits?

    “Can an illegal alien receive Michigan No-Fault benefits?”

    It’s possible, if the person resides with a relative who has auto insurance (or if the “undocumented” person has obtained his or her own auto insurance). If a person is injured in a car accident in Michigan, as long as the person is not in an uninsured vehicle that he or she owns, the person is entitled to no-fault benefits whether the person is in the U.S. legally or not. The courts have ruled that the wording of the No-Fault Act does not exclude undocumented people from the list of people who can apply for no-fault medical benefits. If the legislature wanted to exclude undocumented people from the no-fault system, it would be free to do so, but it has not.

    Of course, it is important to keep in mind that undocumented individuals may be detained or deported if they are identified, and that using false identification papers is a crime for citizens and undocumented persons alike, as is failing to report income or wages for tax purposes.

    But the point of this entry is to answer the basic question of whether a person in the country illegally can claim no-fault benefits (for example to pay medical expenses) from the no-fault policy of a relative that person lives with in Michigan. And the answer to that question is “yes.”

    Source: 272 Mich App 410


  • Nov

    21

    2014

    Aggravation of Pre-existing Injuries

    “I have had a ‘bad back’ for many years. A recent car accident made it worse. How can I prove that?”

    A major insurance company strategy is to “blame the victim” for being involved in an accident that worsens medical conditions the innocent person may already have had. In fact, some insurance companies, and the lawyers they hire, go so far as to suggest that if you had an underlying condition before the accident, you are trying to “take advantage of the system” if you claim your earlier problems are made worse by the accident.

    The law in Michigan allows your lawyer to protect you from this strategy. Here is a summary of the law to get you started.

    If you have a pre-existing injury or medical problem, and you can prove through medical testimony (not to mention the testimony of friends, family and co-workers who knew you before and after an accident) that the accident has made the condition worse, the law that will be read to the jury is that the person who caused the accident is responsible for any increase in your impairment that you can document.

    In addition, if the jury can’t sort out which of your problems existed before the accident from those you have now, the at-fault driver is responsible for all of your pain and suffering!

    We have seen thousands of cases where someone who is injured in an accident gets an MRI or CT scan that shows both long-term and fresh injuries. Lots of us have degeneration in our back, or in other joints, and may not even realize it until a severe impact “jars” us out of alignment. You may have been working every day, enjoying your family life and your hobbies, without serious limitations even though you have early signs of joint degeneration. Now a careless driver slams into you, and all that changes. It’s not just a coincidence that you went from functioning normally up to the time of the accident, and now you are in physical therapy, or are seeing a surgeon about the possible need for an operation. If you are vulnerable to injury due to factors out of your control, and a negligent driver makes these conditions worse, that is their problem, not yours!

    So don’t let an insurance adjuster try to convince you that if you had physical problems before an accident, that’s just your tough luck. The law is on your side, as long as you can prove that you are significantly worse off after an accident than you were before.

    If you are in this situation, it is a good idea to talk to an attorney who knows the area of Michigan no-fault law.

    Source: Jury Instructions M Civ JI 50.10 and M Civ JI 50.11


  • Nov

    18

    2014

    PIP benefits for uninsured passenger

    “If I am a passenger in an uninsured vehicle, and do not have car insurance of my own, can I still get no-fault benefits?”

    Yes, as long as you weren’t an “owner” of the uninsured vehicle you were riding in. (The word “owner” is in quotes because it has special meaning in Michigan no-fault cases, and you should talk to a lawyer about the definition of the term). There are some things you should know. Remember—we are talking about passengers here.

    Even if you don’t have car insurance yourself, you will still qualify for no-fault benefits if you live with any relative who has an insured vehicle. Their insurance covers all relatives in the household for wage loss, medical benefits and several other types of payments—even if their car wasn’t involved in the crash.

    If you are a passenger, don’t own the vehicle you are in, don’t have car insurance yourself, and don’t live with a relative who does, and the driver of the vehicle (this person may not be the owner) does not have car insurance, you can still apply to the Michigan Assigned Claims Plan for wage loss and the other benefits that are available through no-fault in Michigan. You can find out about the Plan online, or you can contact a lawyer who knows about no-fault law for more information about it.

    Assigned Claims will ask you to fill out a form to determine if you qualify. If so, the Plan will assign a no-fault carrier to your case, and you will be eligible for all the no-fault benefits that any insured person would have.

    Something to remember is that an insurance company, whether through the Plan or otherwise, has the right to go against the uninsured person to get the money back that the insurance company had to pay because the uninsured driver caused the insurance company to have to make payments for you or to you. It is important to realize that if you are a passenger in an uninsured vehicle owned or being driven by a friend or family member, that friend or family member could be sued later by the insurance company that has to “clean up” the situation on your behalf. They will probably also lose their drivers license.

    And even if you choose not to file a claim for no-fault benefits because you want to protect your uninsured driver from being sued by an insurance company, you should know that the doctors and hospitals you visit to treat your injuries can file a claim on their own behalf to be reimbursed through no-fault. The insurance company can then go after your uninsured friend or relative whether you agree or not.

    So the bottom line on this point is that it is a very bad idea to get in a vehicle owned or driven by an uninsured person at any time, but especially if you don’t have no-fault insurance of your own!

    Source: MCL 500.3177


  • Nov

    15

    2014

    “Bystander” claims

    “If I witness a serious crash, and it upsets me, can I sue for damages?”

    Over the years, we have had cases where people who weren’t involved in a crash saw it happen, and were upset by what they witnessed afterward. They asked us whether they could file a suit against the driver who caused the crash, even though they weren’t involved in it, or physically hurt themselves.

    It’s possible. Michigan law allows so-called “bystander claims” for witnesses under certain circumstances. There are three basic requirements:

    1. First of all, you would have to be an immediate family member of the injured person; if not, you won’t have a case (unless the at-fault driver hit you, too);
    2. Secondly, the accident has to be serious enough so that it is reasonable to claim that seeing it would be extremely shocking; and
    3. You have to prove that you had a bad emotional reaction to what you saw.

    If you can meet all three requirements, you may be able to sue the driver who caused the accident that you saw, but that you were not directly involved in.

    Source: 67 Mich App 363


  • Nov

    14

    2014

    Comparative fault in auto cases

    “Can I still sue the other driver for pain and suffering if I am partly at fault for the accident?”

    Yes, as long as you are not more than 50% at fault yourself. This issue comes up a lot in cases where, for example, one driver is turning left on a yellow light, and a driver going straight speeds up a little to “make” the light. The turning driver believes that the oncoming driver should know that cars will be turning left on yellow. The oncoming driver says you shouldn’t turn until you are sure the oncoming traffic is stopping. Both parties can be partly at fault, and can still file claims for pain and suffering (“non-economic damages”) against one another. The driver who can convince a judge or jury that he or she was seriously injured, and was not more than 50% at fault is eligible for money damages.

    This is called “comparative negligence.” It means that the court “compares” how much each driver contributed to the crash. If you were mostly the cause of the collision, you can’t get any money for pain and suffering. Note: this is the law in Michigan, but not in all states.

    You should keep in mind that this rule doesn’t apply to claims against the driver for economic losses (financial losses caused by injuries) that are above the no-fault maximums. One example: If you make more than the no-fault monthly maximum for wages (currently about $5400), or you will be disabled for more than three years, you can still go after the other driver for the excess even if you were mostly at fault. The amount you are awarded will be reduced by the percentage the jury finds you at fault.

    Source: MCL 500.3135 (2)(b)


  • Nov

    11

    2014

    Sick leave and PIP benefits

    “My no-fault adjuster wants me to use up my sick days from work before I can collect no-fault wage loss. Is that proper?”

    No. If you are hurt in a car accident, no matter whose fault it was, your auto insurance has to pay you for your approved time off work from day one. The insurance company does not get a credit for sick days you might have had coming anyway.

    Source: 90 Mich App 687


  • Nov

    10

    2014

    Bicyclist hit by car? Does no-fault apply?

    “I was riding my bicycle in the road, and was hit by a car. I don’t have any insurance. How can I pay the medical bills?”

    A caller asked us this recently. She was very concerned, because it turns out the accident was her fault (she swerved right into the path of a car she should have seen). On top of that, she told us that she didn’t own a car, and that she lived alone. Her medical bills from the hospital alone were in the thousands of dollars. She wanted to know what advice we could give her.

    It turns out that she will be getting no-fault benefits through the policy of the owner of the vehicle that struck her. No-fault insurance has that name because you qualify for some benefits in many situations no matter who was at fault. However, the trade-off for that coverage is that you can only sue for pain and suffering if the other driver was the one mostly or totally at fault, and if you had serious injuries.

    Back to this case; the bicyclist would usually apply to her own car insurance, or to the policy of anyone she lived with who was a relative. That is true even if though she wasn’t even in a car. Since she didn’t have any coverage herself, and she lived alone, none of those possibilities were open to her. However, bicyclists and pedestrians who are in her situation can apply to the insurance for the owner or driver of the vehicle that was in the crash with them. It doesn’t matter who was at fault. It’s part of the coverage we pay for with our car insurance.

    The insurance on the vehicle will pay those medical bills, and for our caller’s time off work, too. There are a few other benefits she could qualify for, as well.

    Remember; because she caused the accident, she won’t get anywhere with a case for pain and suffering. But she will get no-fault coverage for those bills!

    The rules covering benefits for car and truck drivers are full of all kinds of exceptions for motorcycles, off-road vehicles, bicycles and pedestrians. You should never assume that you are, or are not, covered until you talk to an attorney who is very familiar with Michigan no-fault law.



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