Articles Posted in PIP Benefits

shutterstock_760039594-300x169Following Michigan’s historical auto insurance reform, many consumers faced uncertainty about their coverage limits. If someone suffers injuries in a Michigan auto accident, the state’s Personal Injury Protection (PIP) medical coverage pays for the medical care, recovery, and rehabilitative treatment. Before the change, Michigan Assigned Claims Plan (MACP) provided coverage to uninsured non-motorists, like bystanders, pedestrians, and passengers. The new insurance laws cap coverage at $250,000 for claims commencing July 2, 2020. However, uncertainty prevailed among uninsured non-motorists who suffered injuries between the law’s enactment on June 11, 2019, and the effective date of July 2, 2020.

Citing consumer protection concerns, the Michigan Department of Insurance and Financial Services (DIFS) issued an order that required MACP to provide unlimited PIP medical coverage to those who suffered injuries before the July 2020 effective date. According to a recent report, the agency that administers the MACP filed a lawsuit asking the Court to overturn the order. After the Court ruled to uphold the order, the The Michigan Automobile Insurance Placement Facility (MAIPF) filed an appeal. However, the appeal was dropped after DIFS reached a settlement that allows unlimited PIP coverage for uninsured vehicle occupants and pedestrians who suffered injuries before the July 2020 implementation. The DIFS director explained that a premature implementation could have seriously affected the livelihood of many Michiganders.

Under the new PIP coverage options, drivers must choose the coverage that pays for medical care if they are in an accident. In return, the law requires insurance companies to reduce the PIP medical portion of premiums based on the policyholder’s choice. There are six levels available, including unlimited coverage, up to $500,00 in coverage, up to $250,000 in coverage, up to $250,000 in coverage with PIP medical exclusions, up to $50,000 in coverage, and PIP medical opt-out.

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In a recent case, an appeals court considered a Michigan personal injury claim involving an employer’s refusal to pay personal insurance protection (PIP) benefits. The issue before the appeals court was whether the claim was timely filed after the employer stopped paying the claimant’s PIP benefits.

In May 2015, the plaintiff was in a car accident while she was driving a state vehicle as she was a state employee. She sought PIP benefits for her injuries from the state, her employer, and received them for almost two years. In August 2017, the state stopped making payments, and stated that it would no longer pay the plaintiff PIP benefits because the state believed she was not disabled. The plaintiff filed a complaint against the state in December 2017, alleging she was entitled to PIP benefits and that the state unreasonably refused to pay her.

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When one party sues another, sometimes there may be other parties that also want to be part of the lawsuit. There are specific laws that govern who may do so and when a party can join into a lawsuit. The Eastern District of Michigan District Court recently heard a case that illustrates this concept and gives an example of when it may apply.

No-Fault Personal Injury Protection

Michigan is a “no-fault” state. That means insurance policies will pay insured individuals after a car accident no matter who was at fault. In this case, a driver had personal injury protection benefits through a commercial insurer. Personal injury protection is meant to pay for injuries suffered by the driver after a car accident. The plaintiff was later in a car accident where he was injured. As part of treating his injuries, he saw physicians at a Michigan medical provider. Instead of paying the healthcare provider directly, the plaintiff assigned his right to collect on the bills to the healthcare provider. Now, the injured driver is suing his insurance company to collect the benefits he is owed. Thus, the healthcare provider filed a motion to join the lawsuit against the insurer to collect on the money they are owed for the healthcare services.

The trial court dismissed the healthcare provider’s action under recently decided Michigan case law that held that healthcare providers do not have their own cause of action against insurance companies for personal injury protection payments. Further, the court held that under the insurance policy itself, the consent of the defendant is necessary in order for the collection rights to be assigned.

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In a procedurally complicated opinion, the Michigan Court of Appeals attempted to clarify whether the “parked vehicle exception” applied to injury during maintenance of the vehicle. In order to collect damages from an automobile insurer, the vehicle must be involved in the injury. This may seem straightforward and obvious, but as often happens with the law, it is not. Michigan law appears to hold that auto insurers do not have to pay for injuries when the vehicle is parked. However, the law also seems to say that insurance will cover injuries that occur during vehicle maintenance. This case looks at these potentially contradictory aspects of the law and discusses how the law should be applied in the instant case and cases with similar facts. While a case may seem simple at first, that is not always the reality. That is why if you are injured in any kind of accident, you should consult an experienced Michigan personal injury attorney as soon as possible. They can help frame and guide your case in a way that leads to the best results.

Facts of the Case

Both parties agreed on the basic facts of the case. A woman was using the vehicle provided by her employer. She stopped at a self-serve carwash to wash it, and as she was washing it she slipped and fell on ice. No one knows whether the ice was created by the water she was using to wash the vehicle, or if it was already on the ground. She attempted to recover damages from the insurer her employer used. It refused to pay for the injuries. The insurance company argued that the case should be dismissed because the injury just happened to occur near the employer’s car and the law excepts insurers from being responsible for accidents when the car is parked. Conversely, the injured party argued that since her injuries occurred during the maintenance of the car, under statutory and case law she is still entitled to payment from the insurance company. The insurance company moved for summary judgment, which would dismiss the case. The court found for the plaintiff and allowed the case to continue for the reasons explained below.

On February 28 of this year — just two weeks after beginning a job at an Ann Arbor recycling plant — 47-year-old maintenance technician Earl Roberts’ arm was crushed under a 500-pound gear box. Earl was seriously injured; the incident severed several tendons and muscles in his left forearm. Over the past five months, Earl has seen five doctors, and he’s still on medication to manage the pain. The doctors tell him he will have problems with his left arm for the rest of his life.Roberts claims that ReCommunity–the North Carolina-based company under contract with Ann Arbor to operate the plant–created an unsafe work environment. What’s more, the plant manager ignored Earl’s prior expression of safety concerns. Last month, Ann Arbor terminated its contract with ReCommunity, due to repeated safety violations. ReCommunity retaliated by suing the city for unlawful breach of contract.

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The Michigan Court of Appeals recently upheld a lower court’s grant of summary disposition to a defendant insurance company regarding a lawsuit for personal injury protection (PIP) benefits, due to the fraud exclusion in the defendant’s policy.Plaintiff Ronald Thomas was involved in a car accident in July 2013. At the time, he was the named insured on a no-fault auto insurance policy issued by the defendant, Frankenmuth Mutual Insurance Company. Thomas received treatment from several medical providers for injuries arising from the accident. The plaintiff’s treating physician, Dr. James Beale, instructed the plaintiff not to drive for a period starting with the day of the accident through January 2014. At his deposition, Thomas denied driving a car at any time during that period. However, surveillance footage collected by the defendant’s employee revealed Thomas driving during that period on two separate occasions. He also used non-emergency medical transportation on both days.

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