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Pedestrian Accident Claims - Michigan No-Fault Law Basics

The laws that govern Michigan pedestrian accidents involving motor vehicles are long and complex. Often, the terms spoken by insurance agents and lawyers can be confusing.

Two important terms you need to know are:

First-Party Benefits
Third-Party Benefits

Michigan is a No-Fault State. This means that your own insurance company pays most of the economic damages you suffer in a Michigan pedestrian/auto accident, whether or not you were at fault in the accident. These economic benefits are called First-Party Benefits.

At the same time, Third-Party Benefits usually cover non-economic losses, including damages for pain and suffering. Both of these types of benefits are described in detail below.

Michigan First-Party Basics

The Michigan law defining First-Party Benefits states:

First-party benefits are payable to anyone who suffers an injury arising out of the ownership, operation, maintenance or use of a motor vehicle as a motor vehicle.

The following analysis looks at:

Who has to pay your Michigan No-Fault Benefits?
What are the specific benefits you may be entitled to receive?

Michigan First-Party Order of Priority

Although your own insurance is first in line to pay in a Michigan pedestrian/auto accident, there are times when an uninsured individual is an innocent passenger in a motor vehicle. In these circumstances, determining who is responsible to pay Michigan No-Fault Benefits can be complex.

If you have questions about the application of these complex rules, you should contact a Michigan pedestrian/auto accident lawyer with experience handling Michigan pedestrian/auto accident. Please submit a simple, free, and confidential legal consultation form for help now.

Pedestrian Order of Priority

1st priority is to your own insurance, if none then...
2nd priority is to the insurance company of a resident relative (i.e. spouse, parent, or sibling), if none then...
3rd priority is to the insurer of the owner of the truck involved in the accident, if none then...
4th priority is to the insurer of the operator of the truck involved in the accident, if none then...
5th priority is to the State of Michigan Assigned Claims Facility.

The Michigan Assigned Claims Facility

The Michigan Assigned Claims Facility is a State Agency with the power to assign an insurance company to provide benefits, if an injured victim cannot obtain benefits from other sources. Remember that uninsured drivers, operating vehicle they own, do not qualify for Michigan Assigned Claim Facility assistance.

To apply for Assigned Claims Benefits, call the Michigan Assigned Claim Facility directly at 517-322-1875.

Specific Michigan First-Party Benefits

The First-Party No-Fault Benefits that you claim from your own insurance company after a Michigan pedestrian/auto accident include:

Medical Bills for Life

Michigan pedestrian/auto accident law requires that medical coverage continue for life, or for as long as you need treatment for injuries suffered in the Michigan pedestrian/auto accident.

There are many complicated factors to getting your medical bills paid, if you are in a Michigan pedestrian/auto accident. If you have questions about the application of these complex rules, you should contact a Michigan pedestrian/auto accident lawyer with experience handling Michigan pedestrian accidents. Please submit a simple, free, and confidential legal consultation form for help now.

To qualify for medical expense reimbursement, a bill must be reasonable (in cost and necessity) and the bill must be actually incurred. Michigan law does not provide for guaranteed pre-payment of bills due to a motor vehicle accident. Sometimes, an insurance company will try to escape its responsibility, by questioning the need to a medical test or procedure, which your physician ordered, or by disputing the amount of the medical bill.

Insurance companies in Michigan provide two types of medical coverage in the event of an accident:

Uncoordinated benefits.
Coordinated benefits.

Your insurance policy states which type of benefits you should receive. An uncoordinated policy pays benefits, regardless of the presence of other health insurance. A coordinated policy requires your other health insurance to pay first, and your automobile insurance to pay amounts that your primary insurer does not cover.

It is common for a primary health insurance policy and a motor vehicle insurance policy to contain contradictory language about which one has the first obligation to pay medical bills. Meanwhile, the motor vehicle insurance company may escape its obligation to pay a bill, if it did not receive it within one year of the date that you got the medical treatment.

If you have questions about this, or find that neither insurance company is paying your medical bills in a timely manner, it is important to talk with an experienced Michigan personal injury attorney immediately. Please submit a simple, free, and confidential legal consultation form for help now.

Wage Loss

Michigan No-Fault Law allows an injured individual to receive 85% of his or her lost wages, if a doctor found the victim disabled from work due to injuries suffered in a motor vehicle accident. This benefit cannot exceed a period of 3 years. The wage loss benefit is set at 85%, rather than 100%, of lost earnings because the benefit is tax-free. The law also sets a monthly cap on the amount of lost wages that the insurance company must reimburse.

In some cases, these and other rules create complicated issues. If you have questions about whether you are getting the correct wage loss benefits, you need to consult an experienced Michigan personal injury attorney.

Attendant Care

Michigan law requires the no-fault insurance company to pay for attendant care (also known as nursing services) for an injured victim who needs supervision or assistance while recovering at home. Sometimes, a physician determines that a person with severe injury needs around-the-clock supervision.

A caregiver who is a member of the victim's family is entitled to attendant care reimbursement. Although the law does not set a specific hourly rate for the caregiver, the reimbursement should reflect the type and complexity of the services that the injured person receives.

Frequently, insurance companies refuse to pay for adequate attendant care. If this happens, you should contact a Michigan personal injury lawyer with experience handling Michigan pedestrian/auto accidents. Please submit a simple, free, and confidential legal consultation form for help now.

Replacement Services

This term refers to reimbursement for services that you would have performed on your own, if you were not injured in a Michigan pedestrian/auto accident. If you paid or promised to pay for household services, chores, errands, etc., which you usually accomplished on your own, then you may be entitled to reimbursement for these expenses.

A physician needs to provide a written statement that you are unable to do these tasks on your own. In addition, your insurance company may require documentation of who performed what services.

Michigan law states that an insurance company is obligated to reimburse up to $20 per day for replacement services and that these benefits last for up to three years.

Mileage Reimbursement

Often, proper medical treatment, tests, and physical therapy require an injured person to travel long distances. Michigan No-Fault Law provides for the reimbursement for mileage traveled to and from this medical care.

Third-Party Basics

While First-Party Benefits cover most economic losses, Third-Party Benefits provide damages for pain and suffering, scarring or disfigurement, death, and wage loss in excess of 3 years.

A Third-Party legal claim is filed against the at-fault driver in the motor vehicle accident. With the exception of excess wage loss, the damages sought in a Third-Party case are non-economic in nature.

In Michigan, to prevail in a claim against a careless driver for non-economic damages, the injured victim must show that he or she suffered a "threshold injury." State law defines this as:

A serious impairment of an important body function, serious disfigurement or scarring, or death.

It is very common for insurance company adjusters to assert that an injury is not a "serious impairment of a body function." However, if you have an objectively documented injury to an important part of your body, and this affects your life, then you should contact our personal injury law firm to protect your rights. Please submit a simple, free, and confidential legal consultation form for help now.

The Statute of Limitations (or time limit) for filing a Third-Party lawsuit is 3 years. Minors have until one year past their 18th birthday to take formal legal action. There are other exceptions for military personnel and those judged mentally incompetent.

However, it is not wise to delay getting legal assistance. To make the strongest possible case, it is extremely helpful to start right away, on collecting valuable evidence and locating potential witnesses.

If you or a loved one was injured in a Michigan accident, talk with an experienced Michigan personal injury lawyer. Please submit a simple, free, and confidential legal consultation form now.

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