Michigan’s no-fault benefits help policyholders to pay for injuries and other losses after a traffic accident, regardless of who caused the crash. One of the no-fault benefits includes coverage for all related medical expenses. After an accident, victims may be confused about the medical expense benefit and often have questions about how it works and what it covers.
Below, Jay Trucks answers some of the most common questions about medical expense benefits in Michigan. Read on to learn more about what they are, how to claim coverage and what you can do if these benefits are denied.
Our auto accident lawyers in Grand Rapids have decades of experience helping injured victims throughout Michigan. We understand the importance of getting compensation for your medical costs after a car crash, and we are ready to help. Call for your 100 percent FREE case review to learn more about what we can do for you.
What Are Medical Expense Benefits?
Medical expense benefits are an included provision under your no-fault insurance. Insured drivers, along with resident relatives or passengers riding in the vehicle, may all be eligible for these benefits after a collision. Other eligible victims may include injured pedestrians, bicyclists and more.
For those who are eligible, benefits could include compensation for:
- Emergency transportation
- Hospital costs
- Surgery
- Diagnostic testing – such as CT scans, MRIs or X-rays
- Physical therapy
- Ongoing doctor appointments or other care needed
- Mileage or transportation to and from related medical appointments
How Do You Obtain Medical Expense Benefits?
The process for obtaining medical expense benefits can be confusing, which is why having an attorney handle the claim on your behalf can be beneficial. To get started, there are a few steps you will need to take:
- Request an application for no-fault benefits from the insurance company responsible for the claim
- Submit your no-fault benefits claim within one year of the accident (we do not recommend waiting to file your no-fault benefits claim – victims who miss the deadline are barred from any recovery)
- Provide a written notice of injury – include your name and address, time, location and nature of the injury
- Get help from an attorney to ensure your claim is properly handled and accurately submitted within the deadline
Once your claim is submitted, the insurance company will review your application for benefits and determine whether the medical treatments you received were both reasonable and necessary.
How Does the Insurance Company Decide What Care is Reasonable and Necessary?
Under Michigan state law, the coverage only applies to related and allowable expenses which are necessary to help you recover from your injuries. If you got elective care, or treatment for an unrelated injury, for example, those costs would not be covered by your no-fault benefits claim.
What Happens if Some of My Medical Expense Benefits Are Denied?
For the most part, all related medical costs should be covered. However, the insurance company may try to say some of your care was not necessary or related to your recovery – even if the cost was valid. If this happens, a qualified attorney will know how to deal with the insurance company and advocate on your behalf.
Under MCL500.3107, medical costs that will not be considered reasonable or necessary and will likely be denied, include:
- Elective hospital care not directly related to the injuries sustained in the accident
- Upgraded hospital rooms – such as private rooms – unless intensive care is required
- Experimental care
- Funeral or burial costs that are less than $1,750 or more than $5,000
What Happens if the Insurance Company Denies My Claim or Delays Payment?
If your medical expense benefits were denied, despite being reasonable and necessary, you can file a no-fault lawsuit against your insurance company for the unpaid medical bills. You may also file a no-fault lawsuit against your insurer if your payments are unreasonably delayed.
It is important to mention that if a no-fault lawsuit becomes necessary, it must be filed within one year of the date of the medical service. This type of claim could quickly become complicated and is best handled by a qualified attorney to make sure your interests are protected.
Is There a Limit to the Amount of Medical Expense Benefits You Can Receive?
Prior to July 2021, there were no caps on the amount of medical expense benefits provided under a Michigan policyholder’s insurance plan. However, the new auto insurance reform laws, effective from July 1, 2021, and going forward, changed that. Today, injured victims are limited by the amount of Personal Injury Protection (PIP) coverage they purchase under their car insurance plan.
While choosing a lesser PIP coverage may save a little money in the short-term, you could end up being short of funds for medical costs when you need them. This is why you may want to consider keeping the unlimited PIP option, which provides better protection overall. If budget is an issue, we recommend that you choose the highest limits that you can afford.
Contact Our Law Firm for Help With Your Medical Expense Benefits Claim Today
Navigating a Michigan no-fault insurance claim is more confusing than ever since the auto insurance reform laws went into effect. However, our team of legal professionals handles these types of cases every day. We have extensive knowledge of the laws. We also know how to negotiate for the medical expense benefits you need to help you with your recovery.
Call for your free, no-obligation consultation today. We can help you get started with your claim so you can avoid missing important filing deadlines. If we take your case, there is nothing to pay up front or while we represent you. This means zero risk to you. Learn more about how we may be able to help and get answers to your legal questions.
