Making a Claim for No-Fault PIP Benefits
How to Make a No-Fault Claim
Although the actual filing of the claim is relatively straightforward, there are two principal requirements in which a victim of a Michigan crash must be ready to prove to establish his or her entitlement to these benefits.
The Reasonable Proof Requirement
A no-fault insurance company is not obligated to pay any benefits until a claimant provides an insurer with “reasonable proof” of the facts giving rise to the claim, and the amount of claim. This requirement is set forth in MCL 500.3142 of the no-fault act. Once the insurer is provided with that, the insurer must pay the claim within 30 days, or the benefits will be considered “overdue.”
Under the recent Michigan no-fault insurance reforms passed in 2019, when an insurer receives proof of claim more than 90 days after the service was rendered or expense incurred, the insurer has 90 days to issue payment, as opposed to the regular 30-day payment rule.
Unfortunately, the no-fault statute does not further define the concept of “reasonable proof.” However, the Michigan Court of Appeals has held that this a claimant is not required to “exact” proof. See Williams v AAA Michigan, 250 Mich App 249 (2002).
As it relates to the actual submission of reasonable proof, no-fault insurance companies ordinarily require claimants to submit claims by using several types of claim forms. Typically, these three forms are:
- an application for no-fault benefits;
- an attending physician’s report form; and
- an employer’s wage loss verification form.
It is advisable for the claimant to provide these forms to the no-fault insurance company so that the claimant cannot later be accused of failing to provide “reasonable proof.”
The Incurred Requirement
No-fault insurance companies have a legal obligation to pay claims for allowable expenses under MCL 500.3107(1)(a) and replacement service expenses under Subsection 3107(1)(c) only when the expense has been “incurred.” The statute does not define the word “incurred.” However, a number of Michigan appellate cases have held that to incur an expense, a person must have either paid for the expense or become legally obligated to pay the expense.
The incurred requirement has been very problematic for many patients, particularly those with catastrophic injuries who require products, services, and accommodations that are very expensive, e.g., handicapper housing, special vehicular transportation, residential facility admission, etc. Unless the injured person has “incurred” expenses for such items, the insurer has no legal responsibility to pay the expense.
There are several ways that patients can “incur” expenses other than by paying the full cost of the item in cash. These include entering into contracts to purchase the product, service, or accommodation or borrowing money to pay for the needed item. Also, patients can file a “declaratory judgment” lawsuit asking for a court to rule that an insurer will be liable to pay for the cost of certain specific products, services, and accommodations once the injured person has incurred the expense for such items.
If you think you need legal assistance following a crash, speak with one of Sinas Dramis Law Firm’s Michigan auto accident attorneys for a free consultation. Whether you’re looking for a Grand Rapids auto accident lawyer or a car accident attorney in Lansing, our firm represents clients statewide.