Auto No-Fault Intentional Injuries Exclusion – You Don’t Have to Prove Innocence

With limited exception, Michigan’s auto no-fault law generally provides every Michigan auto-accident victim with certain financial and medical insurance benefits that pay for accident-related medical care and other related expenses.  Generally, these benefits are payable regardless of whether the injured person claiming them was at fault for the accident.

To use an extreme example, a person theoretically could crash their vehicle into a telephone pole while driving under the influence of marijuana or alcohol, with no sleep, while checking their Facebook account on their phone, and they will generally still receive no-fault benefits.  To be clear, we do not endorse or otherwise suggest that driving in such a manner is acceptable.  However, to be eligible for benefits, the crash itself must still be accidental. Had the unsafe driver in this fictional example driven into the telephone pole on purpose in order to injure or kill himself, no-fault benefits would not be payable (because the underlying injuries were not accidental).   

In other words, regardless of its far-reaching nature, auto no-fault benefits are not endless. They do not cover a person for intentional injuries in auto-related accidents. MCL 500.3105(4) of the Michigan No-Fault Act sets forth this rule as follows:

(4) Bodily injury is accidental as to a person claiming personal protection insurance benefits unless suffered intentionally by the injured person or caused intentionally by the claimant. Even though a person knows that bodily injury is substantially certain to be caused by his act or omission, he does not cause or suffer injury intentionally if he acts or refrains from acting for the purpose of averting injury to property or to any person including himself. 

Benefits Denial Using the Intentional Injuries Exclusion

People in auto-related accidents committing reckless and stupid acts often suffer very serious injuries requiring extensive and ongoing medical care. Needless to say, these types of injuries often lead to very large and expensive insurance claims no-fault claims that no-fault insurers often attempt to avoid paying by accusing the injured person of committing the reckless driving act for the specific purpose of injuring or killing him or herself.

The following example helps to demonstrate this point:

Imagine a case where a husband (we will call him Todd) is arguing with his wife (we’ll call her Margo) on a city sidewalk. Things escalate to the point Todd foolishly attempts to escape the argument by crossing a busy street in rush hour traffic. In the heat of the moment, Todd truly believes he can cross without being hit by a car. Tragically, however, he misjudges the situation, darts into traffic, and a fast-moving vehicle strikes him. As a result, he suffers a massive brain injury and several orthopedic injuries. These injuries eventually result in his death several months later.

Todd and Margo can make a claim for payment of no-fault benefits under these instances. These benefits would cover Todd’s medical bills, funeral expenses, and lost income. Accordingly, Margo files a claim with the responsible no-fault insurer and properly informs them of what happened.

Unfortunately, upon learning that Todd and Margo were in a heated argument at the time of the accident, the insurance company immediately takes the position that Todd darted into traffic with the intention of inflicting harm to himself or killing himself. Ultimately, the insurance company denies the claim under the intentional injuries exclusion.

At this point, Margo has an important decision to make. On the one hand, she can simply do nothing and attempt to move forward with her life. However, doing that will likely be very difficult. Margo could be confronted with endless bills she will never be able to pay. Further, she’ll bear the cost of an unexpected funeral, as well as the loss of his entire income. Ultimately, medical bills resulting from these circumstances are often never paid and eventually absorbed by Michigan taxpayers.

On the other hand, Margo could choose to fight the insurance company’s denial of her no-fault claim. In fact, if she chooses to do so, she stands the likelihood of successfully beating the insurance company. This is because, under Michigan law, insurance companies cannot accuse an injured person of intentionally injuring themselves. An insurance company must have knowledge of specific facts or evidence that support the belief of intentional injuries.

Under these circumstances, the reality is that Todd is the only person who really knows why he darted across the street. What really happened becomes anyone’s guess. Because of this, the insurance company responsible for Margo’s no-fault claim clearly has no factual support for its suicide or intentional injury theory. No-fault providers cannot deny benefits based on pure speculation. Because of this, an insurance company cannot legally rely on the intentional injury exclusion to deny the claim.
While Margo also cannot prove Todd did not commit suicide, it doesn’t matter. Under Michigan law, a person does not have to prove their injuries were suffered accidentally or otherwise.

Getting Help – It’s Easier Than You Think

People often mistakenly believe that hiring a lawyer is too difficult or expensive. Instead, people often just accept it when their auto insurer denies their claim. However, the reality is, getting expert legal representation is not difficult. Further, it doesn’t require you to make a significant sizeable investment up-front. More often than not, lawyers represent clients injured in motor vehicle accidents or involved in no-fault benefit disputes on a contingency basis. A contingency agreement simply means the lawyer will only charge for services if they successfully win the case. Lawyer fees are then paid out of the recovery after the suit is over.

Therefore, if you’ve been wrongfully denied an auto-related insurance claim, qualified representation is often readily available to you without a large up-front payment. Obtaining your denied benefits is important to ensure your financial future. Speak with one of Sinas Dramis Law Firm’s Michigan car accident lawyers for a free consultation. Whether you’re looking for a Grand Rapids car accident lawyer, or an auto accident attorney in Lansing, our firm represents clients statewide.

If you or a loved one are having difficulty obtaining your no-fault benefits, call us today for a free case evaluation at 866.758.0031 or submit an online form.