Important Issues with Insurance Coverage

Following a Michigan car accident, there can be numerous issues and challenges with health insurance plans, managed care plans, ERISA plans, coordinated vs. uncoordinated policies that cause injured victims to lose thousands. In these cases, talking with an experienced Michigan auto accident attorney can help policy holders know how to handle their unique policy issues and ensure the best coverage possible for their injuries.

COORDINATED vs. PRIMARY PIP
Most Michigan No-Fault insurance policies have "Coordinated" Medical coverage. This means that if an injured victim has existing health insurance coverage, separate from his own auto no fault insurance, then the health insurance pays first (considered “primary”), for medical expenses incurred from injuries received in a Michigan car accident.

Exceptions to "Coordinated" medical coverage are as follows:

1. The auto insurance policy provides "Primary PIP". (The policyholder paid extra to have the auto insurance pay first for medical benefits)
2. Medicare recipients
3. Medicaid recipients
4. The Claimant receives Michigan No Fault PIP coverage through the Owner/Driver priority
5. If the Claimant's existing Health Insurance is a self-funded ERISA plan or other type of plan that specifically excludes coverage for a motor vehicle accident when there is already Michigan No-Fault coverage.

ERISA Plans
An insured with both ERISA and coordinated no-fault may end up recovering nothing for their pain and suffering in the event of an auto accident. They may also be unable to secure legal assistance because there may be nothing available to recover. Instead, uncoordinated or “full” coverage is the safe move — a move that will keep injured clients protected. The law, particularly the law regarding self-funded ERISA plans, continues to evolve and new changes are anticipated in the near future. If you are injured in a Michigan auto accident and have a self-funded ERISA plan and Michigan no fault PIP coverage, please discuss whether there have been any recent changes with a Michigan auto injury lawyer. The car accident lawyer is best qualified to provide guidance on issues of which insurance is primary, and whether there will be issues of subrogation or indemnification for medical expenses that are incurred.

With ERISA, car accident victims will need early intervention by an experienced Michigan lawyer, because the plan will try to subrogate or recoup money they pay for medical bills on behalf of the personal injury recovery. In most cases these recovery letters are invalid and improper. There are many plans that identify themselves as ERISA plans, but the only valid plans that are able to recoup are self-funded, a very small percentage.

Again, most plans asserting liens do not legally have the basis to do so. Disability carriers often hire collection companies to assert liens. The disability plan sends a letter stating “if you’ve been injured as result of personal injury accident . . .” claiming that they are entitled to indemnification. Be cautious and get sound advice from an experienced Michigan auto accident lawyer, as most liens turn out to be invalid and do not need to be paid.