Who can Receive Personal Injury Protection (PIP) Insurance Benefits?
In Michigan, in addition to having an auto accident claim against the driver who causes injury in a car accident (third party), accident victims will also receive Michigan No-Fault “first party” or PIP benefits.
There is a five part test to see if there is entitlement to Michigan No-Fault benefits following an auto accident under Michigan law.
The analysis below was originally part of a two day seminar presented by the injury attorneys at Michigan Auto Law for Michigan lawyers handling automobile accident cases in Dearborn, Michigan. The seminar was presented through the Institute for Continuing Legal Education (ICLE) and was intended to better educate small firm lawyers and solo practitioners throughout Michigan who handle car accidents, truck accidents, and motorcycle accidents on what other no fault benefits are available to their clients. A more comprehensive overview can also be found in our Michigan Auto Law no fault advice section.
Who is entitled to receive Michigan No-Fault benefits after a Michigan auto injury accident?
No-Fault PIP benefits are available to any person who suffers personal injury in an automobile accident in Michigan, provided they are not the owner and operator of a car or truck operating without Michigan No-Fault insurance.
Michigan car accident first-party claims, also known as Michigan PIP (personal injury protection) claims, are made to a claimant’s own No-Fault insurer. The claimant’s insurer is required to pay Michigan No-Fault benefits for expenses relating to a motor vehicle accident. These first-party car accident claims involve payments for medical expenses, wage loss, replacement services, mileage, survivor’s loss, funeral expenses, and attendant care, when applicable, if the injuries are serious enough.
There is one year to file an Application for Benefits under Michigan law with the No-Fault insurance company that has the highest priority to pay. There is also a strict one year statute to make sure that an incurred expense from a car accident, such as payment of a medical bill, is made or the claim will be time barred by law. The filing of a lawsuit by a Michigan car accident personal injury lawyer will toll this one year statute of limitations.
Five Part Test – PIP Entitlement – Burden on Plaintiff
§3105(1) provides: “Under personal protection insurance an insurer is liable to pay benefits for accidental bodily injury arising out of the ownership, operation, maintenance or use of a motor vehicle as a motor vehicle, subject to the provisions of this chapter.”
Test 1: Is a motor vehicle involved in the accident? §3101(2)(e)
- Registration is not required. Lee v DAIIE, 412 M 505 (1982)
- Trailers are separate motor vehicles if more than 3 wheels regardless whether it is attached or not. Kelly v Intercity Truck Lines, Inc, 121 MA 208 (1928) (unattached trailer); Citizens v Roadway, 135 MA 465 (1984) (attached trailer). Jasinkski v National Indemnity, 151 MA 812 (1986) (tractor and trailer are separate vehicles).
- A Motorcycle is not a motor vehicle under Michigan No-Fault law. §3101(2)(c)
- A Motorcyclist injured in a motorcycle accident can still qualify for Michigan No-Fault if a motor vehicle is involved in the accident. §3101(2)(f). Blinded by car lights might be enough to create an issue of fact whether a motor vehicle was involved in a motorcycle accident.
- Contact not required to be “involved” in an accident. Bromley v Citizens, 113 MA 131 (1982).
- Certain vehicles with three or more wheels can be considered motor vehicles if operated on a public highway. Public Highway requires (1) open to vehicular travel (shoulder is – median is not) and (2) maintained by government.
- Go cart on a public highway is a motor vehicle. Coffey v State Farm, 162 MA 264 (1987); 4 wheeler on public highway is a motor vehicle. Morris v Allstate, 230 MA 361 (1998); Golf cart on public highway is a motor vehicle. Hahn v Michigan Mutual, unpub, (1982).
- Dual Purpose Vehicles (RVs) most likely need to be in operation (driving the vehicle) when the injury accident occurs to be considered a motor vehicle. Sleeping in trailer disqualified. McKenzie v ACIA, 458 M 214 (1998).
Test 2: Is there a bodily injury in the car accident?
- Injury accident victim must prove actual relationship by competent medical testimony. Dengler v State Farm, 135 MA 645 (1984).
- Must be a single injury producing event; thus, injury from repetitive stress or strain does not qualify. Wheeler v Tucker Freight Lines, Inc, 125 MA 123 (1983).
- A single event that aggravates a pre-existing pathology can be injury under the no-fault act. See both Mollitor v Associated Truck Lines and DAIIE, 140 MA 431 (1985) (carpal tunnel not injury) and McKim v Home Insurance Co, 133 MA 694 (1984).
Test 3: Is the injury accidental? §3105(4)
To not be an accident, there must be (1) an intentional act and (2) intended injury. Thus, a person must intend the consequences, as well as the act, to be excluded for self-inflicted injury. Estate of Martin Roesch v DAIIE, 119 MA 578 (1982).
- Man suffering personal injury after being thrown from hood of car while trying to prevent car from leaving parking lot gets Michigan no fault benefits. Frechen v DAIIE, 119 MA 578 (1982)
- Intentional injury provisions of §3105(4) do not preclude intentional misconduct of another person. DAIIE v Higginbotham, 95 MA 213 (1980); however, many “intentional injury” cases have been dismissed due to test #4 the “arising out of” requirement.
- Person fleeing from police in car is not disqualified for Michigan PIP benefits. Bronson Methodist Hospital v Forshee, 198 MA 617 (1993); however, person fleeing from police on a motorcycle and who suffers personal injury in the resulting motorcycle accident is disqualified from Michigan PIP. Peck v Auto Owners Ins Co, 112 MA 329 (1982) (fails “arising out of” test).
- Passenger who grabs hold of wheel of moving auto during a quarrel and who suffers personal injury is not disqualified from Michigan PIP benefits. Lock v Continental Insurance Company.
Test 4: The “arising out of” or causal nexus requirement
This test requires a sufficient causal nexus between the injury and the ownership, maintenance or use of a motor vehicle. Furthermore, the injury must be foreseeably identifiable with the normal use, maintenance and ownership of the vehicle [motor vehicle as a motor vehicle test].
However, need not prove absolute causal relationship. Thus, contact not required to fulfill “arising out of” Bromley v Citizens, 113 MA 131 (1982)
Repairing vehicle is maintenance. MBPIA v Michigan Mutual, 122 MA 420 (1983)
Installing new equipment on motor vehicle is maintenance. Great American Ins v Old Republic, 180 MA 508 (1989)
Car falling off jack is maintenance. Stanley v State Farm, 160 MA 434 (1987)
Preparing to tow is maintenance. Yates v Hawkeye Security, 157 MA 711 (1987)
Washing a car is maintenance. Musall v Golcheff, 174 MA 700 (1989)
Slip and fall injury while walking to truck is not covered under Michigan PIP. Dembinski v Aetna Casualty & Surety Co, 76 MA 181 (1977).
However, slip and fall injury just inches from car while trying to insert key into door of auto was covered because plaintiff was actually in contact with vehicle. Hunt v Citizens, 183 MA 660 (1990) lv den’d 47 M 880 (1990).
Pool of chemicals left by tanker was splashed into Plaintiff’s face by passing bus causing facial injury is covered by Michigan PIP. Jones v Tronex, 129 MA 188 (1983).
Chemicals spilled in road from passing tanker was splashed into plaintiff’s eyes causing facial injuries is covered.
- Injuries as a result of a car jacking not covered. Bourne v Farmers, 449 M 193 (1995)
- Cab driver shot during hold up, no coverage. Thorton v Allstate, 425 M 643 (1986)
- Armed robbery is not foreseeable. Shaw v Allstate, 141 MA 331 (1985)
- Drive-by shooting injury not covered. Auto Owners Ins v Rucker, 188 MA 125 (1991)
Loading and Unloading of Motor Vehicle:
- Process of loading or unloading and either in contact or immediately vicinity is covered. Hathcox v Liberty Mutual, 90 MA 511 (1979)
- Injury while opening trailer door. Teman v Transamerica, 123 MA 262 (1983)
- Lifting cement slabs with tow truck is not covered. Winter v ACIA, 433 Mich 446 (1989)
Test 5: The motor vehicle as a motor vehicle
- Current Test: Transportational Function Test. McKenzie v ACIA, 458 Mich 214 (1998)
- Asphyxiation while plaintiff was sleeping in case is not covered because sleeping in vehicle is not using motor vehicle as motor vehicle. McKenzie v ACIA, 458 M 241 (1998); See generally, Clute v General American Assurance, 142 MA 640 (1985) on sleeping in vehicle.
- Parent’s psychiatric emotional injuries and medical care following learning of child’s severe injury in auto accident is not covered; however, might be different if parent is in zone of danger. Williams v Citizens Mutual Ins, 94 MA 762 (1980)
- Fuel truck refueling large machine is not using motor vehicle as a motor vehicle. Rice v ACIA, 252 MA 25 (2002)