Insurance attorney explains why the application for No-Fault benefits is the most important part of setting up a No-Fault claim
You do not need a lawyer to fill out an application for No-Fault benefits. But after helping hundreds of car accident injury victims with their benefits in Michigan, our insurance attorneys would like to share some helpful hints.
Today, we will be discussing the application for No-Fault benefits. And in the coming weeks, we will have blogs about each of your No-Fault benefits, so you understand exactly what you’re entitled to following a serious crash.
In Michigan, an auto accident victim sets up a No-Fault claim with his or her auto insurance company by filing an “application for benefits.” This is literally an application. The application must be filed within one year after a car accident.
Under Michigan’s No-Fault Law, MCL 500.3145(1), a Michigan auto accident victim who seeks No-Fault benefits must:
Give “written notice of injury” to her No Fault auto insurance company “within 1 year after the accident …”
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“[I]ndicate in ordinary language [in the written notice of injury] … the time, place and nature of [her] injury.”
An “application for benefits” is the “written notice of injury” referenced in the No-Fault Law.
By timely filing an “application for benefits,” an auto accident victim becomes entitled to No- Fault benefits such as unlimited lifetime medical coverage, wage loss, replacement services, attendant care, mileage and prescription reimbursement.
You MUST apply for No-Fault insurance benefits within one year of the accident
But, here’s the kicker: failure to file an application for benefits within one year of an automobile accident will be fatal to an auto accident victim’s attempt to collect and/or sue for No-Fault benefits. A No-Fault auto insurance company is not obligated to pay benefits nor can it be sued for non-payment if the auto accident victim failed to give an “application for benefits” or otherwise provide a “written notice of injury” to the No-Fault insurer within one year of the accident.
This is really important because every year, I am contacted by people who thought they were going to get better — but did not. These people went on to undergo very expensive medical treatment, such as back surgery, that has required them to miss months of work. Because they did not file an application for benefits within one year, it is too late and there’s nothing I can do to help them get their No-Fault insurance benefits.
The one and only exception to the one-year filing requirement is when a victim’s No-Fault insurance company “has previously made a payment of personal protection insurance benefits for the injury” or injuries suffered in the accident.
No-Fault benefits are also known as “personal protection insurance,” “personal injury protection” or “PIP” benefits.
Indicating the personal injury to your auto insurance company
Aside from complying with the one-year filing limitation, the most important aspect of an “application for benefits” is the requirement that an auto accident victim “indicate in ordinary language … [the] nature of [her] injury.”
The emphasis here is on “injury.”
That’s because if an auto accident victim does not “indicate” her particular “injury” — or injuries — in her application for benefits, then she will be barred from receiving No-Fault benefits related to that injury or those personal injuries.
Michigan courts have ruled that the only accident-related injuries for which No-Fault benefits may be sought are those injuries which the auto accident victim “indicated” in an application for benefits filed within the first year after the accident.
In Ross v. Allstate Insurance Company, the Michigan Court of Appeals ruled:
“[I]t is not the [No Fault benefits] ‘claim’ which a plaintiff must give notice of, it is the injury. The plain language of the statute mandates that the nature of the injury must be indicated for the defendant to be properly notified.”
Accordingly, the Ross court ultimately rejected the plaintiff’s No-Fault benefits claim because she failed to notify her No Fault insurer within one year of the accident “of the injury for which she seeks benefits by way of this action.”
We know you’re not a doctor, but you have to list your personal injuries
It is crucial that a Michigan auto accident victim include or “indicate” in her application for benefits each and every injury that she suffered as result of the accident.
Although the No-Fault Law uses the singular “injury,” Michigan auto accident victims are not limited to including or indicating only one injury in their application for benefits.
Despite its enormous importance, complying with the “injury” — or injuries — requirement is relatively simple and easy.
For instance, if a victim injured her back in an auto accident, then she should indicate “back injury” on her “application for benefits” form.
If she injured her neck, then she should indicate “neck injury.”
If she injured her head, then she should indicate “head injury.”
And, so on for “shoulder injury” or “knee injury” or “wrist injury” or whatever other injury the victim suffered in the accident.
In other words, you are not a doctor and you did not go to medical school. You are not required to write the actual medical diagnosis in the application for benefits. But, you do have to list out all your injuries or your insurance company will refuse to pay for the medical bills of injuries that were not listed on your application for benefits.
Worse still, if you become disabled from an injury that was not listed on your application for benefits, the insurance company will also refuse to pay for No-Fault benefits that flow from that injury – such as your wage loss or attendant care if it becomes required.
Staying current on your application for No-Fault benefits, when injuries change
The “application for benefits” is not necessarily a one-shot deal for notifying a No-Fault insurer of an auto accident victim’s accident-related injuries.
If an accident-related injury only becomes symptomatic after or is not properly diagnosed until after an auto accident victim has filed her “application for benefits,” then she can indicate the injury in an “application for benefits – addendum” — so long as the addendum is filed within the one-year-from-the-date-of-the-accident filing limitation.
Check out the Michigan Auto Law website for “Application for Benefits” forms for various insurance companies that you can use.
– Steven M. Gursten is one of the nation’s top insurance lawyers. He is head of Michigan Auto Law and president of the Motor Vehicle Trial Lawyers Association. Steve has received the highest verdict in the state for a car accident or truck accident victim in 2008, 2009 and 2010, according to Michigan Lawyers Weekly. He frequently writes about No-Fault insurance law and is available for comment.
Related information to protect yourselves:
Michigan Auto Law is the largest law firm exclusively handling car accident, truck accident and motorcycle accident cases throughout the entire state. We have offices in Farmington Hills, Detroit, Ann Arbor, Grand Rapids and Sterling Heights to better serve you. Call (800) 777-0028 for a free consultation with one of our insurance lawyers.