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How the MI Assigned Claims Plan application prevents uninsured auto accident victims from receiving No Fault benefits

May 27, 2015 by Steven M. Gursten

Many of the new MACP questions  require personal information that has nothing to do with determining a car accident victim’s “eligibility” for PIP benefits Michigan Assigned Claims Plan application

Yesterday, I wrote about the problems that both myself and the other attorneys here at Michigan Auto Law have already seen when uninsured car accident victims are trying to obtain No Fault benefits from the Michigan Assigned Claims Plan (MACP).

The MACP is the program that ensures Michigan No Fault insurance benefits are provided to people who are uninsured but who are involved in motor vehicle accidents, so long as those people are not also the drivers and the owner/operators of the car involved in the car crash. Keep in mind, this category is meant to provide No Fault legal protection to people hit by cars. It’s not meant to reward and provide No Fault benefits to people who drive without auto insurance. In fact, those people are specifically excluded by law.  Instead, the category is limited to pedestrians, bicyclists, passengers and other non-drivers who are involved in an injury-producing event with an automobile in the state of Michigan.

Today I’d like to discuss the problems I’ve been seeing with uninsured car accident victims who are now having big trouble being deemed “eligible” under the new Michigan Assigned Claims Plan, starting with a laundry list of intrusive questions they must now first answer.

And these are questions the MACP should not be asking.

After for-profit auto insurance companies took control over the MACP in 2013 — in their capacity on the Board of Governors of the Michigan Automobile Insurance Placement Facility (MAIPF) which operates the MACP) — the MACP’s application underwent a dramatic overhaul.

Not only did it double in size, but many of its newly created questions require personal information that has absolutely nothing to do with determining a car crash victim’s “eligibility for benefits under the assigned claims plan …” (MCL 500.3173a(1))

Under Michigan’s No Fault Law, a car accident victim is “eligib[le] for benefits under the assigned claims plan …” if:

  • She doesn’t have No Fault insurance coverage and/or does not have access to No Fault insurance coverage. (MCL 500.3172(1))
  • Her claim for No Fault insurance benefits under the MACP is not “obviously ineligible” based on “an initial determination” which the MAIPF (which controls the MACP) “shall make” of “a claimant’s eligibility for benefits under the assigned claims plan …” (MCL 500.3173a(1))

So long as those requirements are met, the “assigned claims plan” “shall promptly” arrange for the auto accident victim’s claim for No Fault insurance benefits to be assigned to and handled by a Michigan No Fault auto insurance company. (MCL 500.3174)

But despite the No Fault Law’s simple, straight-forward MACP “eligibility” formula, the MACP’s application poses questions that delve into the following irrelevant issues:

  • A “full description of how the accident occurred.” (#18)
  • Whether the auto accident victim was “contacted by a doctor’s office or other person about this claim,” and, if so, the name, address and phone of the “doctor” or “other” person. (#22)
  • The auto accident victim’s pre-existing or prior medical conditions (including medications) that existed before the auto accident and treatment history. (#26-28)
  • Does the auto accident victim “have a primary care doctor?” If so, who? (#29)
  • How did [the accident victim] normally get to work prior to this accident? (#41)
  • “Was there damage to the vehicle [the accident victim was] occupying or struck by?” If so, describe the damage. (#43)
  • Was the damaged vehicle towed and/or repaired? If so, by whom? And, where is the damaged vehicle now? (#43, a, b, c)
  • “Did [the accident victim] lease or have use of the involved vehicle at any time before the date of the accident? What was the frequency at which [the accident victim] used the vehicle?” (#43, d and e)
  • Did the accident victim: Have his own set of keys to the vehicle? Have to ask permission to drive the vehicle? Get denied permission to use the vehicle? Ever put gas in the vehicle? Ever do any maintenance on the vehicle? (#43, f-j)
  • Names, addresses, phone numbers and insurance status of the vehicle’s occupants. (#43, q)
  • Names, addresses and phone numbers of witnesses to the accident. (#44)
  • Whether the accident victim has “ever filed a claim for Personal Injury Protection Benefits,” and, if so, with what auto insurer and under what claim number? (#47)

Burden of investigating MACP ‘eligibility’

Despite the clear and unequivocal mandate of Michigan’s No Fault Law, the MACP has taken it upon itself to “rewrite” the Legislature’s rules for who has the “burden” of investigating a car crash victim’s “eligibility for benefits under the assigned claims plan …”

Specifically, the No Fault Law unquestionably states that the burden falls squarely on the MACP (MAIPF):

“The Michigan automobile insurance placement facility [which operates the MACP] shall make an initial determination of a claimant’s eligibility for benefits under the assigned claims plan and shall deny an obviously ineligible claim.” (MCL 500.3173a(1))

Yet, in open defiance of the No Fault mandate, here is how the MACP has extra-legally chosen to reassign the investigative burden from itself to the car accident victims seeking the MACP’s help:

  • On May 22, 2014, Terri Miller of the Michigan Auto Insurance Placement Facility (MAIPF), which administers the MACP, submitted written testimony (which was dated January 24, 2014) to the Michigan House of Representatives’ Insurance Committee, which stated the following: “[A]pplicants must first establish that there was [an] injury sustained as a result of an auto accident. The MACP has transitioned the burden of proof to the injured party or their representative … This now includes actions like requesting that the injured parties contact their resident relatives to file claims with their auto insurance companies, requiring the injured parties to contact the involved vehicle’s owner for insurance information and insisting that the injured parties provide the necessary documentation to support that there was in a fact a motor vehicle incident. These tasks previously fell to Servicing Insurers, which led to higher administrative costs and, in some cases, unnecessary litigation.”
  • In Bronson Methodist Hospital v. Michigan Assigned Claims Facility, the MACP argued to the Michigan Court of Appeals that “the duty of investigating” and “the burden” of establishing eligibility for No Fault insurance benefits under the MACP was on the car accident victim. In rejecting the MACP’s argument, the unanimous panel of appellate judges concluded in their February 19, 2015, ruling that the MACP was erroneously making the issue much more complicated than it really is. The Bronson Methodist Hospital judges explained: “The MACP must “make an initial determination of the claimant’s eligibility for benefits under” the plan but may only deny an application if based on ‘an obviously ineligible claim.’ MCL 500.3173a. If the claim is not ‘obviously ineligible,’ the MACP must ‘promptly’ assign the claim to a servicing insurer. Mich Admin Code, R 11.108(3).”

Tomorrow, I’ll wrap up my series on the new Michigan Assigned Claims Plan changes, with a look into the new extra-legislative hurdles and obstacles uninsured motor vehicle accident victims now face in receiving their No Fault insurance benefits.

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