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Insurer can’t rewrite ‘notice of injury’ rule to avoid bill

A medical provider’s ‘medical records and associated bills’ contain ‘all of the information’ legally required for proper notice of injury under No-Fault law

Notice of injury rule

A recent Michigan Supreme Court ruling clarifies what’s required in a proper No-Fault notice of injury — a frequently thorny legal issue for Michigan auto accident attorneys that can sometimes mean the difference between a car crash victim’s lawsuit being able to proceed to trial or being thrown out of court.

An insurance company cannot simply rewrite the Michigan No-Fault law.

And one insurance company’s attempt to do so with Michigan’s “notice on injury” rule to avoid paying for a car crash victim’s hospitalization was recently dispatched by the Michigan Supreme Court in Perkovic v. Zurich American Insurance Company.

In Perkovic, the insurer tried to get out of paying No-Fault medical benefits to a hospital that cared for an injured trucker by insisting that the “medical records and associated bills” provided by medical center didn’t constitute the “written notice of injury” it was entitled to under the No-Fault law.

In a 6-1 opinion, the Supreme Court rejected Zurich’s attempt to avoid its responsibility by requiring more than it was legally entitled to demand.

After pointing out that the No-Fault notice of injury statute required only the “name and address” of the person claiming benefits and “the name of the person injured and the time, place and nature of his injury,” the justices concluded:

  • “[T]he documentation provided [to Zurich] by the medical provider [for car crash victim Dragen Perkovic] contains all of the information required by MCL 500.3145(1)” and, thus, “the statutory notice requirement is satisfied …”
  • The law “does not mandate any particular format for this notice, nor does it require language explicitly indicating a possible claim for benefits. … The statute contains no temporal requirement that the insured be [actively] claiming benefits at the time the notice of injury is transmitted to the insurer.”
  • The “plain language” of the notice of injury law “does not impose any unarticulated requirements as to the form of the notice,” such as that it be labelled “as an explicit request for no-fault benefits.”

The Supreme Court’s Perkovic ruling — and its effect on the process of applying for No-Fault PIP benefits — is very important for car accident victims and for lawyers like me and my attorney colleagues at Michigan Auto Law.

First and foremost, it clarifies to what’s required in a proper No-Fault notice of injury — a frequently thorny legal issue for Michigan auto accident attorneys that can sometimes mean the difference between a car crash victim’s lawsuit being able to proceed to trial or being thrown out of court.

Secondly, the Perkovic decision serves as both a source of comfort to the medical professionals who care for motor vehicle accident victims and, more importantly, as a warning to overreaching auto insurance companies:

  • It provides vital reassurance to doctors, hospitals and medical providers who treat car accident victims that they won’t be denied payment for their services based on insurer’s made-up, form-over-substance rules.
  • It reminds insurers that — despite having unparalleled influence on the making of the insurance laws — they’re not above the law once it’s enacted and they must comply with it.

The notice of injury requirement and suing for No-Fault benefits

An injured car accident victim or someone who has provided medical or therapeutic services to the victim has “1 year after the date of the accident” to sue for unpaid “No-Fault PIP” benefits. (MCL 500.3145(1))

However, that one-year limitation doesn’t apply if:

“[W]ritten notice of injury … has been given to the insurer within 1 year after the accident …” (MCL 500.3145(1))

Once the notice of injury has been given, a lawsuit can be filed “at any time within 1 year after the most recent” unpaid No-Fault benefit “has been incurred.” (MCL 500.3145(1))

In Perkovic, the notice of injury requirement became an issue because Zurich claimed it wasn’t sued within a year of the accident and because Zurich argued that the notice of injury exception didn’t apply because it hadn’t received a “proper” notice.

What’s required in a ‘proper’ No-Fault notice of injury under Michigan’s auto law?

Under Michigan’s No-Fault law, the required contents of a No-Fault notice of injury are rather simple and straight-forward:

  • The “name and address” of the person or entity claiming No-Fault benefits;
  • The car crash victim’s “name”;
  • The “time, place and nature of [the motor vehicle accident victim’s] injury.” (MCL 500.3145(1))

In Perkovic, the Supreme Court held the notice of injury requirement was satisfied by a hospital’s “medical records and associated bills,” which contained the following information:

  • The car accident victim’s “name and address”;
  • A summary that stated: “46 yo male semi truck driver c/o R upper back pain after MVC. States that he was driving down interstate when car in front of him began to spin[;] he swerved to avoid the car since in semi and ran into a wall hitting front[]driver side.”
  • Records showing that the motor vehicle accident victim “may have suffered a ‘back sprain, cervical sprain or fracture, chest wall contusion, contusion, head injury, liver injury, myocardial contusion, pneumothorax, splenic injury, sprained or fractured extremity.’”
This entry was tagged Tags: Michigan Supreme Court
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