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What injury information must be in a MI No Fault application?

Court rules that a car accident victim’s No Fault application must describe injury’s inherent characteristics and traceable symptoms

No Fault application

Every person injured in a car accident in Michigan who is setting up a claim for No Fault insurance must submit a No Fault application for benefits. But just how specific must the injury information be in that No Fault application for benefits?

The answer to this question about the Michigan auto No Fault Law’s “notice of injury” rule has long been a thorny issue for auto accident victims — and for the car accident lawyers who help them.

The law hasn’t always been clear on how specific personal injury information must be. Insurance companies have exploited and continue to fight over alleged “insufficiencies” in car accident victims’ notices to avoid paying PIP (personal injury protection) benefits.

What is Michigan’s Notice of Injury Rule?

Under the “notice of injury” rule, an auto accident victim must provide “notice” to his or her auto insurer of the “injury” for which he or she may seek No Fault benefits. The window of time during which a victim can sue for unpaid, overdue No Fault PIP benefits depends on whether a valid notice was provided to the insurer.

The Michigan Supreme Court has recently issued an important opinion about this crucial, often-controversial No Fault procedural issue … which the justices recently expressed unanimously in a three-page order.

In Dillon v. State Farm Mutual Automobile Insurance Company, the Court ruled:

  • A car accident victim cannot satisfy the No Fault law’s notice-of-injury rule “by merely providing notice that she was physically injured.”
  • The rule’s requirement that the victim “indicate in ordinary language the … nature of his injury” “refers to an injury’s inherent characteristics.”
  • “A description of symptoms that are traceable to a diagnosed injury is sufficient to constitute” the “notice” required by the No Fault law.
  • No Fault “does not require” a victim “to provide a precise medical diagnosis, as this would not constitute ‘ordinary language.’”

In so ruling, the justices in Dillon tweaked the Michigan Court of Appeals holding (when it was deciding the case) that a car crash victim “can satisfy the [No Fault Law’s notice-of-injury rule] by merely providing notice of a physical injury” — without “demand[ing] anything more specific” about the injury or injuries.

As I explain below, what’s even more intriguing for Michigan auto accident attorneys who are reading the Supreme Court’s weighing in on the “notice-of-injury” rule’s specificity requirements is the justices’ practical application of their interpretation.

How did the Court determine whether a hip injury was covered by a victim’s No Fault application?

In Dillon, State Farm tried to get out of paying No Fault benefits for Jessica Dillon’s hip injury by claiming it wasn’t specifically identified as an “injury” in her application for No Fault benefits — which she provided to State Farm more than two years before claiming benefits related to her hip injury.

Based on its interpretation that the No Fault law’s “notice-of-injury” rule does not require an auto accident victim to “identify the specific injury for which the insured later seeks coverage,” the Court of Appeals in Dillon concluded the victim’s No Fault application covered her hip injury and, thus, State Farm had to cover it.

However, once the case reached the Michigan Supreme Court, the justices unanimously voted to “vacate that part of the Court of Appeals judgment analyzing MCL 500.3145 and concluding that a claimant can satisfy the statute by merely providing notice of a physical injury.”

But — and this is the intriguing part for Michigan auto lawyers — the justices agreed with the Court of Appeals that the victim’s hip injury was covered by the No Fault application and, thus, No Fault PIP benefits were still owed:

  • “[A]fter being involved in a motor vehicle accident, the claimant provided timely notice of injuries causing pain to her left shoulder and lower back.”
  • “Years later, the claimant sought treatment for an injury to her left hip that, according to the jury, was caused by the same accident.”
  • “Because, as the claimant’s doctor pointed out, the hip injury could have created the lower back pain, her initial notice can be traced to the eventual injury and was sufficient for the purposes of MCL 500.3145(1) …,” i.e., the No Fault Law’s notice-of-injury rule.

How does Michigan’s notice of injury rule apply to a No Fault application?

Michigan’s No Fault insurance law has the following “notice of injury” rule that applies to a victim’s No Fault application:

  • A victim must provide a “written notice of injury … to the insurer within 1 year after the accident” in order to preserve her right sue for unpaid No Fault auto insurance benefits.
  • So long as the “written notice of injury” is given to the auto insurance company within a year of the accident, a lawsuit for unpaid No Fault benefits can “be commenced at any time within 1 year after the most recent allowable expense, work loss or survivor’s loss has been incurred.”
  • The “notice of injury” must include “the name and address of the claimant and indicate in ordinary language the name of the person injured and the time, place and nature of his injury.” (MCL 500.3145(1))
This entry was tagged Tags: application for no fault benefits, Michigan Court of Appeals, Michigan Supreme Court, State Farm insurance
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