As you have learned this past month through my blogs, no-fault benefits may be payable in circumstances where you may not have thought they would be because the injury was not caused by a typical motor vehicle crash. However the injury DID involve a motor vehicle.

 We know that in order for Michigan No Fault benefits to be payable you need to ask the following question: Was there an accidental injury that arose out of the ownership, operation, use or maintenance of the motor vehicle as a motor vehicle?  If the answer is yes, then the Michigan motor vehicle injured victim may be entitled to no fault benefits.

Here is an example of an unusual circumstance where benefits may still be payable:

Loading & Unloading:

• A man loading or unloading a motor vehicle usually is entitled to PIP.
• If patient is loading a heavy bag of salt in his trunk and injures his back, he may be entitled to PIP.
• Man stacking boxes in back of a truck when a pallet falls on his head is entitled to PIP.
• Camper ladder collapses as man carries heavy cooler to roof. Entitled to PIP.

As you have learned this past month through my blogs, no-fault benefits may be payable in circumstances where you may not have thought they would be because the injury was not caused by a typical motor vehicle crash. However the injury DID involve a motor vehicle.

 We know that in order for Michigan No Fault benefits to be payable you need to ask the following question: Was there an accidental injury that arose out of the ownership, operation, use or maintenance of the motor vehicle as a motor vehicle?  If the answer is yes, then the Michigan motor vehicle injured victim may be entitled to no fault benefits.

Here are a few examples of unusual circumstances where benefits may still be payable:

Not Logical or Fair:

        Figuring out which or whose auto insurance company is obligated to pay medical bills and other PIP benefits can be confusing.  To determine which auto insurance company is responsible for paying benefits, answer the following questions:

1.  Was there an accidental injury that arose out of the ownership, operation,  use or maintenance of a motor vehicle as a motor vehicle? If answer is “Yes,  continue. 
     For an Insurance Company to be obligated to pay under the No-Fault Law a “motor vehicle” has to be “involved.”  This typically means a car, van, truck, trailer or bus was somehow involved in the accident. 
      A motorcycle is not defined as a motor vehicle under the No-Fault Law.  If patient was injured in a single motorcycle accident (e.g. biker hits tree, deer, or other motorcycle), no PIP benefits are available.  However, if a car cut the biker off, a “motor vehicle” was “involved” and benefits would be available.
 

2.  Do any exclusions apply? If no exclusions apply, continue.

• If the patient is an owner of an uninsured vehicle that was involved, he or she is not entitled to PIP.
• A patient that stole the accident vehicle is not entitled to PIP.
• A patient from a different state in a car registered in a different state MAY be excluded from benefits.
• If the patient's injury occurs while performing his job, worker's compensation insurance MAY pay some of the benefits that would normally be paid by the automobile insurance.

3.  Was the patient an “Occupant of a privately owned vehicle”, a

    Non-Occupant (pedestrian, bicyclist, etc.) or a Motorcyclist?
The determination as to which auto insurance company is responsible for PIP benefits is different for an occupant, non-occupant and motorcyclist.  The next three pages explain the process for determining which company is responsible.
 

IN A NUT SHELL:
1.                  A Motor Vehicle must be involved.
2.                  You don't get PIP if you stole the accident vehicle or are the owner of an uninsured motor vehicle involved in the accident.
3.                  You must figure out if patient is an Occupant, a Non-Occupant or a Motorcyclist to  ascertain which insurance company is responsible for paying PIP.
 

Here are a few examples of situations where No-Fault benefits must be paid, although the circumstances of the injury wouldn't normally make someone think they would be.

First let's look at the law which makes no fault benefits payable in a Michigan incident: the Michigan no-fault law states that

No Fault Benefits are payable to anyone who suffers an injury "arising out of* the ownership*, operation*, maintenance* or use* of a motor vehicle* as a motor vehicle*".

I have placed asterisks next to important words or phrases that have special meaning under Michigan's no-fault law. If the injury "arises out of" the "use" of a motor vehicle then no-fault benefits must be paid. An example of this is if you are getting out of your car, put 1 foot on the pavement, attempting to standup but your foot slips, you fall to the ground breaking your hip--- the analysis is your injury arose out of the use of your motor vehicle. Case law that has developed over the years has shown that getting in or out of your vehicle, as long as you're in very close proximity to it, justifies no-fault benefits being paid. This includes all of the medical bills for the injury.

Overview:

1. When should bills be paid by an auto carrier?

A: If a "Motor Vehicle" is "involved" in the accident, the injured person is entitled to First Party or PIP (Personal Injury Protection) benefits. This includes payment of medical bills.

2. What are First Party or PIP (Personal Injury Protection) benefits?

A: "First Party" or "PIP" are phrases used by the insurance industry for the claims opened for medical bills, up to three years of wage loss, up to three years of replacement services (household chores, a.k.a. essential services), medical mileage and attendant care. These claims are made against an automobile insurance company.

3. How do I set up a PIP claim so I can submit bills for payment?

A: Get an Application for Benefits Form from the appropriate Auto Insurance Company, have the patient fill it out and send it back. Many companies now don't bother with the Application for Benefits Form and just set up the claim over the phone by speaking to the patient. The assigned PIP adjuster will then contact the patient within days of the call with the claim number, address and instructions for obtaining benefits. The claim must be filed within one year after the accident.

4. How do I know which auto insurance company has to pay the bills?

A: The Michigan No Fault Act (MCLA 500.3101 et. seq.) sets forth the rules for determining which insurance company pays under different circumstances. These rules are detailed on the following pages entitled No-Fault PIP Priorities.

The Michigan Supreme Court has just recently decided a major case that will change a victim's ability to recover against a negligent driver for pain and suffering damages.
 
15 years ago when the Michigan Legislature passed the law, it indicated in order for a person to receive compensation for pain and suffering resulting from a Michigan accident that they must have a threshold level injury. There are four ways a victim can meet the threshold requirement.
 
The new case recently decided called McCormick, deals with the one of the four threshold requirements: "serious impairment of important body function."
 
In 2004, the Michigan Supreme Court decided a case called Kreiner which changed the interpretation of what amounted to a "serious impairment of important body function."  That court read into the statute something that was not there--- and it said that "a victim's course and trajectory of his or her life must be significantly affected."
 
On August 1, 2010 the current Michigan Supreme Court overturned the Kreiner case saying it wrongly interpreted the no-fault statute and ruling that the statute did not require such a significant life change to meet the threshold.  The court went on to define each of the important words and phrases at issue when a trial judge is deciding whether the victim has met the threshold requirement.
 
The present threshold as to "serious impairment of important body function" requires an observable or perceivable impairment from actual symptoms or conditions, that affects a body function of value, significance or consequence to the injured person, and that influences some of the victim's capacity to live in his or her normal manner of living.
 
The bottom line: this statutory law has not changed.  However, now trial judges have better guidance as to the meaning of the phrase "serious impairment of important body function." It is now easier for a Michigan motor vehicle accident victim to be compensated for pain, suffering, mental anguish, fright and shock, denial of social pleasure and enjoyment and other noneconomic damages.
 
Anyone who has been a victim of a motor vehicle collision because of the negligence of another driver in the last three years should call our office to see if they may meet the new threshold requirement.  The statute of limitations is three years for motor vehicle accident in Michigan and unless you are a minor, you are barred from filing a lawsuit if over three years have passed since the accident.