Filing a No-Fault Claim? Here’s What You Need to Know First
Michigan’s no-fault insurance system is designed to cover medical bills, up to 3 years of lost wages, 3 years of household service reimbursements, and attendant care benefits after an accident, no matter who caused it. Filing a no-fault claim can be complicated, with strict deadlines and detailed paperwork. Taking the right steps early can protect your rights and make the claims process smoother.
To protect yourself and your family, you should always purchase a "full benefits" unlimited medical coverage policy. Any savings you think are available will cost you significantly more if an accident occurs.
Even if you have health coverage from an employer or from a governmental benefit such as Medicare, ALWAYS PURCHASE AN UNLIMITED FULL BENEFITS POLICY. These are benefits you cannot afford to be without:
If you need in-home attendant care following an injury or surgery, Medicare does not pay for that, but no-fault coverage will.
If you have a claim against an at-fault driver, your health insurer may be able to take back what it has paid for your medical services out of your recovery against the at-fault driver. If you have full benefits, your no-fault carrier will protect your recovery.
If you lose your job and your health coverage, your no-fault policy can provide coverage for all your medical care needed as a result of the accident for the rest of your life.
At Schefman & Associates, PC, we guide Michigan clients through every stage of their no-fault claim, and we are happy to advise you as to the coverage you need and the coverage you should avoid. We have seen too many clients who purchased the wrong insurance, and after the accident, it is too late. Contact us today to handle your claim with the care required.
Eligibility Requirements for Filing a No-Fault Claim
To file a no-fault claim in Michigan, certain eligibility criteria must be met. Only individuals injured in a covered accident while operating or riding in a motor vehicle can submit a claim. It’s also important to file within Michigan’s strict deadlines to make sure your claim is valid.
Notice of the claim must be filed within one year of the date of loss;
Any unpaid claim must be filed as a lawsuit within one year of the date of the medical service;
If you are the driver and owner of an uninsured vehicle, you are ineligible for no fault coverage;
If your vehicle is in the state for longer than 30 days, you must have Michigan insurance covering the vehicle or you will be ineligible for no-fault coverage;
If you are an out-of-state resident here iin school, you may be ineligible for coverage under certain circumstances;
If you are listed on your parents' coverage policy but you no longer reside in their home, you may be ineligible.
Working with an experienced no-fault claims attorney can help confirm that your situation qualifies and avoid mistakes that could delay your case. Understanding eligibility lays the groundwork for gathering the correct information for the claim process.
How to Notify Your Insurance Company About a No-Fault Claim
Notifying your insurer promptly is a critical step in the claims process. You’ll need to provide your personal information, accident details, and supporting documentation. Submitting accurate and complete information prevents delays and misunderstandings. Always retain counsel before giving any statement to your insurer.
It’s best to document every communication with your insurer, including dates and names of representatives. Proper notification sets the stage for medical and repair benefits, so having everything organized makes subsequent steps smoother.
Medical Expenses and Personal Injury Protection Benefits
No-fault claims in Michigan cover medical treatment and personal injury protection (PIP) benefits. This includes hospital bills, physician visits, and rehabilitation, attendant care and in-home services.
Understanding what’s included, how it’s calculated, and how it must be documented helps avoid delays in coverage and gaps in the proofs needed to support your claim. Working with an experienced no-fault claims attorney can help you make sure all eligible medical expenses are claimed accurately and paid promptly.
Disputes and Challenges With a No-Fault Claim
Even with thorough documentation, some claims face disputes. Denials often result from missing paperwork, unclear medical records, or disagreements about the severity of injuries, or even a dispute over whether there was fraud in purchasing the insurance coverage at the outset. Hiring a skilled no-fault claims attorney early is the best way to protect yourself.
Understanding the obstacles, attention then turns to settlements and payments.
Settlement Considerations in a No-Fault Claim
Settlements are often made so an insurer can avoid court, where it may face an assessment of interest and attorney fees. However, you may not be home-free.
A health insurer or a governmental agency may have filed a reimbursement lien. These must be satisfied and documented as part of the settlement, and then the payment must be reflected and documented, especially to Medicare. A provider may reject an offer to resolve a claim, and the matter may have to be brought before the court. Your health insurer may have made a claim for repayment that includes charges unrelated to the accident.
An experienced no-fault claims attorney knows how to handle these and many other situations to protect the client. At Schefman & Associates, this is what we have done for more than 40 years.
Impact of Preexisting Conditions on a No-Fault Claim
Preexisting conditions can affect how insurers evaluate a no-fault claim, so it is essential to consult an attorney first. Insurers may question whether the current medical treatment is related to the accident or a prior condition. While the Affordable Care Act disallows screening for a pre-existing condition, your no-fault insurer is still allowed to do that. Clear medical documentation can demonstrate which injuries are directly caused by the accident.
Properly addressing preexisting conditions assures your claim reflects your actual losses and sets up accurate handling of long-term medical needs. At Schefman & Associates, we put our experience in this area to work for you.
Dealing With Long-Term Medical Needs in a No-Fault Claim
Some injuries require ongoing treatment, therapy, or rehabilitation. Documenting all long-term care is crucial for a no-fault claim, including future anticipated expenses. Insurers rely on clear evidence to approve coverage for extended medical needs.
Working with an experienced no-fault claims attorney can help you account for future treatments and coordinate with medical providers. Planning ahead assures your claim captures the full scope of care necessary for recovery. After medical concerns are addressed, it’s important to coordinate benefits with other insurance policies.
Get the Support You Need Today
Filing a no-fault claim in Michigan can feel overwhelming, but careful preparation and accurate documentation make the process much smoother. At Schefman & Associates, PC, we guide clients through every step and handle communication with insurers so you can focus on recovery.
We proudly serve clients in Bloomfield Hills, Oakland County, Wayne County, Macomb County, and Washtenaw County, providing personalized support for no-fault claims of all types. Our firm assures your claim is thorough and properly managed to protect your rights. Contact us today to discuss your case and get the guidance you need to move forward confidently.
