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Theory of Lifetime Benefits v Reality

While the actual Michigan No-Fault Act does not limit medical benefits by time, or dollar amount, very few claims are actually paid for anything more than a few months.

The vast majority of no-fault claimants treat for a short period of time, and then simply stop treating, or taking time off work, because they no longer need to see a doctor, and no longer need to be off work.

Like a pyramid, the next category has fewer people in it. These are the folks who do not stop treating on their own, but are referred to a IME/DME, cut off, and then do not dispute that cutoff. By this time, we are done with probably 80% of all no-fault claimants.

The next, smaller group, the 20%, are those who fight the benefit cutoff, usually after a defense medical exam. Most commonly, those folks have retained counsel. Of those, probably 50% win or settle, and 50% lose.

In other words, about 80% of no-fault claimants do not fight when their benefits are cut off, and payouts occur in only half of the remaining 20%, or 10%.

Just as no-fault insurance carriers find ways to turn lifetime medical claims into closed files with no payment, I know how to turn your no-fault claim into one with a much stronger likelihood of being paid.

Learn more about Michigan No-Fault Insurance Laws & Protections.

Typically, health insurance pays “primary” to no-fault, meaning that the health insurer pays first, and any remaining unpaid accident-related expense should then be paid for by no-fault.  This is called “coordination of benefits”. There are exceptions to this for “ERISA-qualified plans”, discussed below.
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I cannot stress enough the importance of cooperating with your insurance company, before you have to hire me as your attorney. If you do have to hire a lawyer, he/she (or I) will be your contact with the insurance company.
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Sometimes, there are potentially more than just one insurance company, who might be responsible to pay your no-fault benefits.  Specific rules, allocating this responsibility are set forth in MCLA §500.3114, in order, more or less as follows:
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