No-Fault Medical Benefits for Michigan Auto Accident Victims

Posted over 4 years ago. Applies to Michigan, 4 helpful votes

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Two Types of Medical Benefits

Most people have what's called "coordinated" or "excess" medical benefits on their auto insurance policies. This means that in the event the person is injured in a car or a truck accident, his or her health insurance is supposed to pay first, then the auto insurer is responsible for the balance under the Michigan No-Fault law. There is also an option to have primary medical benefits on your insurance policy. Another term for this is primary medical PIP (personal injury protection benefits). This means that in the event of an auto accident injury, the injured person receives medical benefits from their auto insurance company. Coordinated coverage is less expensive than primary coverage, as your auto insurance company expects it will not have to pay first in the event of a motor vehicle crash.

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in some cases, the auto insurer does end up paying first

One such example is if the health insurance policy contains an auto accident exclusion, which is an exclusion in the policy that states the insurance company will not pay for treatment related to auto accidents if there is Michigan No-Fault insurance coverage that applies. An even more common situation is when people lose their health coverage due to a work layoff or termination and forget to tell their auto insurer that they no longer have health insurance. When this happens, the auto insurer will usually charge a higher medical deductible than it would have had the health insurer been paying first. Most insurers charge anywhere from $0 to $300 for a medical lifetime deductible if the policy is set up correctly. If the insurance company ends up in a primary position, they will increase this amount to $500 or $600 (as an example).

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GMAC or Medicare/Medicaid Coverage

GMAC Financial Services charges a $2,500 deductible if the insured person was supposed to have primary coverage and did not. Additionally, Medicare and Medicaid are not supposed to be used for auto accidents, as they are payers of last resort. If an insurance agent asks you if you have other health insurance, remember that Medicare and/or Medicaid do not count. Therefore, you need to have any medical benefits from your auto insurance as primary on your auto insurance policy. Finally, keep in mind that there can be substantial penalties if someone is using Medicare or Medicaid instead of No-Fault insurance to treat for personal injuries caused by an auto accident. Many medical doctors do not understand this issue, and will simply send bills to Medicare or Medicaid instead of submitting them to a No-Fault insurer as they are supposed to. Please make sure to contact a knowledgeable No-Fault insurance attorney immediately if this happens.

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Situations when Michigan drivers should choose primary medical PIP benefits

1. Auto Accident Exclusions. If you have any type of auto accident exclusion in your health insurance policy, you should elect primary medical on your auto No-Fault insurance. To find out whether you have an auto accident exclusion, you should contact your health insurer and request a copy of the "summary plan description" or the plan itself. Review this with your insurance agent as well. 2. Beware of ERISA plans. If your health insurance is a self-funded ERISA plan, you should elect primary medical on your auto No-Fault insurance. These plans can claim a federal lien against your auto accident negligence case (your case for pain and suffering after a car accident). The best way to avoid the problem is to elect primary medical on your auto No-Fault insurance.

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Continued....

3. If you have an HMO. HMOs can be very restrictive and can often result in delayed medical treatment. By electing primary medical PIP, you do not have to treat within the HMO and can substantially expedite your treatment and improve your choice of providers. 4. Medicare and Medicaid: If you have Medicare, Medicaid, Veterans Administration Benefits or any county health plan, you should have primary medical PIP on your auto No-Fault insurance. This helps to avoid the "super liens" that providers of government benefits may otherwise have against your automobile negligence case (the case for your personal injuries and pain and suffering that you would bring against the person who has caused your accident). 5. Blue Cross Blue Shield. Be aware that there is the possibility of a "double dip" if you have traditional Blue Cross and full coverage on your No-Fault insurance policy.

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Conclusion

If you lose your health insurance for any reason, or you have a situation as noted above, you should immediately contact your auto insurer and change to primary medical coverage. A special thanks to Michigan Auto Law attorney Jeffrey A. Bussell for his contributions to this article. Jeff is an attorney in Michigan Auto Law's pre-litigation division, where he works closely with auto accident victims in the early stages of their lawsuits, helping them recover important insurance benefits making certain they receive whatever medical treatment is necessary for a full recovery.

Additional Resources

To learn more about what medical benefits you are entitled to when injured in a Michigan car accident as well as how to apply for these benefits, visit the Michigan Auto Law Medical Benefits Overview webpage below.

Michigan Medical Benefits Overview

Michigan Car Accident Legal Resource Center

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