Michigan’s No-Fault System Promises Benefits but Getting Them Is Another Story

Every Michigan driver pays for no-fault coverage. When you’re hurt in a crash, that coverage is supposed to pay your medical bills and a portion of your lost wages without requiring you to prove the other driver was at fault. That’s the promise. The reality is that Michigan no-fault insurers have powerful financial incentives to dispute, delay, and deny those benefits and since the 2019 No-Fault Reform, they have more tools to do it than ever. Scott Reizen spent years on the defense side of these claims. He knows exactly how insurers challenge PIP benefits, and he uses that knowledge to fight back.

What Michigan Law Says About No-Fault PIP Claims

Michigan’s Personal Injury Protection benefits are governed by the No-Fault Act, MCL 500.3101 et seq. Under MCL 500.3107, your no-fault insurer must pay for “all reasonable and necessary” medical expenses caused by the accident. That includes hospital and doctor bills, surgery, physical therapy, prescriptions, medical equipment, and in-home attendant care when needed.

PIP also covers 85% of lost income, up to a monthly maximum, for up to three years from the date of the accident (MCL 500.3107(1)(b)), and certain replacement service expenses for household tasks you can no longer perform.

Since the 2019 No-Fault Reform took effect on July 2, 2020, drivers choose from four PIP tiers: $50,000 (Medicaid-eligible policyholders only), $250,000, $500,000, or unlimited. The tier you selected determines the ceiling on your first-party medical benefits and if your bills exceed that ceiling, you may have an “excess medical” claim against the at-fault driver.

The 2019 reform also introduced a fee schedule under MCL 500.3157: insurers pay medical providers 190% of the Medicare rate for covered services. For policies issued or renewed after July 1, 2020, a family-provided attendant care cap of 56 hours per week applies under MCL 500.3157(10) and (14).

One critical protection for earlier accident victims: in Andary v. USAA, the Michigan Supreme Court held that the fee schedule and attendant care cap do not apply retroactively to accidents that occurred before June 11, 2019. If your crash predates that date, your benefits are governed by the older, more favorable rules.

You have one year from the date of the accident to file your PIP claim under MCL 500.3145. That is a hard deadline. It is much shorter than the three-year personal injury statute of limitations, and it is the deadline most often missed.

How No-Fault PIP Claims Work in Michigan

After a crash, you notify your own no-fault insurer and submit your bills for PIP reimbursement. In straightforward cases, benefits flow without major friction. In practice, many claims get complicated quickly.

Insurers routinely schedule Independent Medical Examinations IMEs with physicians they hire to evaluate whether continued treatment is “reasonable and necessary.” These doctors often conclude that you’ve reached maximum medical improvement earlier than your own treating physicians believe. When that happens, the insurer uses the IME to justify cutting off benefits.

Insurers also dispute whether specific treatments fall within the scope of covered benefits. They question whether your ongoing symptoms are causally related to the crash or are pre-existing conditions. They challenge facility charges as exceeding the fee schedule.

In-home attendant care is one of the most heavily contested areas. Family members providing necessary care are often entitled to compensation, but insurers frequently dispute the number of hours needed or deny that family-provided care qualifies at all.

Under MCL 500.3145, once a bill goes unpaid, you have one year from the date of that specific unpaid expense to bring a lawsuit to recover it. That rolling deadline applies to each unpaid item which means staying on top of what’s been denied is essential.

What The Reizen Law Group Does Differently

Scott spent years at an insurance defense firm handling exactly these claims from the insurer’s side. He knows what arguments adjusters use to reject IME challengers. He knows how insurers categorize treatment as “not causally related.” He knows the specific strategies used to reduce or terminate attendant care compensation.

That insider knowledge matters in PIP disputes because the fight is technical. It’s not just about whether you’re hurt it’s about knowing the correct procedural and substantive responses when benefits are cut off. Scott knows which medical documentation is most important, how to counter an insurer’s IME, and when a dispute needs to go to litigation rather than negotiation.

He also knows that delay is itself a tactic. Insurers know that injured people under financial pressure will sometimes accept reduced settlements just to get cash flowing again. Scott recognizes that pressure and pushes back against it.

The Insurance Insider on Your Side.

Common No-Fault Claim Issues

  • IME cutoffs: Insurer-hired doctors ending your benefits based on a single examination
  • Pre-existing condition denials: Insurer arguing your injury predates the crash
  • Attendant care disputes: Denial or underpayment of in-home care provided by family members
  • Wage loss disputes: Challenges to self-employment income or the scope of work restrictions
  • Fee schedule conflicts: Providers billing above the 190% Medicare schedule; disputes about what’s “covered”
  • Causal relationship challenges: Insurer arguing your treatment isn’t related to the accident
  • Exhausted PIP limits: When a limited policy runs out and excess medical claims are needed

Frequently Asked Questions

Which insurance company handles my no-fault PIP claim?

Your own no-fault insurer handles your PIP claim, not the at-fault driver’s insurer. Michigan’s no-fault system is first-party: your coverage pays your benefits regardless of fault. You would pursue the at-fault driver’s insurer separately for pain, suffering, and noneconomic losses if you meet the tort threshold.

What happens if my insurer schedules an IME and the doctor says I don’t need more treatment?

An IME conclusion is not final. It is the insurer’s hired physician’s opinion not a legal determination of what you’re entitled to. Scott regularly challenges IME cutoffs by marshaling contradictory evidence from treating physicians, establishing the causal record, and, when necessary, litigating the dispute directly.

My no-fault benefits were cut off. What can I do?

When benefits are wrongfully terminated, you generally have one year from each unpaid expense to bring suit under MCL 500.3145. Document everything denials, bills, correspondence. Contact Scott as soon as possible, because waiting can cost you specific claims even within the one-year window.

Does the 56-hour/week attendant care cap apply to me?

It depends on when your accident occurred. For accidents before June 11, 2019, the Michigan Supreme Court’s Andary v. USAA decision held that the cap does not apply. For accidents after July 1, 2020, the cap under MCL 500.3157 generally applies to family-provided care. The period between those two dates involves a more nuanced analysis.

What is the difference between PIP and a lawsuit against the at-fault driver?

PIP is a first-party claim against your own insurer for medical bills, wage loss, and services no fault determination needed. A lawsuit against the at-fault driver (a “third-party claim”) seeks noneconomic damages like pain and suffering, but requires proving that driver was 50%+ at fault and that you suffered a “serious impairment of body function” under MCL 500.3135.

Can I sue my insurer if they wrongfully deny my PIP claim?

Yes. If your insurer unreasonably denies or terminates benefits, you can bring a first-party PIP lawsuit. In some circumstances, attorney fees may be recoverable under MCL 500.3148 if the court finds the insurer’s denial was unreasonable.

Talk to Scott

A denied or terminated PIP claim is not the end of the road it’s often the beginning of a fight your insurer expects you to lose alone. Scott Reizen has over two decades of experience handling Michigan no-fault claims, with an insider’s understanding of how insurers build their denials. Free consultation, no fee unless we win. Call (248) 554-3440.

No Fault Claims

Michigan’s No-Fault System Promises Benefits but Getting Them Is Another Story

Every Michigan driver pays for no-fault coverage. When you’re hurt in a crash, that coverage is supposed to pay your medical bills and a portion of your lost wages without requiring you to prove the other driver was at fault. That’s the promise. The reality is that Michigan no-fault insurers have powerful financial incentives to dispute, delay, and deny those benefits and since the 2019 No-Fault Reform, they have more tools to do it than ever. Scott Reizen spent years on the defense side of these claims. He knows exactly how insurers challenge PIP benefits, and he uses that knowledge to fight back.

What Michigan Law Says About No-Fault PIP Claims

Michigan’s Personal Injury Protection benefits are governed by the No-Fault Act, MCL 500.3101 et seq. Under MCL 500.3107, your no-fault insurer must pay for “all reasonable and necessary” medical expenses caused by the accident. That includes hospital and doctor bills, surgery, physical therapy, prescriptions, medical equipment, and in-home attendant care when needed.

PIP also covers 85% of lost income, up to a monthly maximum, for up to three years from the date of the accident (MCL 500.3107(1)(b)), and certain replacement service expenses for household tasks you can no longer perform.

Since the 2019 No-Fault Reform took effect on July 2, 2020, drivers choose from four PIP tiers: $50,000 (Medicaid-eligible policyholders only), $250,000, $500,000, or unlimited. The tier you selected determines the ceiling on your first-party medical benefits and if your bills exceed that ceiling, you may have an “excess medical” claim against the at-fault driver.

The 2019 reform also introduced a fee schedule under MCL 500.3157: insurers pay medical providers 190% of the Medicare rate for covered services. For policies issued or renewed after July 1, 2020, a family-provided attendant care cap of 56 hours per week applies under MCL 500.3157(10) and (14).

One critical protection for earlier accident victims: in Andary v. USAA, the Michigan Supreme Court held that the fee schedule and attendant care cap do not apply retroactively to accidents that occurred before June 11, 2019. If your crash predates that date, your benefits are governed by the older, more favorable rules.

You have one year from the date of the accident to file your PIP claim under MCL 500.3145. That is a hard deadline. It is much shorter than the three-year personal injury statute of limitations, and it is the deadline most often missed.

How No-Fault PIP Claims Work in Michigan

After a crash, you notify your own no-fault insurer and submit your bills for PIP reimbursement. In straightforward cases, benefits flow without major friction. In practice, many claims get complicated quickly.

Insurers routinely schedule Independent Medical Examinations IMEs with physicians they hire to evaluate whether continued treatment is “reasonable and necessary.” These doctors often conclude that you’ve reached maximum medical improvement earlier than your own treating physicians believe. When that happens, the insurer uses the IME to justify cutting off benefits.

Insurers also dispute whether specific treatments fall within the scope of covered benefits. They question whether your ongoing symptoms are causally related to the crash or are pre-existing conditions. They challenge facility charges as exceeding the fee schedule.

In-home attendant care is one of the most heavily contested areas. Family members providing necessary care are often entitled to compensation, but insurers frequently dispute the number of hours needed or deny that family-provided care qualifies at all.

Under MCL 500.3145, once a bill goes unpaid, you have one year from the date of that specific unpaid expense to bring a lawsuit to recover it. That rolling deadline applies to each unpaid item which means staying on top of what’s been denied is essential.

What The Reizen Law Group Does Differently

Scott spent years at an insurance defense firm handling exactly these claims from the insurer’s side. He knows what arguments adjusters use to reject IME challengers. He knows how insurers categorize treatment as “not causally related.” He knows the specific strategies used to reduce or terminate attendant care compensation.

That insider knowledge matters in PIP disputes because the fight is technical. It’s not just about whether you’re hurt it’s about knowing the correct procedural and substantive responses when benefits are cut off. Scott knows which medical documentation is most important, how to counter an insurer’s IME, and when a dispute needs to go to litigation rather than negotiation.

He also knows that delay is itself a tactic. Insurers know that injured people under financial pressure will sometimes accept reduced settlements just to get cash flowing again. Scott recognizes that pressure and pushes back against it.

The Insurance Insider on Your Side.

Common No-Fault Claim Issues

  • IME cutoffs: Insurer-hired doctors ending your benefits based on a single examination
  • Pre-existing condition denials: Insurer arguing your injury predates the crash
  • Attendant care disputes: Denial or underpayment of in-home care provided by family members
  • Wage loss disputes: Challenges to self-employment income or the scope of work restrictions
  • Fee schedule conflicts: Providers billing above the 190% Medicare schedule; disputes about what’s “covered”
  • Causal relationship challenges: Insurer arguing your treatment isn’t related to the accident
  • Exhausted PIP limits: When a limited policy runs out and excess medical claims are needed

Frequently Asked Questions

Which insurance company handles my no-fault PIP claim?

Your own no-fault insurer handles your PIP claim, not the at-fault driver’s insurer. Michigan’s no-fault system is first-party: your coverage pays your benefits regardless of fault. You would pursue the at-fault driver’s insurer separately for pain, suffering, and noneconomic losses if you meet the tort threshold.

What happens if my insurer schedules an IME and the doctor says I don’t need more treatment?

An IME conclusion is not final. It is the insurer’s hired physician’s opinion not a legal determination of what you’re entitled to. Scott regularly challenges IME cutoffs by marshaling contradictory evidence from treating physicians, establishing the causal record, and, when necessary, litigating the dispute directly.

My no-fault benefits were cut off. What can I do?

When benefits are wrongfully terminated, you generally have one year from each unpaid expense to bring suit under MCL 500.3145. Document everything denials, bills, correspondence. Contact Scott as soon as possible, because waiting can cost you specific claims even within the one-year window.

Does the 56-hour/week attendant care cap apply to me?

It depends on when your accident occurred. For accidents before June 11, 2019, the Michigan Supreme Court’s Andary v. USAA decision held that the cap does not apply. For accidents after July 1, 2020, the cap under MCL 500.3157 generally applies to family-provided care. The period between those two dates involves a more nuanced analysis.

What is the difference between PIP and a lawsuit against the at-fault driver?

PIP is a first-party claim against your own insurer for medical bills, wage loss, and services no fault determination needed. A lawsuit against the at-fault driver (a “third-party claim”) seeks noneconomic damages like pain and suffering, but requires proving that driver was 50%+ at fault and that you suffered a “serious impairment of body function” under MCL 500.3135.

Can I sue my insurer if they wrongfully deny my PIP claim?

Yes. If your insurer unreasonably denies or terminates benefits, you can bring a first-party PIP lawsuit. In some circumstances, attorney fees may be recoverable under MCL 500.3148 if the court finds the insurer’s denial was unreasonable.

Talk to Scott

A denied or terminated PIP claim is not the end of the road it’s often the beginning of a fight your insurer expects you to lose alone. Scott Reizen has over two decades of experience handling Michigan no-fault claims, with an insider’s understanding of how insurers build their denials. Free consultation, no fee unless we win. Call (248) 554-3440.