When you have to file a lawsuit against your no-fault provider, you already know you're in for a fight. Find out some of the industry's top defensive strategies and what you and your personal injury attorney can do to fight back against them.
The Michigan No-Fault Act lays out an auto insurer's duty to pay benefits after a crash. They may seem rather straight forward:
• All reasonably necessary medical expenses arising out of a motor vehicle accident
• Up to 3 years of lost wages
• Up to 3 years of necessary replacement services
Still, Michigan courthouses are full of auto-insurance lawyers fighting not to pay injured motorists for their claims. Here are some of the most common defenses and what you can do to keep them from derailing your case.
One of the most popular no-fault defenses in recent years as been auto insurance fraud. In these claims, an insurance company says you made some false statement on your original application for insurance or failed to disclose something while your vehicle was insured. This is a very powerful defense because if the insurance company can prove you made a "material misrepresentation" on your application, it is allowed to rescind the policy entirely and deny all claims related to it.
The best way to fight against an auto insurance fraud claim starts long before any accident. Be very careful to disclose all relevant information in your insurance application, including occasional drivers living in the home, traffic tickets, and previous accidents. These details could cause your insurance premium to go up. But the alternative could leave you paying far more if your case is dismissed.
Auto accidents don't always happen to 100% healthy people. If you have ever visited a doctor to treat a part of your body that is later injured in a car accident, you can anticipate facing a pre-existing condition defense. In these cases, the insurance company says the auto accident didn't cause your injury; you already had it at the time of the crash.
Just because you had a bad back or neck pain before the accident doesn't mean you're not entitled to benefits. If your auto accident aggravated a pre-existing condition, you are entitled to coverage for the additional medical expenses. For example, if you were seeing a chiropractor once a month before the crash and three times a week afterwards, your insurance company may be required to pay for all but one visit per month. However, it will be up to you and your attorney to prove that the injury was aggravated. Your lawyer may ask your doctor to testify. You will also need to be ready to explain how much worse things were after the crash than before.
Insurance providers like to pick apart treatments recommended by doctors after a car accident. They will often claim they are not required to pay for certain treatments because they are not reasonable necessary to treat your injury.
You are entitled to coverage for any medical expenses reasonably related to treating your injuries after a car accident. The insurance company doesn't get to pick and choose. However, you and your lawyer will need to prepare to defend against this claim by discussing why the treatment was chosen and whether it helped you recover. Your doctor may also be able to help explain the course of treatment and why he or she though it was necessary.
Another favorite defense of insurance providers is that doctors charge too much for the services they render. This defense has historically been raised in lawsuits filed by the doctors and hospitals to collect their fees directly. Because the Michigan Supreme Court recently eliminated these kinds of suits, unreasonable expense defenses are now making their way into the patients' cases for no-fault benefits.
You are entitled to be compensated for the cost of your treatment. Most of the work in these cases is handled by the experts. Your attorney may ask your doctor's office to testify about how it sets its fees and whether it has received no-fault compensation in the past. If the jury or a settlement awards you less than the full amount of your medical expenses, you can ask the court to divide that award up to satisfy all of your medical debts. That way you won't remain liable for your medical expenses after the case is closed.
In some more complicated no-fault cases, the insurance company may claim that it is not the right defendant. This usually happens when you are filing for benefits as a passenger or pedestrian, or have filed a claim with the Michigan Assigned Insurance Placement Fund (MAIPF). This claim comes down to "priority" under the statute: which insurance provider has the closest connection to your case.
Priority issues are not supposed to stand between you and your no-fault benefits. The law allows an insurance provider to pay the benefits and then be reimbursed by the insurance company with higher priority. However, many insurance companies still ask for the case to be dismissed, rather than go through the process. Because of this, your attorney may choose to bring a case against multiple defendants and sort out which insurance company has priority later.
Insurance company defense attorneys are constantly coming up with new strategies to avoid paying no-fault claims. If you have been seriously hurt in an auto accident, you need a personal injury team that is up to the challenge to fight back against their legal defenses.
At Sachs Waldman, our experienced personal injury attorneys know how to respond to insurance company defenses. We will review your case and help you prepare to fight back and get the benefits you need. If you have been seriously injured in a motor vehicle accident, contact our Detroit personal injury law office at 1-800-638-6722.
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