mopdf.com

auto InsuranceNO-FAULTBenefits

N O - FAU LTCount on AAA to handleyour claimpromptly,courteously &professionally.Injuries as a result of auto accidents can be astressful event in our lives. Focusing on healingshould be your immediate priority. At AAA,we aim to assist you by simplifying the claimprocess and setting expectations for whatservice you will receive.Please take a minute to read this brochure.It outlines the benefits you are entitledto and some important information youshould know to make your claimgo smoothly.2What is the MichiganNo-Fault Law all about?This brochure contains an overview of Michigan’sNo-Fault Law. It is a general description and doesNOT include all of the law’s details or provisions.Please consult your auto policy for specific coverageinformation and exclusions.As always, please feel free to raise any questionswith your claim representative regarding theprocedures that apply to your claim.Just the facts.The Michigan No-Fault Law provides certainbenefits to an injured person without regard towho was at fault in the accident. These benefitsare called no-fault benefits.A no-fault auto insurance policy covers the personand his or her family whether the injured personwas in their motor vehicle, someone else’s vehicle,or was a pedestrian involved in an accident with amotor vehicle.3

N O - FAU LT B E N E F I T Sif the HMO limits the number of physical therapyvisits to 16 and your doctor recommends 20,the no-fault carrier would be responsible for thereasonable, necessary and customary amountcharged for the remaining 4 physical therapy visits.A summary of yourMedical BenefitsThe No-Fault Act requires that the no-fault insurerpay all reasonable charges for reasonably necessaryproducts, services and accommodations for an injuredperson’s care, recovery or rehabilitation arising outof a motor vehicle accident. The medical expensesare payable for life and are unlimited in amount.Medical Benefits include such things as:z Hospital billsz Doctor visitsz Medical tests z Physical therapy z Prescriptions z Prosthetic devices z Transportation to andfrom medical care z Durable medical equipment(i.e. crutches, wheelchairs) z Home modifications z Home or residential careIn some cases, the no-fault carrier will pay familymembers for care they provide for the injuredperson. Nursing care benefits provide care forthe injured person.Coordinated Medical CoverageIf your auto policy is a Coordinated or ExcessCoverage policy, you must use your health careinsurance or HMO first if a service is available totreat your injuries. The no-fault insurer will pay for thereasonable and necessary care that is not covered bythe health insurance or HMO or in excess of theHMO or health insurance coverage. For example,4With a coordinated policy, the no-fault insurer willrequire proof that the bills have been submitted tothe other health plan first and that the other healthplan has either rejected them or made the appropriate partial payment under its contract before theno-fault insurance company will consider honoringthe bill.If you have selected Coordinated Coverage with adeductible, any Medical Benefits that we pay willbe reduced by your deductible amount. UnderCoordinated Coverage, payments made by yourprimary health carrier will be used toward satisfyingthis deductible.If you have Coordinated Medical Coverage onyour policy and you do not have underlying healthinsurance coverage or your health insurance coverageexcludes payment for medical expenses resultingfrom a motor vehicle accident, any amounts otherwise payable for Medical Benefits will be reducedby 300 in addition to any applicable deductible.For example – you have Coordinated MedicalCoverage and you’ve recently retired. Medicareis now your underlying health coverage and doesnot cover automobile accident injuries. Therefore,you would need to change your policy to Primary(uncoordinated) Benefits or expect to have yourmedical benefits reduced by 300, in addition toany applicable deductible.Since Medicare does not cover auto accidentinjuries, all auto-related medicalbills should be submitted to yourno-fault insurer and not Medicare.5

N O - FAU LT B E N E F I T SPrimary Medical CoverageIf you are covered by a health policy and havePrimary (uncoordinated) Medical Benefits underyour auto no-fault policy, under some circumstances, the medical bills will be paid twice orduplicated, once by the health insurer to theprovider and a second time by the no-fault carrierdirectly to the injured person.There are some health insurance policies or planswhich include policy language to avoid paying formedical expenses resulting from motor vehicleaccidents if there is no-fault coverage.Others have a coordinated provision that preventsduplication of benefits and states that the healthinsurer is not responsible for no-fault benefits if thereis a primary (uncoordinated) no-fault policy. Thattype of coordination clause has been allowed whenthere is a primary (uncoordinated) no-fault policy.If you have a health insurance policy, you shouldalso examine it to determine whether or not itexcludes motor vehicle accidents.Medical MileageMedical Expense Benefits include mileage to andfrom medical care. You should keep a record of themileage expenses by date, location, and miles drivenfor submission to the no-fault carrier.Funeral ExpensesThe No-Fault Act provides a Funeral and BurialExpense Benefit up to 2,500. This benefit willbe paid toward the funeral and burial expensesin the event of a death resulting from a motorvehicle accident.6Work Loss andSurvivor’s Loss BenefitsWork Loss Benefits are payable for up to three yearsfrom the date of the accident. As no-fault Work LossBenefits are not considered taxable income, thebenefits are reduced by 15%, unless verifiable proofis presented to the no-fault carrier that your total taxadvantage is less then 15%. The Work Loss Benefitspaid reflect 85% of a person’s wage and salary orthe current monthly maximum amount as annuallydetermined by the State of Michigan.The monthly maximum in effect at the time of theaccident is the maximum for that injured personfor the next three-year period. The income that isrecoverable is what would have been earned, notwhat could have been earned. It is also not basedon the last year or even the last month’s earnings.A new job, a promotion, and a new wage rate(if provable) is recoverable under no-fault insurance.No-fault Work Loss does not include most fringebenefits unless they are actual monetary payments,such as cash bonuses or contributions to a specificsavings or retirement fund. Other non-cash fringebenefits such as health insurance, life insurance andothers are not recoverable as a no-fault work loss.However, no-fault Work Loss does include overtimepay, wage increases, and bonus payments thatare lost.7

N O - FAU LT B E N E F I T SSurvivor’s LossIf you are a qualifying dependent of an individualwho has died because of injuries sustained in amotor vehicle accident, you may be entitled toSurvivor’s Loss payments similar to the Work LossBenefits of a surviving disabled claimant. Generally,the three-year income payment is paid to a narrowgroup of dependents, usually the spouse and minordependent children.As with Work Loss Benefits, the monthly maximumamount payable for Survivor’s Loss Benefits isannually determined by the State of Michigan andincludes replacement services (see page 10) of upto 20 per day. However, survivor’s income loss isbroader than work loss and includes fringe benefits,including the cost of health insurance and otherpremiums and coverages that the decedent’semployment would have provided, plus lost wages,salary and other income up to the allowablemonthly maximum amount.Important InformationCoordination or Set-off of Other BenefitsThe no-fault Work Loss and Survivor’s Loss Benefitsare reduced by governmental benefits such as SocialSecurity disability or survivor’s benefits or worker’scompensation benefits.If the no-fault policy that applies is a coordinatedpolicy, the no-fault insurer is also entitled to a creditfor any disability or employee wage continuationpayments made by an insurance company or anon-ERISA self-funded plan. The no-fault insureris not entitled to a credit or reduction from theWork Loss or Survivor’s Loss Benefits for sick payor vacation pay.Survivor’s Loss payments include income andbenefits which would have been earned, not whatcould have been earned. An increased wage rate,a bonus, or changes in fringe benefits (if provable)are recoverable under no-fault insurance during thethree-year period.Statute of LimitationsYou have one year from the date an expense isincurred, (including medical bills, replacementservices or work loss) to submit an expense tothe no-fault insurer for payment of benefits. Inaccordance with the Michigan No-Fault Law, ifmedical and associated claim expenses are notsubmitted to the no-fault insurer within one yearfrom the date they are incurred, it may resultin the denial of payment for those benefits.89

N O - FAU LT B E N E F I T SReplacement ServicesAn injured person or the survivor of the deceasedmay recover replacement services. The No-FaultLaw provides for the payment of up to 20per day for the loss of ordinary and necessaryservices that the injured or deceased personwould have provided for himself or herself (if theperson is surviving) and for their dependents. Thereplacement services are only payable for the firstthree years after the accident.Typical replacement services include things such as:z Housecleaning z Washing dishesNext steps in the claim process z Yard work z Home maintenance z Babysitting z Child transportation, etc.These services can be provided by and paid tonon-family members or provided by familymembers with a payment or promise to pay bythe injured person.Along with this brochure is an Application For Benefitsform. It is important that you provide all requestedinformation and return it to your handling claimrepresentative as soon as possible. The claim processmay be delayed if you do not return the application orprovide all requested information.Once received, the claim representative may requestmedical documentation to verify and support theinjury and necessity of medical treatment. If necessary,the claim representative may request a secondmedical opinion, which may include an independentmedical examination by a doctor of the no-faultinsurer’s choosing.Throughout the claim process, your claimrepresentative will be contacting you to keep youinformed about the status of your claim.If you have any questions about your claim, pleasecontact your claim representative. We appreciate yourcontinued trust in AAA and look forward to assistingyou on your road to a successful recovery.1011