Why am I Not Being Compensated When I have Full Insurance Coverage?

Automobile accident cases in Michigan are governed by the Michigan No-Fault Act which provides full coverage to those who have insurance. The Michigan No-Fault Act basically breaks down injury claims against the at fault driver into two categories:

  1. Non Economic Benefits. These are claims for economic damages relating to payment of medical bills, lost wages, household services, attendant care and transportation costs among other medically necessary services or accommodations and the second
  2. Non Economic Damages – Pain and Suffering

NO FAULT, FIRST PARTY CLAIMS FOR ECONOMIC PERSONAL INJURY BENEFITS

More often than not, a person's No-Fault, first party personal injury protection (PIP) claim is going to be made with the person's own insurance company.  This is the company to which the person has paid premiums for car insurance with some examples being Allstate, AAA, Citizens or State Farm among many others.  Because Michigan is a No-Fault system, a person typically looks to her insurance company for the economic losses that are incurred following an auto accident due to a person's injuries.  If a person injured in an automobile accident is a pedestrian or a passenger in another driver’s vehicle, the correct insurer may be someone else's insurance company.  One of the many benefits of the Michigan No-Fault Insurance Laws is the fact that most everyone injured in an automobile accident will have No-Fault first party (PIP) coverage for economic losses related to injuries suffered in the accident. 

Even though a person may have full No-fault coverage available to her, insurance companies often times deny claims too often and too early, thereby causing the injured person to stop treatment or to go without benefits too soon in the claims process.  The reason, simply put, is money.  The insurance company’s’ claim handling departments are designed to shut down claims often and early.  By doing this, the insurance companies can save large amounts of money.

Insurance companies shut down No-Fault first party (PIP) claims by requiring the injured person to fill out much paperwork, in significant detail and to continually follow up with the insurance adjuster so as to keep the benefits being paid.  If the paperwork is not filled out properly or timely or if there are any minor inconsistencies or ambiguities, the insurance companies will use such an occurrence to delay or shut down a claim.

In addition to paperwork, the insurance companies will seek to learn everything about the claiminents’ past medical history and at some point early on in the claims handling process will require the injured person to see doctor hired by the insurance company. Not all doctors or medical experts hired by insurance companies are bias against claims or injured persons and in favor of insurance companies, but, unfortunately, far too many of them are quite biased and unfair.  An evaluation by such a doctor usually results in termination of benefits by the insurance company.

A person finding himself or herself injured in an automobile accident and needing No-Fault first party (PIP) benefits should consult with an Attorney as soon as reasonably possible following an automobile accident.  The Person should be meticulous about preparing and submitting forms, documents, and requests for compensation.  Whenever a person receives notification from an insurance company that the insurance company requests an exam by a doctor hired by the insurance company, the person should be mindful of the fact the insurance company is likely getting ready to cut them off.

NO-FAULT THIRD PARTY CLAIMS FOR NON-ECONOMIC DAMAGES (PAIN AND SUFFERING) AGAINST THE AT-FAULT DRIVER

A third party claim for non-economic damages (pain and suffering) against at-fault drivers are claims being made against the person that caused the accident through their negligence.  Some examples include, running a red light, causing a rear-end collision or texting while driving.  Even though the claim is made against the at-fault driver, it is usually the at-fault driver’s insurance that steps up to pay for the defense and/or the compensation owed to the injured person for pain and suffering.

Like with first party No-Fault (PIP) claims, insurance companies often deny or attempt to pay very little for third party claims for the same reason, money.  Insurance companies deny these claims or pay little for these claims when injuries and treatment for injuries are not properly documented, or when the injured persons don’t know the value of their injuries and/or when the injured persons do not know how to establish negligence on behalf of the at-fault driver.

Particularly with third party claims against an at-fault driver, a person injured in a car accident should contact an attorney as soon as reasonably possible because without the experience and the knowledge about establishing negligence, proving a claim, documenting injuries and, most importantly, evaluating the value of a claim, it is almost impossible for a non-represented person to get a fair result from an insurance company.

f you are have been in an accident and are struggling with filing your claims and need the help of a legal professional, contact the team at Giroux Ratton. An auto accident attorney or insurance claim lawyer will be ready to assist you in your case and help get you on the right track. Contact us today for a consultation. 

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