Disclaimer: This article is for informational purposes only and does not constitute legal advice. Consult a licensed attorney for guidance on your specific situation.
Detailed Answer
Overview of PIP Benefits Under Michigan’s No-Fault Law
Under Michigan’s no-fault law, your auto insurer must pay Personal Injury Protection (PIP) benefits for “reasonable charges” of “necessary services” related to injuries from a motor vehicle accident. See MCL 500.3135. PIP covers medical expenses, rehabilitation, and attendant care without regard to fault.
When an Adjuster Disputes Causation
If your insurer’s adjuster asserts that your treatment is not related to the crash, they may withhold PIP payments. Insurers must still pay treatment charges that your medical provider deems necessary to address crash-related injuries.
Steps to Take When Your Adjuster Disagrees
- Obtain a Clear Medical Opinion: Ask your treating physician to explain in writing how each treatment links directly to your crash injuries. A signed narrative or letterhead note helps establish causation.
- Compile Complete Records: Collect imaging reports, therapy notes, and hospital records. Present a chronological timeline that connects your accident to your symptoms and care.
- Submit a Demand Package: Send a formal demand letter with medical records, itemized bills, and your doctor’s narrative. Request payment within a specified timeframe.
- Request an Independent Medical Examination (IME): If the insurer remains unconvinced, they may insist on an IME by a doctor they select. Attend the exam and provide full cooperation.
- Use Michigan’s Appraisal Process: Michigan law allows you to demand appraisal if you dispute payable benefits. Each party picks an appraiser; they choose an umpire to decide the dispute.
Dispute Resolution Options
If informal efforts stall, consider these formal routes:
- File a Complaint with DIFS: The Michigan Department of Insurance and Financial Services (DIFS) handles unfair insurance practices. Submit a complaint at Michigan.gov/DIFS.
- Request Mediation or Arbitration: Some insurers offer internal mediation. Check your policy or ask your adjuster if this option is available.
- Pursue a No-Fault Lawsuit: Under MCL 500.3112, you may file suit if benefits are overdue or wrongfully denied.
Seeking Additional Help
While you can handle many disputes on your own, talking to a qualified attorney can clarify your rights and options. An attorney experienced in Michigan no-fault law can help negotiate with your insurer or represent you in court.
Helpful Hints
- Keep a detailed symptom and treatment diary with dates and costs.
- Follow your doctor’s prescribed plan of care to show consistency.
- Send all correspondence to the insurer by certified mail to track delivery.
- Review your auto policy for deadlines on filing disputes or lawsuits.
- Act promptly—Michigan’s no-fault statutes include strict time limits.