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A recent decision by the Michigan Court of Appeals has changed the rules on a filing no-fault notice of claims. By ruling that medical bills and records didn’t give the auto insurance company notice of the injured person’s claims, the court has added another hurdle to medical providers seeking to get paid for their services.
In February 2009, the plaintiff, Dragen Perkovic, was injured when his truck hit a wall sending him to the hospital.
Two months after the accident, the Nebraska Medical Center sent its medical bills and medical records related to the plaintiff’s accident to Zurich American Insurance Company, including the plaintiff’s name, address, and a description of the accident, which is the common practice in the industry. That claim was denied on May 12, 2009, because Zurich had “no injury report on file for this person.”
While the plaintiff filed his lawsuit in August, 2009, Zurich wasn’t added to the case until March 25, 2010 – over one year after the accident happened.
MCL 500.3145(1) requires:
An action for recovery of personal protection insurance benefits payable under this chapter for accidental bodily injury may not be commenced later than 1 year after the date of the accident causing the injury unless written notice of injury as provided herein has been given to the insurer within 1 year after the accident. . . . The notice of injury required by this subsection may be given to the insurer or any of its authorized agents by a person claiming to be entitled to benefits therefor, or by someone in his behalf. The notice shall give the name and address of the claimant and indicate in ordinary language the name of the person injured and the time, place and nature of his injury.
Zurich claimed that the medical bill didn’t count as notice of claim, so it wasn’t required to pay Plaintiff’s benefits because the claim was beyond the one year statute of limitations.
Surprisingly, the Court of Appeals agreed. In its September 10, 2015 decision, the court ruled:
In this case, however, no letter or written notice form was sent that would alert defendant to the possible pendency of a no-fault claim. . . . Rather, the medical bill and medical records were sent to defendant without any indication of a possible claim. . . . for the purpose of obtaining payment. This notice of injury, which was unrelated to a possible claim for no-fault benefits, did not trigger defendant’s investigative procedures or advise defendant of the need to appropriate funds for settlement.
This decision is a radical change in Michigan No-Fault law. Rather than medical providers being allowed to seek benefits on their patients’ behalf, this new ruling gives insurance companies a defense if the injured party didn’t file a separate written notice of claim with the right insurance provider within a year.
David Christensen is an auto accident attorney at Christensen Law in Southfield, Michigan. He has over 20 years of experience representing plaintiffs against auto insurance companies. If your client is facing a difficult insurance claim denial, contact Christensen Law for a referral today.