Car Accidents – No Fault Claims
This section applies to car accident cases in the state of Minnesota.
Minnesota law provides that whenever you have been injured as the result of an automobile accident, you have a right to make a no-fault claim against the insurance company responsible for providing no-fault insurance coverage in connection with the accident. Usually that will be your own insurance company.
For example, assume that Tom runs a stop sign and collides with a car driven by Mary and Mary is injured. Despite the fact that Tom is at fault for the automobile accident, Mary would make a no-fault claim against her own insurance company, not Tom’s insurance company. Likewise, if Tom was also injured in the accident, he would have a right to make a claim for no-fault benefits against his insurance company even though he was at fault for the accident.
The identity of the insurance company responsible for paying no-fault benefits may differ depending upon the circumstances. For example, assume that Mary was a passenger in Tom’s car and Tom fell asleep at the wheel and ran off the road injuring Mary. Assume also that Mary did not have any insurance of her own. In that case, since Mary does not have her own insurance, she would be entitled to make a claim for no-fault benefits against Tom’s insurance company.
The first thing that you should do if you have been injured as the result of an accident involving a motor vehicle is to contact the insurance company who will be providing no-fault benefits. Again, as mentioned above, most of the time that will probably be your own insurance company. You should let the company know that you have been involved in an accident and would like to make an application for no-fault benefits. Once you complete the application and send it in to the insurance company, the insurance company will usually contact you and provide you with the name of the adjuster, as well as the adjuster’s address and the claim number.
You have a right to make the following claims for no-fault benefits:
Medical Expenses. You should give your medical providers the name of your no-fault insurance company, along with the name and address of the adjuster and the claim number. The medical providers will then send their bills directly to the no-fault insurance company.
Mileage. You have a right to submit a claim for mileage back and forth to your medical providers. You should keep track of the mileage on a separate piece of paper by date, destination, reason for trip and round trip mileage. You can then submit that mileage directly to the adjuster. You should put the claim number on any paperwork you send to the adjuster and keep a copy for your own records.
Prescription Drugs. In order to obtain reimbursement for the cost of prescription drugs, you must submit a copy of the prescription from the doctor along with a copy of the receipt showing that you purchased the medication. You may send that information directly to the adjuster. Again, keep a copy for yourself. Also, whenever you submit paperwork to the adjuster, it is a good idea to include a cover letter which explains what you are sending to the adjuster.
Wage Loss. Your no-fault insurance company is obligated to pay 85% of your wage loss up to a maximum of $250.00 per week. Most no-fault insurance companies would require your employer to provide written verification that you were off work (wage verification form), as well as a statement from your doctor indicating that you should not go to work (disability statement). You should ask the adjuster whether or not the insurance company will obtain the wage verification form and disability statement or if you should do that. The procedure differs somewhat among various insurance companies and adjusters.
Replacement Services. If your doctor tells you that you should not do things at home, such as housework or lawn care, and it becomes necessary for someone else to do that work for you, you have a right to submit a claim for replacement services to the no-fault insurance company. Most of the time you will need a written statement from your doctor which indicates that you should not do that work. You should send that statement to the adjuster along with a record of the work that was done by someone else. That record should include the date, the nature of the work that was done, the identity of the person doing the work, the number of hours it took, and, if you paid that individual, the amount of each payment.
You may also be eligible for certain other no-fault insurance benefits depending upon the case. For example, it is possible to obtain benefits for re-training. Since all cases differ, it would be a good idea to check with your attorney regarding the extent of your claim.
In addition, you should keep in mind that once you submit a claim to the no-fault insurance company, that insurance company has thirty (30) days to pay the claim. You should be prepared for such delays. Also, be prepared to follow up with the adjuster to make sure the adjuster has everything the adjuster needs to consider each portion of your claim.
There are a number of other things that you may have to know about your no-fault claim. For example, at some point in time the no-fault insurance company will probably request that you see a doctor of their choice in order to have an adverse medical examination (AME). The insurance company will call it an independent medical examination (IME). That doctor will examine you and then prepare a report for the insurance company. If the AME doctor is of the opinion that you no longer need any medical care (and/or no longer have to miss work), the no-fault insurance company may refuse to pay any additional no-fault benefits. If that occurs, you would then have a right to petition the American Arbitration Association and request a hearing to determine whether or not the no-fault insurance company had a right to discontinue payments.
You should also be aware that most no-fault insurance policies provide $20,000 worth of medical expense coverage (which includes mileage and prescription drugs) and an additional $20,000 worth of wage loss coverage (which includes replacement services). It is possible to purchase additional no-fault coverage through your insurance company.