What if I was not driving or riding in my own car when the accident happened? Who pays my benefits?

If you own your own car and carry insurance on it, or if you live with a relative who owns an insured vehicle, or you are otherwise a named insured under a policy of no-fault insurance underwritten in Minnesota, then you are covered by the no-fault benefits provided by that policy wherever you go (so long as you stay within the United States, United States possessions, or Canada). Even if you are driving or riding as a passenger in someone else’s car, or are struck by a car while a pedestrian or riding a bike, you will be entitled to no-fault benefits under your policy.

In the vast majority of situations, your policy will pay your no-fault benefits. In some limited circumstances benefits may be payable by an insurer other than your insurer. For example if you were driving or riding in a business vehicle that was being used to transport people or property at the time of the accident; or you were riding as a passenger in a bus, or were hit by a bus as a pedestrian or while riding a bike; the insurers for those vehicles may have to pay your benefits.

Questions of priority of coverage can be quite complicated. If you are facing such an issue, call me to discuss the particulars of your situation.

What benefits are payable by my no-fault insurer?

Medical Expense Benefits: Your no-fault insurer will cover reasonable expenses for necessary treatment of injuries caused by the accident. See “What do I need to know about medical expense benefits?” for a more complete discussion of this benefit. If you have basic coverage, your policy limit for medical expense benefits will probably be $20,000.00.

Wage Loss Benefits: Your no-fault insurer will pay you 85 percent of your lost income from inability to work caused by the injuries you suffer from the accident.  See “What do I need to know about medical expense benefits?” for a more complete discussion of this benefit. If you have basic coverage, your wage loss benefit will be limited to $250.00 per week and a policy limit of $20,000.00 that also applies to replacement service loss benefits and vocational rehabilitation services.

Replacement Service Loss Benefits: Your no-fault insurer will reimburse you for reasonable expenses you incur obtaining usual and necessary substitute services for the benefit of your household, such as having someone come in to clean your house, mow the lawn, shovel snow, etc., while you are recovering from your injuries. See “What do I need to know about replacement service loss benefits?” for a more complete discussion of this benefit. If you have basic coverage, this benefit will be limited to $200.00 per week, will not apply to the date of injury and the first 7 days thereafter, and will count toward the same $20,000.00 policy limit that applies to your wage loss benefits.

Vocational Rehabilitation Benefits: Your no-fault insurer will pay reasonable expenses relating to helping you find a new job or a new career, including educational expenses, if you are unable to return to your normal job because of your injuries. See “What do I need to know about vocational rehabilitation benefits?” for a more complete discussion of this benefit. There is no weekly limit to this benefit, but it does count toward the same $20,000.00 policy limit that applies to wage loss and replacement service loss benefits.

Death Benefits: In death cases, no-fault insurers cover: reasonable funeral and burial expenses up to $2,000.00; survivor’s economic loss benefits covering loss of monetary support the survivor would have received from the decedent, limited to $200.00 per week; and survivor’s replacement services loss covering expenses incurred in obtaining usual and necessary substitute services for the benefit of the survivor’s household the decedent would have normally performed, such as hiring someone to clean the survivor’s house, mow the lawn, shovel snow, etc., limited to $200.00 per week.

How do I apply for payment of no-fault benefits?

Contact your agent and report the accident. Tell your agent you were injured and need to treat with a doctor. Ask your agent to send you an Application for No-Fault Benefits. Fill out the form and mail it to the address indicated on the form. Your no-fault insurer will send you a letter confirming receipt of your claim. The letter will list your claim number and contact information for the adjuster who will oversee payment of your benefits. Make sure to give this information to your doctors so they can submit their bills for payment.

The Application for No-Fault Benefits will include a medical records authorization and an employment authorization. You may not want to sign these authorizations as they are written by your insurer.

The medical records authorization enables your insurer to obtain records from your health care providers concerning both the injuries you suffered in your accident and anything else for which you have received treatment in the past. The authorization attached to the application is intentionally written as broadly as possible so that your insurer can get every record that exists concerning you. The authorization also provides that a copy shall be as valid and enforceable as an original. This enables your insurer to reuse the authorization over and over to obtain records from providers without your express prior knowledge and consent.  You may want to consider not signing the authorization as written. ou should definitely make copies of the authorization and provide separately signed authorizations to specific providers, filling in the name and address of the provider where indicated to prevent your insurer from reusing the authorization. You should also cross out the sentence saying copies of the authorization shall be as valid and enforceable as the original. Write in: “Accept only this original.” You may also want to specifically exclude any conditions or treatment you don’t want your insurer to see, such as treatment for depression, mental health issues, sexually-transmitted diseases, etc. Your insurer is certainly entitled to obtain records relating to past treatment of physical conditions similar or identical to your current injuries, but they are not entitled to obtain copies of records relating to treatment of totally unrelated, possibility sensitive or private conditions.

The employment authorization enables your insurer to obtain records from your employer to confirm any loss of income you may have sustained as the result of your injuries. If you are not making a claim for wage loss benefits, and do not want your no-fault insurer contacting your employer, then do not sign the employment authorization attached to the application.

What do I need to know about medical expense benefits?

Your no-fault insurer is obligated to pay all reasonable expenses for necessary treatment of injuries caused by your accident. This includes both the bills of the providers from whom you receive treatment, and any out-of-pocket expenses you incur such as mileage traveling to and from your doctor’s office or the pharmacy; prescription medications you pay for yourself; crutches; etc.

Your no-fault insurer may refuse to pay for “items” (such as a mattress) claiming they are only obligated to pay for “services” and “prosthetic devices” specifically identified in the No-Fault Act. If this happens to you, call me to discuss the specifics of your situation.

You have the right to choose both the type of doctor you want to see and the individual doctor or clinic you want to go to. If you want to see a chiropractor rather than a medical doctor, that is your right. If you want to see your family doctor, that is your right. If you want to see a specialist, that is your right. Your no-fault insurer cannot require you to treat with any type of provider, or any specific provider, with whom you do not want to treat.

Your medical expense benefits will be limited to the policy limit you chose to purchase. The minimum policy limit for medical expense benefits under any policy underwritten in Minnesota is $20,000.00. If you owned two or more vehicles on the date of your accident, insured them with the same insurer, and chose to “stack” your policy limits, then your medical expense benefits will be limited to $20,000.00 times the number of policies you stacked: For two vehicles the policy limit would be $40,000.00; for three vehicles the policy limit would be $60,000.00; etc. If your agent failed to offer stacking to you at the time you purchased your policy, you may be able to force your no-fault insurer to add this coverage to your policy even after your accident. If you don’t currently have stacking on your policy, call your agent today and ask for it. It is well worth the extra premiums.

If you exhaust your policy limits, your medical expenses will be payable by your health insurer.

What do I need to know about wage loss benefits?

Your no-fault insurer is obligated to pay 85 percent of your loss of present and future gross income from inability to work caused by your injuries from the accident. You need to be able to prove that you lost a specific amount of income because you were unable to work as the result of limitations stemming from the injuries you suffered in the accident. Your no-fault insurer will ask you for an authorization so they can contact your employer and verify your loss of income. You will also need to have your doctor provide your no-fault insurer with a disability note verifying the work limits stemming from your injuries.

If you are totally disabled from working, your benefit will be 85 percent of your average weekly wage at the time of your accident, assuming your wages would likely have continued at the same rate had the accident not occurred. If you return to work but are unable to work as many hours or are required to take a lower paying job because of limitations stemming from your injuries from the accident, your benefit will be 85 percent of the difference between what you would have earned had the accident not occurred and the amount you actually make.

In most policies, wage loss benefits are subject to a maximum of $250 per week. That means if you earn more than $294.12 per week ($7.35 per hour for a 40 hour work week), you will be subject to the maximum and will not receive 85 percent of your lost income.

If you chose to purchase a policy with stacking or enhanced wage loss benefits, you might be entitled to more than $250.00 per week. With stacking, your weekly limit would be $250.00 times the number of policies you stacked: For two policies your limit would be $500.00 per week; for three policies your limit would be $750.00 per week; etc.

Your wage loss benefits will also be limited to the policy limit you chose to purchase. If you owned two or more vehicles on the date of your accident, insured them with the same insurer, and chose to “stack” your policy limits, then your wage loss will be limited to $20,000.00 times the number of policies you stacked:  For two vehicles the policy limit would be $40,000.00; for three vehicles the policy limit would be $60,000.00; etc. If your agent failed to offer stacking to you at the time you purchased your policy, you may be able to force your no-fault insurer to add this coverage to your policy even after your accident. If you don’t currently have stacking on your policy, call your agent today and ask for it. It is well worth the extra premiums.

What do I need to know about replacement service loss benefits?

Your no-fault insurer is obligated to reimburse you for expenses reasonably incurred by you or on your behalf to obtain usual and necessary substitute services in lieu of those that, had you not been injured, you would have performed not for income but for direct personal benefit or for the benefit of your household.  This means expenses you incur to have someone clean your house, or mow your lawn, or shovel your driveway, or buy your groceries, or prepare your meals, etc., while you are recovering from your injuries.

Generally, you will need two things to establish your entitlement to this benefit:  a disability note from your doctor specifically stating you are unable to perform whatever household chore you are claiming you cannot perform; and a signed receipt from whomever performs the household chore for you, verifying the chore performed, the date it was performed, the amount of time it took, and the amount you paid.  The amount you paid must be reasonable in light of the chore performed and the amount of time it required.

If you are the person who normally, as a full time responsibility, takes care of your home, and you are rendered unable to take care of your home because of your injuries, you may be entitled to replacement service loss benefits even if you do not actually incur any expense paying someone else to take care of your home.  You can claim the reasonable value of the household services you normally would have performed had you not been injured.

In most policies, replacement service loss benefits are not available on the date of injury and the first seven days thereafter, and are limited to $200.00 per week.

Your replacement service loss benefit will also be limited to the policy limit you chose to purchase.  The minimum policy limit for replacement service loss benefits under any policy underwritten in Minnesota is $20,000.00.  However, wage loss benefits, replacement service loss benefits and vocational rehabilitation benefits all count towards this single $20,000.00 limit.

What do I need to know about vocational rehabilitation benefits?

Your no-fault insurer is obligated to pay for “occupational training” if the training is reasonable and appropriate for your particular case, its cost is reasonable in relation to its probable rehabilitative effects, and it is likely to contribute substantially to occupational rehabilitation. This means expenses you incur looking for a new job or a new career, including educational expenses, if your injuries prevent you from returning to the job you had when the accident occurred.

Usually the “occupational training” is provided by persons called qualified rehabilitation consultants, or QRCs.  QRCs are people who are experts at helping injured persons find new jobs or new careers.  Usually the services consist of assisting you with looking for a new job.  In some cases, educational expenses for skills enhancement can be covered.

You are required to notify your no-fault insurer that you are claiming this benefit within 60 days of incurring an expense exceeding $1,000.00 for occupational training.

Any expense you incur for vocational rehabilitation services counts toward the same $20,000.00 policy limit that applies to your wage loss benefits.  Therefore, you may have to make a choice between spending the $20,000.00 on vocational services or collecting the $20,000.00 as wage loss benefits.

Are there limits to my benefits?

Yes. For a more complete discussion of the limits applicable to each type of benefit payable under your no-fault policy, see my discussion under the headings for each benefit.

The overall policy limits that apply to basic policies are $20,000.00 for medical expenses benefits, and a separate $20,000.00 for wage loss benefits, replacement service loss benefits, and vocational rehabilitation benefits.

If you owned two or more vehicles on the date of your accident, insured them with the same insurer, and chose to “stack” your policy limits, then your policy limits will be $20,000.00 times the number of policies you stacked:  For two vehicles the policy limits would be $40,000.00; for three vehicles the policy limits would be $60,000.00; etc.  If your agent failed to offer stacking to you at the time you purchased your policy, you may be able to force your no-fault insurer to add this coverage to your policy even after your accident.  If you don’t currently have stacking on your policy, call your agent today and ask for it.  It is well worth the extra premiums.

My insurer has scheduled an appointment for me to be examined by a doctor of their choice, called an “IME.” What is this and do I really have to go?

Your no-fault insurer is entitled to require you to submit to a physical examination by a physician or physicians of their choice “as may reasonably be required.”  Your insurer prefers to call these “independent” medical examinations, or IMEs.  In reality, there is nothing independent about them. These examinations are conducted by doctors hand-picked by the insurers, and in the vast majority of cases result in opinions that enable the insurer to stop paying benefits.  They are truly adverse to your interests, not independent.

Your no-fault insurer is required to satisfy certain requirements before you must submit to an adverse examination:  The examination must be conducted by a “qualified physician”; the examination must be conducted within your city, town or statutory city of residence; if there is no qualified physician within your city, town or statutory city of residence, then the examination must be conducted as close as possible to your residence; your insurer must agree to provide you with a copy of every written report rendered by the physician; and your insurer must agree to compensate you for any mileage, parking expense and wage loss you incur in attending the examination.

Unfortunately, if your no-fault insurer complies with these requirements, you cannot refuse to attend the exam unless you are willing to forfeit your entitlement to further no-fault benefits.  Unreasonably refusing to attend an adverse examination entitles your no-fault insurer to suspend payment of your benefits based solely upon the refusal.  The mere fact that your no-fault insurer has not paid for all of the treatment you have received prior to the date of the exam, is not a reasonable basis for refusing to attend the exam.

How do I sue my no-fault insurer if they refuse to pay my benefits?

If the amount in dispute is $10,000.00 or less, you may file a petition for no-fault arbitration with the American Arbitration Association.  The current filing fee is $45.00 and the current arbitrator’s fee (payable if a hearing is actually held) is $300.00.  The process usually takes 3-6 months.  Your claim will be decided by an arbitrator, who is usually a local attorney or retired judge who practices in the area of no-fault litigation.  The process is relatively quick, relatively inexpensive, and relatively simple.

If the amount in dispute is more than $10,000.00, you must pursue your claim in district court unless you are willing to forever waive enough of your claim to bring the amount down to $10,000.00 or less.  District court actions are much more expensive, much more complicated, and take much more time than arbitrations.  Your chances of success may also be somewhat less.

If your no-fault insurer is asserting a coverage issue, you are probably required to pursue your claim in district court.

If I decide to continue to treat after my no-fault insurer cuts off my benefits, am I liable for the bills?

Yes, you are personally liable for any medical expenses you incur.  That means that if your no-fault insurer cuts off payment of benefits, you have a choice to make.  You can continue treating despite the cut off, in which case you will receive additional care of your injuries that hopefully will help you recover to the greatest extent possible, but will generate unpaid bills for which you will be personally responsible and will require you to sue your no-fault insurer if you wish to obtain payment; or, you can discontinue your treatment, in which case you will not incur any additional unpaid bills, but you will not receive further treatment thereby potentially jeopardizing your health.

When can I sue the driver who caused my accident?

Under Minnesota law, you cannot sue the at-fault driver for personal injury damages unless and until you satisfy or surpass one of five thresholds: 1) you are disabled from working or from substantially all of your usual and customary daily activities for 60 days or more; 2) you incur qualifying medical expenses of $4,000.00 or more (expenses relating to diagnostic tests like x-rays, CT scans or MRI scans do not count); 3) your injuries result in permanent functional impairment; 4) your injuries or surgery necessitated by your injuries cause permanent disfigurement; or 5) you die from your injuries.

If you do not satisfy or surpass at least one of these five thresholds, you cannot sue the at-fault driver for personal injury damages.

What damages can I recover from the driver who caused my accident?

Generally, the jury will be asked to award you an amount they determine will reasonably compensate you for six general categories of damages:  1) past medical expenses; 2) past wage loss; 3) past pain and suffering; 4) future medical expenses; 5) future loss of earning capacity; and 6) future pain and suffering.

If any of your past medical expenses or wage loss was paid by any “collateral source” such as your no-fault insurer, your health insurer, a short-term or long-term disability insurer, etc., those payments will be subtracted from the amount awarded to you by the jury.  The jurors are never told that this occurs.  Therefore, the jurors may award you $15,000 for past medical expenses and $10,000 for past wage loss, and leave the courtroom thinking you will receive $25,000.  In reality, after the jury leaves the judge will reduce the jury award by the amount paid by your no-fault insurer, health insurer, disability insurer, or any other “collateral source,” and you will likely end up receiving much less than the jurors intended you to receive.

What if I was partially at fault for the accident?

If you were partially at fault for causing the accident, your damages will be reduced by the percentage of fault apportioned to you by the jury.  For example, if the jury finds you to have been 40 percent at fault for the accident, your damages will be reduced by 40 percent.  If the jury finds you to have been more at fault for the accident than the defendant, you will not receive any damages even if the jury found the defendant to have been 49 percent at fault.  The jury must find the defendant to have been more at fault than you for you to be entitled to damages.

What if I was a passenger. Can I sue the driver of the car I was riding in?

Passengers can sue both the driver of the vehicle they were riding in at the time of the collision and the driver of any other involved vehicle if both were negligent in the operation of the vehicle they were driving.  Passengers can sue the driver of the vehicle they were riding in at the time of the collision even in single vehicle accidents.

What if the driver who caused my accident was uninsured?

If the at-fault driver was uninsured, you may have a claim against your own insurer under the underinsured motorist benefits portion of your policy.

What if my damages exceed the amount of insurance carried by the driver who caused my accident?

If your damages exceed the amount of liability coverage carried by the at-fault driver, you may have a claim against your own insurer under the underinsured motorist benefits portion of your policy.