History – Before No-Fault
The Minnesota No-Fault Act became law on January 1, 1975. Prior to its enactment, compensation for medical, chiropractic and wage loss benefits were regulated by a much different set of rules that were based strictly upon fault.
Before January 1, 1975, an injured person in an automobile accident could only obtain compensation for their health care treatment from the other car insurer if they could show that another individual caused the accident. In other words, if you were at fault, you have to pay out of your pocket for your treatment. In addition, cases could take years to settle ad the medical providers and your wage loss would not be paid till the end. It was burdensome and risky.
Therefore, nearly all payments to the treating doctors were paid, at least initially, through health insurance and/or cash payment from the patient. The insured individual was forced into our litigation system because it was only after providing the other driver was at fault would the insurance company compensate the individual for these benefits.
The system changed after January 1, 1975. Three major changes occurred: 1) the Act removed fault as the basis for compensation for medical, chiropractic and wage loss benefits; 2) the Act provided for immediate entitlement of benefits without the need for litigation; and 3) the Act limited the parameters whereby a non-negligent person could bring a lawsuit against the negligent driver (called no-fault thresholds).
Over time there have been law changes, but the heart of the No-Fault Act is intact.
Source of Coverage – What No-Fault Policy Will Cover You?
The Minnesota No-Fault Act provides that all vehicle owners are required to purchase no-fault insurance. In an individual unlawfully chooses not to insure their vehicle, they personally, and all other adult family members in their household, will potentially be barred from receiving no-fault benefits. A determination of which no-fault insurer is responsible for an individual’s health care provider treatments is very complicated.
A general rule is a person’s own vehicle, whether or not involved in the crash, will provide no-fault coverage. If you do not own a car, but live with a blood relative or marriage relative, their policy will cover you. If neither of these are options the car you are in will provide coverage. The last option is the Assigned Claims Plan which is free coverage for a person who does not own a non-insured vehicle, does not live with a relative who owns a non-insured vehicle and who was in a vehicle without insurance.
If you are a pedestrian hit by a vehicle, your no-fault coverage will be either your own policy (on your parked car), a resident relative, the car that hit you or assigned claims.
Maintenance And Use – The Injury Must Arise Out of Maintenance or Use of a Motor Vehicle
In addition to attaching onto a no-fault policy, the injured party must also show that the injury arose out of the maintenance or use of a motor vehicle. The Minnesota Supreme Court has outlined the following principles to determine if the injuries arose out of the maintenance or use of the motor vehicle.
- There must be a causal connection between the injury and use of the vehicle for transportation purposes, i.e., the vehicle must be more than just the site of the injury;
- The injury must be a natural ad reasonable consequence of the use of the vehicle; and
- If the cause of the injuries is ore properly included under general liability coverage, homeowner’s insurance coverage or workers’ compensation, a claim should be made under those policies rather than under the No-Fault Act policy.
Our attorneys will properly investigate the existence of a no-fault policy and analyze the law to see what you qualify for.
The following is a short list of cases our attorneys may utilize to determine your coverage:
- In Midwest Family Mut. Ins. Co. v. Krupe, 430 N.W.2d 856 (Minn. Ct. App. 1988), the Court determined that the injuries did not arise out of the maintenance or use of a motor vehicle when a tool broke while a person was repairing a tire.
- In Strand v. Illinois Farmers Ins. Co., 429 N.W.2d 266 (Minn. Ct. App. 1988), the Court determined the injuries arose of the maintenance or use of a motor vehicle when gasoline leaked from the automobile and ignited.
- In Kolkin v. American Family Ins. Co., 347 N.W.2d 538 (Minn. Ct. App. 1984), the Court determined the injuries did not arise out of the maintenance or use of a motor vehicle when an intoxicated person froze to death after being left in the car over night.
- In Nadeau v. Austin Mut. Ins. Co., 350 N.W.2d 368 (Minn. 1984), the Court determined a pedestrian injured while jumping out of the way of an oncoming vehicle, even though the vehicle did not contact the person, is entitled to no-fault benefits.
- Minn. Stat. § 65B.43, Subd. 3 states, “no-fault benefits will not be available for loading or unloading of a vehicle unless it occurs while occupying and entering or alighting from the motor vehicle.
- In Petrick v. Transport Ins. Co., 343 N.W.2d 876 (Minn. Ct. App. 1984), the Court determined no-fault coverage existed for a truck driver who slipped on oil while in the truck’s trailer during unloading.
- In Jorgenson v. Auto-Owners Ins. Co., 360 N.W.2d 397 (Minn. Ct. App. 1985), the Court determined no-fault coverage existed when a person was unloading a can filled with gasoline and faulty wiring in the trunk ignited the gasoline.
- In Brehm v. Illinois Farmers Ins. Co., 390 N.W.2d 475 (Minn. Ct. App. 1986), the Court determined no-fault coverage extended to an individual injured when he slipped on some oil while washing the windows of his car.
- In Barry v. Illinois Farmers Ins. Co., 386 N.W.2d 299 (Minn. Ct. App. 1986), the Court determined no-fault coverage extended to a woman who slipped on some ice when she was returning to her running vehicle after closing her garage door.
- In Marklund v. Farm Bureau Mutual Co., 400 N.W.2d 337 (Minn. 1987), the Court determined no-fault coverage is not extended to a person who slipped on ice after refueling his vehicle but before he had paid for the gasoline. The reason given by the Court for denial of no-fault coverage was the fact that the premise liability policy of the gas station should apply instead of the no-fault policy.
- In Nation Family Ins. Co. v. Boyer, 269 N.W.2d 10 (Minn. 1978), the Court determined no-fault coverage does not extend to persons injured as a result of an accidental firearm discharge in a vehicle.
- In Progressive Ins. Co. v. Hoekman, 359 N.W.2d 685 (Minn. Ct. App. 1984), the Court determined no-fault coverage does extend to a person injured when a garage door collapsed on him minutes after a vehicle had struck the garage door.
- In Hedlund v., Milwaukee Mut. Ins. Co., 373 N.W.2d 823 (Minn. Ct. App. 1985), the Court determined no-fault coverage extends to a party injured while attempting to jump start a tractor when using cables connected to a truck.
- In Holm v. Mutual Service Casualty Ins. Co., 261 N.W.2d 598 (Minn. 1977), the Court determined no-fault coverage does not extend to a person assaulted by a police officer following a high-speed chase.
Types of no-fault benefits
No-fault benefits are limited to economic loss resulting from an accident involving one or more cars or trucks. These are losses which have a readily determined dollar value, such as medical bills or wage loss; no-fault does not compensate general damage such as pain and suffering. The types of benefits available are:
- Medical Expense
This benefit is very broad, including all medical care, chiropractic , x-ray, optical, dental and rehabilitation services, as well as artificial limbs, prescription drugs, ambulance and all other reasonable transportation incurred in traveling to receive covered medical benefits including hospital, extended care and nursing services.
- Disability and Income Loss Benefits
These provide payment of 85% of the injured person’s loss of gross income, up to a $250.00 maximum per week. This includes the costs incurred by a self-employed person to hire substitute employees.
- Funeral and Burial Expenses
Reasonable funeral and burial expenses are covered up to $2,000.00
- Replacement Services and Loss
This provides replacement of services that the injured person would have performed not for income but for the personal benefit of the person or the person’s household. For example, if an injured person cannot mow the lawn or shovel snow due to his/her injuries, the no-fault carrier must pay the cost of hiring someone to perform this task. If the injured person had full time responsibility for providing care and maintenance of a home with or without children, the benefit is the reasonable value of such care, whether actual amounts have to be spent for those services or not. This benefit is limited to $200.00 per week and has a 7 days delay after the day of the crash.
- Survivor’s Economic Loss Benefits
The survivor of someone killed in a car accident may collect benefits for the monetary support provided by the decedent.
- Survivor’s Replacement Services Loss
This provides reimbursement for expenses incurred by surviving dependents in obtaining services the deceased would have provided, subject to a maximum of $200.00 per week.
Basic Insurance limits for no-fault coverage in Minnesota are $20,000.00 for medical expenses and $20,000.00 for income loss, replacement services loss, funeral expense loss, survivor’s economic loss and survivor’s replacement loss. These are separate limits, meaning a claimant is entitled to up to $20,000 in medical expenses and up to $20,000 of economic loss. However, the coverage cannot be combined. Thus, a person incurring more than $20000 of medical expenses cannot utilize some of the wage loss benefit to cover additional medical expenses, and the reverse is also true.
When you purchase insurance, you may elect to “stack” your policies for a nominal additional fee. Instead of $20,000 in medical, you would have $40,000. You must have multiple vehicles with the same insurance company to stack the policies.
Making a Claim for No-Fault Benefits
Any vehicle crash involving injuries should be immediately reported to the insurance companies for the involved vehicles. It is very important to identify the drivers of all vehicles involved in a collision, as well as their insurance companies. Minnesota law now requires all vehicle operators to carry insurance information in the vehicle. Thus, under most circumstances, it should be simple to determine the insurer for the vehicle. In the event that proper insurance identification information is not available, the police should be notified before the parties leave the scene of the collision.
The insurance company responsible for no-fault benefits will request an application for benefits, signed authorizations for medical and wage information and a list of current and part medical providers. An attorney should be consulted before forms are signed to ensure fairness in the information requested.
In most cases, your insurance company may ask for an “independent medical examination” or they may simply cut off benefits.
An Independent Medical Exam (Adverse Exam or IME) is a medical evaluation scheduled by the no-fault insurance company. They are real doctors but they are chosen because of certain opinions that tend to always be the same. The end result of these exams is the insurance company concluding you are not hurt or your injuries were caused by something other than a car accident or injury.
IME doctors are professionals who are often called to testify at trial and make great witnesses. Your law firm needs to be familiar with these types of doctors so a cross examination can be effective. The attorneys at Walker Law Office, P.A. keep extensive histories of these doctors and have prior reports to show bias. We also keep track of their income to help juries understand the financial windfall some of these professional doctors are getting.
Termination of Benefits and Arbitration
After obtaining an opinion from their doctor recommending no further treatment or limitation of treatment, the no-fault insurer will send a letter to the insured indicating the limitation of treatment or that they refuse to pay for any future benefits.
Many people hire attorneys at this point because they disagree with the IME doctor. An effective attorney may be able to negotiate payment of more bills or can file for a no-fault arbitration.
A no-fault arbitration is an informal legal proceeding used to get past wage and medical bills paid and to reinstate no-fault benefits. A neutral party is selected by your attorney and the insurance attorney to serve as a judge with the hearing done in a law office. Attorneys at Walker Law Office, P.A. have done hundreds of no-fault arbitrations and have the expertise to get your bills paid.
This fact would be investigated by our firm. The driver may not have insurance, but the owner may. If no one has insurance coverage, you are eligible to receive compensation for your injuries with an uninsured motorist claim under your own insurance. This coverage is much like the “no-fault” coverage explained in answer #2. Uninsured coverage is something you already pay for with your premiums and is mandatory in Minnesota. Using the uninsured coverage will not raise your premiums.
If you did not obtain auto insurance on your own vehicle, our attorneys may be able to find other sources of coverage. You may be eligible for assigned claims, which is sponsored by the State of Minnesota. Assigned claims has specific eligibility requirements that our lawyers can best explain over the phone.
If you own a car or live with a relative who owns a car without insurance, you are not eligible for assigned claims. Instead you will have to wait until your case is settled or won at trial to force the at fault party to pay. There was controversy in this area until the Munoz case, clarified that the at fault party is ultimately responsible for all unpaid bills and wage loss, even in the injured party broke the law by not having auto insurance. We will gladly provide a copy of the Munoz case to you if you email us.
Thresholds for Bodily Injury Claim in the No-Fault Setting
In addition to working with the no-fault insurance company, most cases will have a different insurance company on the bodily injury side.
The bodily injury insurer may be legally pursued to pay for unpaid medical expenses and wage loss, permanent injury or pain and suffering. In order for an injured party to bring a claim against the bodily injury insurer, the injured party must prove three elements:
- That another person was more negligent than him/herself in causing the accident (more than 51%);
- That the tort threshold has been reached; and
- The claim must be brought within the statute of limitations.
The four elements necessary to establish negligence are duty, breach of the duty, causation and injury. Minnesota liability laws have established the basic duty of all drivers is the duty of ordinary or reasonable care. The essential question asked is, “What would a reasonable driver do under similar circumstances?” The driver’s negligence must be the cause of the injuries sustained.
The second essential element an injured party must show is that they have reached the threshold. The Minnesota Motor Vehicle Liability Law has established that in order to bring a claim, one of the five tort thresholds must be reached by the plaintiff.
- That a permanent disability has resulted from the motor vehicle accident;
- That a permanent disfigurement has resulted from the motor vehicle accident;
- Death has occurred from the crash;
- That the motor vehicle accident has resulted in over sixty (60) days of lost work time; or
- The cost of the medical and chiropractic treatment is in excess of $4,000.00. (This does not include diagnostic x-rays or MRIs.)
If one of these five conditions occurs, the tort threshold has been reached ad a potential claim arises against the bodily injury insurer of the negligent driver.
With an attorney’s help, most no-fault claims proceed swiftly and without difficulty. For more information on no fault issues and a free consultation with our experienced and professional staff, call Walker Law Office, P.A. at (612) 821-0094, (214) 550-3333 or email firstname.lastname@example.org.