The following is a publication that will help an injured person obtain a basic understanding of the workings of the Minnesota No-Fault Act. Hopefully, with this understanding of your basic rights, you will be better able to protect yourself from a legal standpoint in your dealings with you insurance carrier. If you have any specific questions which have not been covered, please feel free to contact Palmer O'Dea Law Office. This summary of the Minnesota No-Fault Act provided for informational purposes only and is not to be considered legal advice. Consult an attorney before acting on any of information contained herein.
Injury to Person
Location of Accident
If the accident causing injury occurs in this state, every person suffering loss from injury arising out of the maintenance or use of a motor vehicle or as a result of being struck as a pedestrian by a motorcycle , has a right to basic economic loss benefits, i.e. medical expenses, wage loss, etc. No distinction is made between residents and non-residents. For all persons suffering loss from Minnesota automobile accidents, benefits will be payable. If one is insured under a Minnesota No-Fault automobile insurance policy, the policy provides coverage for accidents occurring outside the State of Minnesota, in the United States, United States possessions or Canada.
Motor Vehicle
In order for the Minnesota No-Fault Automobile Insurance Act to apply, a vehicle must be both subject to state registration laws and be self-propelled or a trailer attached to such a vehicle. To Act does not include motorcycles. Injuries suffered by a person while on, mounting or alighting from a motorcycle are specifically excluded from coverage under the Act. You should be aware, however, that no-fault insurance may be purchased as an optional coverage as opposed to a mandatory coverage for motorcycles.
Maintenance or Use of a Motor Vehicle
The Minnesota No-Fault Act does not apply to an injury unless the injury occurred in connection with the maintenance or use of a motor vehicle. Maintenance or use of a motor vehicle includes acts which are incident to the maintenance or use of such vehicle, including occupying, entering into and alighting from such vehicle. Maintenance or use of a motor vehicle does not include conduct within the course of a business or repairing, servicing or otherwise maintaining motor vehicles unless the conduct occurs off business premises.
Thus, the injury must be a natural and reasonable incident or consequence of the use of the vehicle. The vehicle must be more than the mere situs of the accident in that it must be an active accessory to the injury sustained.
Examples of maintenance or use of a motor vehicle would include the following:
1 . Injuring oneself when fueling and cleaning the vehicle.
2. Injuries caused by the use of an automobile jack.
No-Fault Benefits
The No-Fault Act provides for $40,000.00 of coverage for basic economic loss benefits, with $20,000.00 being allocated for medical expenses and $20,000.00 for other no-fault benefits, including income loss, replacement services, funeral expense loss, survivors economic loss, and survivors replacement services loss arising out of the injury to any one person.
Medical expense benefits include all reasonable expenses for necessary medical, surgical, x-ray, optical, dental and rehabilitation services. The Minnesota No-Fault Act specifically provides for inclusion of chiropractic care and treatment.
Obviously the care and treatment sought must be causally related to the motor vehicle.
The decision as to the form of medical care is left entirely to the injured person. The insurance company does not have any right to make a choice as to your treating physician.
As long as the treatments are reasonable and necessary to cure or relieve from the effects of the automobile accident, the insurance company remains responsible for payment up to the statutory maximum of $20,000.00.
In addition to the actual cost of treatment, the insured is entitled to the reasonable cost of transportation to and from treatment. Transportation costs include medical mileage which is typically reimbursed in the area of 37.5 cents per mile, cab fare, bus fare or other costs of transportation.
Disability and Income Loss
Disability and income loss benefits shall provide compensation for 85% of the injured person's loss of present and future gross income from inability to work proximately caused by the injury subject to a maximum of $250.00 per week. Loss of income includes the cost incurred by a self-employed person to hire substitute employees to perform tasks which are necessary to maintain the income of the injured person which are normally performed by the injured person and which cannot be performed because of the injury.
Inability to work is defined by the No-Fault Act as:
a) disability which prevents the injured person from engaging in any substantial gainful occupation or employment on a regular basis.
A partially disabled person who is unable to work full-time or return to the same type of work he or she performed prior to the injury has an inability to work within the meaning of the statute. If the injured person returns to employment and is unable by reason of the injury to work continuously, compensation for loss of income shall be reduced by the income received while the injured person is actually able to work. Income Loss Benefits are payable for loss of time from work while receiving reasonable and necessary chiropractic or medical treatment.
Replacement Services
Replacement service loss shall reimburse expenses reasonable incurred by or on behalf of the injured person in obtaining usual and necessary substitute services in lieu of those that had the injured person not been injured the injured person would have performed not for income but for direct personal benefit or for the benefit of the injured person's household.
If the injured person normally, as a full-time responsibility, provides care and maintenance of a home with or without children and by reason of the injury is unable to perform such services, then such person is entitled to the reasonable expenses incurred in obtaining substitute care and maintenance of the home.
These benefits are subject to a maximum of $200.00 per week. All replacement service loss incurred on the date of the injury and the first seven days after the injury are excluded in calculating the replacement service loss.
Rehabilitation
In appropriate cases the insurer is obligated to pay for the costs of retraining and rehabilitation of an injured person.
Funeral Expenses
If a person is killed in a motor vehicle accident, reasonable expenses for funeral and burial of such person not to exceed $2,000.00 are payable by the insurance company.
Survivors Economic Loss
In the event of death occurring within one year of the date of the accident, caused by the accident, survivors are entitled to a maximum of $200.00 per week to cover losses incurred after the insured's death for contributions of money or tangible things of economic value. This is not limited to wage or salary loss but also includes other tangible things of economic value.
Survivors Replacement Service Benefits
Beyond compensation for direct wage loss incurred by the death of an individual, services rendered for the household are also compensation under the No-Fault Act. These benefits are also subject to a maximum of $200.00 per week.
Payment of No-Fault Benefits
An insurance policy may prescribe a period of not less than 6 months after the date of the accident within which an insured must notify the insurer of the accident and the possibility of a claim for no-fault benefits. Failure to provide the notice will not render the person ineligible to be both subject to state registration laws and be self-propelled or a trailer attached to such a vehicle. The Act does not include motorcycles. Injuries suffered by a person while on, mounting or alighting from a motorcycle are specifically excluded from coverage under the Act.
Payment of Benefits
Benefits must be paid within 30 days of presentation to the insurer. A rejection of a claim must be made promptly and in writing by the insurance company. Overdue payments bear simple interest at the rate of 15% per annum.
Lapse in Treatment and Disability
An insurer is allowed to include a clause in its policy that provides that where a lapse occurs in the period of disability or in the medical treatment of a person for over a year, they may terminate their responsibility for future payments. Thus, it is very important for the insured to see to it that there is not a treatment gap in excess of one year. Thus, it would appear yearly checkups are a must in order to keep the insurance carrier responsible for future benefits.
Medical Examinations
The Minnesota No-Fault Act requires an injured person to submit to a medical examination at the insurance carrier's request. The examinations must be conducted within the city, town or statutory city of residence of the injured person. If there is no qualified physician to conduct the examination within such town of residence of the injured person, then such examination must take place at the closest proximity to the insured person's residence.
The statute only requires attendance at a physical examination by a physician of the insurance carrier's choice. Thus, the statute does not appear to give the insurance carrier the right to multiple examinations.
The insured is entitled to medical mileage for attending the examination and a copy of the report of the adverse examining physician.
Termination of Benefits
In many cases, the insurance carrier, based on the examination by the adverse examining physician, will terminate ongoing responsibility for payment of chiropractic or medical expenses and wage loss. Once this termination takes place, the insured has a right to file a claim for mandatory arbitration with the American Arbitration Association if the amount of the claim is $10,000.00 or less at the time of the filing of the arbitration. From a mechanical standpoint, the arbitration claim is initiated by filing a petition with the American Arbitration Association and a $60.00 filing fee. The American Arbitration Association will then provide the parties with a list of 4 lawyers who will act as arbitrators on a particular case. Each party is entitled to strike one of the lawyers from the list leaving one of the remaining lawyers to act as arbitrator. The arbitration hearing is in essence a mini-trial at which time an arbitrator will make a decision whether or not the termination of benefits by the insurer was justified and if not the amount of benefits the injured person is entitled to.
In the event the claim of the insured is over $10,000.00, an insurance company may properly refuse to arbitrate and therefore the insured is required to bring a direct action in district court against the insurance company for the benefits claimed.
Exclusions From Coverage Under the No-Fault Act
The Minnesota No-Fault Act excludes certain circumstances and injuries from coverage under the Act. They are as follows:
1 . Intentional injury;
2. Persons injured in the course of an official racing contest;
3. Vehicle owners who are uninsured.
The Right to Bring a Claim Against the Party Who Caused Your Injuries
When one is involved in a motor vehicle accident, they sustain losses other than economic losses covered under the Minnesota No-Fault Act. These include, pain and suffering, disability and loss of life style occasioned by the injuries. Since January 1, 1975, an injured person cannot bring claim against the party who caused such persons injuries for such pain and suffering, disability and change of life style, unless they meet one of four requirements. The 4 requirements are as follows:
1. Medical or chiropractic expenses in excess of $4,000.00;
2. Permanent injury;
3. Permanent disability;
4. Disability for more than 60 days.
In the event a person reaches one of these thresholds, then they do have a right to bring a claim against the party who caused their injuries in the motor vehicle accident. If the insured does not reach one of these thresholds, then they are limited to receiving the basic economic loss benefits which we have just gone though under the Minnesota No-Fault Act.
In regard to the permanent injury threshold, a permanent injury is one form which it is reasonably certain a person will not fully recover. The injury may improve or worsen, but it will continue to some degree throughout the person's life. From a practical perspective, treating chiropractors and physicians generally want to wait at least 9 to 12 months after an injury before they make a determination that the injury is in fact permanent. Thus, from a practical perspective it is important to wait at least the 9 to 12 month period before inquiring of your treating chiropractor or physician as to whether the injuries are in fact permanent.
Conclusion
The purpose of our discussion here was to provide the injured person with a basic understanding of the workings of the Minnesota No-Fault Act. Hopefully, with this understanding of your basic rights, you will be better able to protect yourself from a legal standpoint in your dealings with you insurance carrier. If you have any specific questions which have not been covered, please feel free to contact Palmer O'Dea Law Office.
The information on this web site has been prepared for you by Palmer O'Dea, L.L.C. for your information only and is not intended to constitute legal advice or create an attorney/client relationship between the viewers of this web page. No information on this web site should be relied on without first obtaining legal advice from an attorney who has knowledge of the specific facts and circumstances of the matter.