These benefits include coverage for:
- Medical Expenses. Includes chiropractic care, hospital expenses, ambulance service, physical therapy, prescriptions, transportation expenses to medical appointments, translation services for medical appointments, and almost any type of medical treatment that is related to the motor vehicle accident.
- Lost Wages. This includes money actually lost, even if you are self-employed. You need to provide the insurance company with documentation proving you had a loss of income and a note from the doctor stating you can not work. The benefit is usually limited to 85% of your weekly gross income with a cap of $500 per week. However, some policies may have higher limits, depending on the insurance coverage purchased.
- Replacement Services. The no-fault insurance company will reimburse you for the cost of having an outside company/person come into your home to perform the essential services that you are primarily responsible to perform, but are unable to do so as a result of your injuries. You need to have a note from your doctor setting your physical limitations, a log detailing the work performed, the person who performed the work, the amount of time it took the person to perform the work, and the amount of money charged for the work.
- Primary Homemaker Replacement Services. If you are primarily responsible for maintaining a home, and you are unable to do all, or part of your duties, the no-fault insurance company is responsible for reimbursing you the reasonable value of those services that you have not been able to perform. It is not necessary to actually pay someone to perform the tasks for you. You will need a note from a doctor detailing those tasks that you should avoid, as well as a chart of tasks that you were unable to perform, along with the amount of time you usually would spend on an average week. The benefit is limited to $200 per week.
- Retraining. If you are unable to return to your job and you have to get retrained to find a job that has a similar rate of pay, the no-fault insurance company is required to pay for the cost of the retraining. Of course, your inability to return to your job after an auto accident will likely be challenged by the insurance company. For that reason, you will need the opinion of your doctor, as to whether you will need retraining. The retraining benefit is part of the lost wages benefits, and is typically limited to $20,000. However, some policies may have higher limits, depending on the insurance coverage purchased.
Quite often, your insurance company will refuse to pay a benefit. In that case, their decision can be disputed through an alternative dispute method called arbitration. We routinely arbitrate no-fault claims in an effort to make the no-fault insurance company pay for the benefits that you are entitled to.
If the no-fault insurance company is not paying your bills, or if they have you visit a doctor that they choose (commonly called an independent medical exam or “IME”) you may need legal help to get the no-fault insurance company to pay your bills. Call Heller & Thyen, P.A. so we can help protect your benefits.