What is Minnesota No-Fault Automobile Insurance?
Minnesota Law requires every owner of a motor vehicle which is required to be registered, licensed, or principally garaged in Minnesota to carry no-fault insurance. That insurance coverage provides for the payment of medical expenses, wage loss, mileage, replacement services, and possibly retraining benefits. No-Fault benefits are commonly referred to as "Personal Injury Protection" (PIP) Benefits.
Automobiles are required to carry at a minimum $20,000.00 for medical coverage per person and $20,000.00 for "other" losses. "Other" losses include income loss, replacement service loss, funeral expenses, survivor's economic loss, and survivor's replacement service loss. Some automobile policies provide for more than $20,000.00 for medical coverage if purchased by the patient. Patients may also have additional coverage if they have multiple vehicles and have purchased a "stacking" option.
What type of healthcare expenses are covered under Minnesota No-Fault Law?
Medical coverage includes reimbursement for all reasonable expenses for necessary medical, surgical, x-ray, optical, dental, chiropractic, and rehabilitative services, including prosthetic devices, prescription drugs, necessary ambulance and all other reasonable transportation expenses incurred in traveling to receive covered medical benefits, hospital, extended care and nursing services. Other medical benefits also include necessary remedial treatment and services recognized or permitted under the laws of Minnesota for an injured person who relies upon spiritual means through prayer alone for healing in accordance with that person's religious beliefs.
Who is entitled to Minnesota No-Fault Benefits?
Any person injured as a result of the operation, use or maintenance of a motor vehicle in the State of Minnesota may be eligible for no-fault benefits. In addition, Minnesota residents injured in other states but covered under a Minnesota no-fault insurance policy may also be eligible for no-fault health care coverage.
A patient would not be entitled to no-fault healthcare benefits if they owned an uninsured motor vehicle and are not covered under someone else's automobile insurance policy.
Whose automobile insurance carrier pays no-fault insurance benefits?
Minnesota law sets up a priority scheme for the payment of no-fault medical expense benefits. If the patient is a driver or occupant of a motor vehicle used in the business of transporting persons or property, the insurance covering that vehicle is primary. Such vehicles do not include commuter vans; vehicles used to transport children as part of a family or group or daycare program, vehicles being used to transport children to school or to a school sponsored activity, or taxis.f
In other cases, the patient must first look to the policy covering any cars that he or she owns or policies under which they are insureds. (Named insureds of someone they live with or if they live with a relative who owns a car and has insurance.)
If the above does not apply, the patient would then look to the automobile insurance covering the vehicle in which they were a passenger or driver.
If that does not apply, injured persons who are neither insureds nor drivers nor occupants of an involved motor vehicle can make a claim against any involved motor vehicle in the accident.
What if there is no automobile insurance applicable to the motor vehicle accident?
In certain cases, a patient can make a claim to the Minnesota Assigned Claims Plan. The Minnesota Assigned Claims plan is available to patients not covered by any applicable no-fault automobile insurance policies but who are injured arising out of the maintenance or use of a motor vehicle. The patient cannot make a claim against the assigned claims plan if they are an adult and owned a motor vehicle which is uninsured or if they live with an adult with an uninsured motor vehicle if the adults are married or dwell and function together as a family. Minors are always allowed to make a claim through the Assigned Claims Plan.
If a person is ineligible to received Minnesota no-fault benefits and he/she is not at fault for causing the motor vehicle accident, the patient would still be eligible to collect his/her medical expenses from the insurer for the at-fault driver. It is likely that the patient will need a lawyer to obtain reimbursement for his/her healthcare expenses.
What if the patient is covered by health insurance or workers' compensation insurance?
If the patient is in the course and scope of his employment at the time of his car accident, he would likely be covered by workers' compensation insurance. Workers' compensation insurance is primary over no-fault insurance. However, healthcare expenses not paid by workers' compensation may be payable by no-fault automobile insurance in certain cases.
No-Fault automobile insurance is primary over health insurance. However, if an automobile insurance company refuses to pay for treatment after the patient is examined by the insurance company doctor, the patient's bill can be submitted to the health insurance carrier in most cases.
How does a patient make a claim for no-fault health insurance benefits?
When a patient is involved in an automobile accident, he/she should contact his/her automobile insurance agent. The patient will need to fill out an application for benefits. Oftentimes there is a delay between notifying the agent and the patient actually receiving the application for benefits. The patient can certainly submit an application right away. In the Appendix are sample applications for benefits from some of the major automobile insurance carriers. There is also a generic form that can be used. The patient needs to be very careful filling out the application. Insurance carriers have been known to attempt to deny coverage when misrepresentations are made in the application. It may be prudent for your patient to contact a lawyer before filling out the application.
In addition, the insurance carrier often requires medical authorizations to obtain the patient's medical records. Carriers often suggest generic broadly written authorizations which allow the carrier to get any and all medical information pertaining to the patient. It is suggested that only limited medical authorizations be provided to the insurance carrier, specifically directed to each healthcare provider. In the Appendixf you will find an example of a sample limited insurance company medical authorization. Again, it may be prudent for your patient to consult with an attorney before signing any medical authorization.
Applications for no-fault benefits with appropriate authorizations should be mailed directly to the applicable insurance company. In the Appendixf you will find central mailing information for the major automobile insurance carriers in Minnesota. Prompt submission of the application and authorizations should insure prompt payment of the patient's medical bills.
How does the patient make a claim with the Minnesota Assigned Claims Plan?
If the patient does not qualify for coverage under an automobile insurance policy, he or she may be eligible to submit a claim to the Minnesota Assigned Claims Plan. In the Appendixf you will find an application for benefits through he assigned claims plan. The patient will also need to submit an Affidavit of No Insurance a sample of which can also found in the Appendixf.
What if my patient is disabled from employment?
Benefits referred to as "income loss benefits" are paid for the period of time in which a patient cannot work due to the accident. Income loss benefits provide compensation for 85% of a patient's loss of present and future gross income due to the inability to work caused by the accident; however, the maximum weekly income loss benefits is $250.00 per week. NOTE: If the patient has elected "stacking" the income loss benefits are increased (i.e. two vehicles stacked entitled the policy holder to a maximum weekly benefit of $500.00; three vehicles stacked to $750 per week, etc.)
You may be asked to provide a disability slip for a patient. In the Appendixf you will find a sample disability form. The patient must submit the disability form along with verification of his employment in order to be entitled to income loss benefits.
Self-employed patients are also entitled to income loss benefits. A self-employed person, who has costs which are incurred by hiring substitute employees to perform tasks which are necessary to maintain the income of the business and which normally are performed by the injured patient are reimbursable up to the maximum of $250.00 per week.
What if my patient is disabled from performing household duties because of his/her injuries?
Benefits referred to as replacement services benefits entitle an injured patient to benefits up to a maximum up to $200.00 per week. Replacement services include the cost of the value of replacing non-income producing household chores which were performed by the patient prior to the automobile accident. Such household chores include cleaning, lawn mowing, snow shoveling, babysitting, grocery shopping, etc.
If you have a patient who is disabled from certain household duties, you may be asked to fill out a disability slip for those duties. A sample disability form can be found in the Appendix.
What if I am asked by an attorney for a narrative report?
There is no one right way to do a narrative report. Doctors need only remember that any opinions expressed in their narrative report need only be expressed to a reasonable degree of medical certainty which simply means more likely true than not true. Narrative reports should address questions submitted by the attorney who is requesting the narrative. A sample narrative report can be found in the Appendix.
What if a patient's no-fault insurance benefits are terminated following an examination by an insurance company doctor?
Termination of benefits following an insurance company's doctor examination can be challenged. There are two ways to resolve the dispute. First, if the patient claim is for under $10,000.00, he or she may proceed with his/her dispute through arbitration. If the patient's claim is for over $10,000.00, the patient must proceed with his/her dispute through district court unless the insurance company agrees to arbitrate his/her dispute. In either case, the patient should consult with an experienced attorney if he or she wishes to contest the denial of no-fault benefits.
III. Sample Medical Authorization for No-Fault Insurer PDF
IV. Assigned Claims form Application for Benefits PDF
V. List of Mailing Address for Major No-Fault Insurers PDF
VI. Sample Disability Slip (Short Form) PDF
VII. Sample Disability Slip for Employment and Household Duties (Long Form) PDF
VIII. Sample Narrative Report PDF
IX. Replacement Services Form for Patient PDF