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Denial letter worksheet

Got a letter denying or stopping your no-fault benefits? Print this page or keep it open, fill in what the letter says, and gather the records listed for its reason. It takes about ten minutes and you don’t send us anything.

A question about your own claim? Request a free case review or call 313.733.1204.

On this page
  1. 1. What the letter says
  2. 2. Match the reason, then gather its records
  3. 3. The dates that decide what can still be recovered
  4. 4. Questions to ask when you call
  5. A filled-in example (fictional)
  6. Questions people ask us

Short answer

After a Michigan no-fault denial, write down three dates: the date on the letter, the last payment, and each unpaid bill or month. Then match the letter’s reason to one of seven common reasons and gather the records for it. The dates matter because a lawsuit generally recovers only losses from the year before it is filed, with that clock paused between a specific claim and the insurer’s written denial (MCL 500.3145).

Or save it as a PDF from your browser’s print menu.

1. What the letter says

Fill this in from the letter itself. Leave blanks where the letter doesn’t say.

Insurer’s name
Claim number
Date printed on the letter
Date you received it
Date of the crash
Date of the insurer’s last payment

Which benefits stopped or were denied?

  • Medical bills
  • Lost wages
  • Attendant care
  • Household help (replacement services)
  • Mileage to appointments

2. Match the reason, then gather its records

A denial letter usually gives one reason. Find the one closest to yours and check off what you have. The full explanation of each is in the denial guide.

A. A doctor the insurer chose says I’m better, or that it isn’t from the crash

  • The exam report (ask the insurer for a copy)
  • Your treating doctors’ notes and any letter disagreeing with the report
  • A note of the exam date, how long it actually lasted, and who was in the room
  • Bills and services that went unpaid after the date of the letter

Read more about this reason

B. They say another insurer should pay

  • Every auto policy in your household, with declarations pages
  • Proof of where you lived on the crash date
  • Who owned and insured the vehicle you were in
  • Each letter you received, and the dates you notified each insurer

Read more about this reason

C. They paid, but less than I expected

  • Pay stubs, W-2s or tax returns for the year before the crash
  • Your employer’s wage verification form
  • Attendant care or household help logs, and the doctor’s written prescription for care
  • The insurer’s payment explanations

Read more about this reason

D. They say the treatment isn’t necessary, or they cut the bill

  • The explanation of benefits or denial for each bill
  • Your doctor’s orders and treatment plan
  • Any balance bill you received from a provider

Read more about this reason

E. They say I misrepresented something, or they’re canceling the policy

  • The rescission or fraud letter and its envelope
  • Your application and any renewal paperwork
  • Any premium refund check: don’t cash or deposit it before getting advice
  • Everything you told the insurer, in writing or recorded

Read more about this reason

F. They say I was too late

  • Anything showing when the insurer first heard about the crash: claim number, emails, the application
  • Records of any payment the insurer made
  • Dates of each bill and each denial

Read more about this reason

G. They haven’t paid or answered at all

  • Copies of what you sent and when (forms, bills, wage proof)
  • A log of calls, with dates and names
  • Any request the insurer made for more information

Read more about this reason

3. The dates that decide what can still be recovered

  • One-year-back rule. A lawsuit for no-fault benefits can generally recover only losses incurred in the year before it is filed. That period is paused from the time you submit a specific claim until the insurer formally denies it in writing; after the denial, it picks up where it stopped (MCL 500.3145). The longer a denial sits, the more unpaid dates can fall outside the window.
  • Overdue benefits. Benefits are overdue if they aren’t paid within 30 days after the insurer receives reasonable proof of the loss, and overdue benefits carry 12% interest a year (MCL 500.3142). If a court finds the insurer unreasonably refused or delayed payment, it can order the insurer to pay your attorney fees (MCL 500.3148). Neither is automatic.
Unpaid item (bill, month of wages, care log)Date of service or periodDate you sent itDenied on

Want every date calculated from your crash date? Use the deadline calculator.

4. Questions to ask when you call

  • Which of my unpaid bills or months are still inside the one-year window?
  • What record would answer the reason in this letter?
  • Should my doctor write anything, and what?
  • Is there a claim against the at-fault driver as well?
  • What does it cost if you take the case? (Injury cases: no attorney fee unless money is recovered; terms in writing.)

A filled-in example (fictional)

This example is made up to show how the worksheet is used. The person, insurer and dates are not real.

“Dana” receives a letter dated March 3 saying her wage-loss benefits will stop because the insurer’s doctor says she can return to work. Her last payment was February 20. She writes those dates in part 1, checks “Lost wages,” and picks reason A (the insurer’s doctor). She gathers the exam report, her surgeon’s note restricting her from lifting, and a note that the exam lasted about fifteen minutes. In part 3 she lists the March and April wage periods as unpaid. On the call, she asks whether her surgeon should write a letter answering the exam report.

Sources: MCL 500.3145, MCL 500.3142, MCL 500.3148. The reasons and records come from the firm’s denial guide. General information, not legal advice for your situation.

Questions people ask us

Do I need to send you the denial letter before calling?

No. Start with a call or the short form. If a lawyer needs the letter or records, the office will ask and give you a secure way to send them. This worksheet is for your own notes.

Why does the date on the letter matter?

A lawsuit for no-fault benefits can generally recover only losses from the year before it is filed. That period is paused from when you submit a specific claim until the insurer formally denies it in writing, then picks up where it stopped (MCL 500.3145). Each unpaid bill or month of wages has its own date.

Request a free case review

Three things are enough to start: your name, your phone number and what you need help with. Everything else is optional. Please don’t attach medical records or insurer letters yet. If we need them, we will ask and give you a secure way to send them.

Prefer to talk now? Call 313.733.1204.

Justin Grove, Michigan attorney since 2007 (P71253). One office: Woodward Avenue, Bloomfield Hills.

  1. Tell us what happened. By phone or this short form; there’s nothing to send yet.
  2. Justin reviews it with you. Which claims you may have, which insurer pays and your deadlines.
  3. You decide. If you hire the firm, the fee terms are in writing before you sign.
“Everyone at the Grove Law Firm was professional, knowledgeable and kind. I highly recommend this law firm.”
Ladaisha, client. Quoted on the firm’s previous website, date not recorded.

The review is free. No attorney fee unless money is recovered.

Example: 313-555-0147

Add details (optional) email, crash date, what happened, call language

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