Two sources of payment
Your own no-fault insurer pays allowable expenses: reasonable charges for reasonably necessary products, services and accommodations for your care, recovery or rehabilitation (MCL 500.3107(1)(a)). The at-fault driver is responsible for non-economic damages and for economic losses above what PIP pays (MCL 500.3135). A spinal cord injury that causes paralysis or lasting loss of function meets the serious impairment threshold in nearly every case; the dispute is usually about the cost of future care and how to pay it.
What PIP pays for after a spinal cord injury
- Acute hospital care, surgery and inpatient rehabilitation
- Ongoing physical and occupational therapy, physiatry, urology and wound care
- Attendant care at home, from agencies or family (family care capped at 56 hours per week unless an exception applies)
- Wheelchairs, lifts, hospital beds, bowel and bladder supplies and other equipment
- Home modifications reasonably necessary because of the injury, such as ramps, widened doors and accessible bathrooms
- Vehicle accessibility modifications, but not the base price of a vehicle (Admire v Auto-Owners, 2013)
- Medical mileage and transportation to appointments
- Wage loss for up to three years and household help up to $20 a day
Your PIP coverage level decides how long PIP lasts
Since July 2, 2020, Michigan drivers choose a PIP medical limit: unlimited, $500,000, $250,000, or $50,000 for qualifying Medicaid enrollees, and some people with Medicare Parts A and B have opted out. A spinal cord injury can exhaust a $250,000 or $500,000 limit quickly. With unlimited coverage, the Michigan Catastrophic Claims Association reimburses your insurer for losses above its retention, which is how lifetime benefits are funded; see the MCCA.
If you were covered by a policy issued before June 11, 2019, the Michigan Supreme Court held in Andary v USAA (July 31, 2023) that the 2019 cuts do not apply to your claim. See Andary explained.
The claim against the at-fault driver
When PIP runs out, MCL 500.3135(3)(c) lets you claim future allowable expenses above your PIP limit, and lost income above the monthly cap or after three years, from the at-fault driver. If you opted out of PIP medical coverage, that claim has no PIP-based limit. A life care plan, prepared by a qualified planner with your treating physicians, is usually how the cost of decades of care is proven. See excess economic damages.
The size of a spinal cord injury claim often exceeds the driver’s bodily injury limit, which is $250,000 per person by default and can be as low as $50,000. Identifying every policy, including owner, employer, commercial and your own underinsured coverage, is often the most important early work. See how much insurance the other driver has.
Common disputes with the insurer
- Hours of attendant care and the rate paid for it
- Whether a home modification is reasonably necessary or an ordinary household expense
- Equipment upgrades and replacement schedules
- Reimbursement under the fee schedule, which limits what many providers are paid and can affect access to care
Keep the one-year PIP rule in view. You cannot recover PIP benefits in a lawsuit for any expense incurred more than one year before the suit is filed (MCL 500.3145(2)), subject to tolling while a specific claim awaits a formal denial. Long-term claims lose money when unpaid bills age past that line.
Sources: MCL 500.3107(1)(a); MCL 500.3107c; MCL 500.3107d; MCL 500.3157(10); MCL 500.3104; MCL 500.3135(3)(c); MCL 500.3145; Admire v Auto-Owners Ins Co, 494 Mich 10 (2013); Andary v USAA (Mich, July 31, 2023).
Questions people ask us
Does Michigan no-fault pay for a wheelchair-accessible van?
PIP pays for the accessibility modifications as allowable expenses, but not the base price of the vehicle. The Michigan Supreme Court held in Admire v Auto-Owners (2013) that the base vehicle is an ordinary transportation expense.
What happens when my PIP limit runs out after a spinal cord injury?
Medical and care costs above your PIP limit can be claimed from the at-fault driver as excess economic damages. Collecting depends on the driver’s insurance, other available policies and your own underinsured motorist coverage.
Can my family be paid to care for me?
Yes. Attendant care provided by family members is an allowable expense, but family-provided care is capped at 56 hours per week under MCL 500.3157(10) unless an exception applies. Care from an agency is not subject to that cap.
