Supplying Proof of Loss to Insurance Companies

Supplying Proof of Loss to Insurance Companies
What Do I Need to Do For My Replacement Services Claim?
After a motor vehicle accident, individuals frequently tell us that they need help around the house due to the injuries sustained. These could be injuries to shoulders, neck, back, or these could be head injuries, injuries to legs, arms, hands, and others. For injuries that prevent someone from performing these tasks around or outside the home, it is important to note that under the no-fault act, an individual can only make a claim for services that they themselves could and did do BEFORE the accident, and that after the accident, they can’t do. This could be cooking, cleaning, yard work, child care and others. In that case, someone is entitled to up to $20 per day in reimbursement for services performed. MCL 500.3107(c) states someone is entitled to:
“Expenses not exceeding $20.00 per day, reasonably incurred in obtaining ordinary and necessary services in lieu of those that, if he or she had not been injured, an injured person would have performed during the first 3 years after the date of the accident, not for income but for the benefit of himself or herself or of his or her dependent.”
So again, this only applies for things that your injuries prevented the injured person from doing, not for something they never did in the first place. But also note that it is not for income, only reimbursement, and only up to $20.00 per day maximum. Further still, case law requires that at a bare minimum there be an expectation of payment for these services by the person performing. Therefore, it is always a good idea to promise to pay, and possibly even put in writing that the $20.00 per day will be paid to whoever is helping you, otherwise the benefit may not be compensable.
Finally, the benefit is also only compensable if reasonable proof is submitted to the insurance company. An attorney can help you provide the proper documentation of all this, but at a minimum, a doctor will have to disable the injured person from the activities and the individual that assists the injured person must make a record of the activities performed.
But filling out a calendar once a month may not be the best way to assert a claim. In fact, the person assisting the injured party should be filling out a form or keeping a record EVERY DAY. Why? Because small mistakes in the form could lead to an allegation of fraud in the claim, which could prevent both the household services provider and the the injured party themselves from collecting benefits. Therefore, it is a good idea for an entry to be made on a calendar or other record keeping documentation every day either that day or the day after to prevent mistakes from being made.
This necessity for accurate record keeping has become more and more important in a digital age where almost everything is verifiable. If you indicate you shoveled the snow, meteorological records (weather reports) including the amount of rainfall and snowfall is available for every day and easily accessible by investigators. Facebook and other social media accounts are monitored, and again, small mistakes can lead to allegations of fraud. For these reasons, it is EXTREMELY important to keep an accurate record of the services performed.
John T. Schroder
Attorney at Law
Law Offices of Joumana Kayrouz, PLLC
The information contained above and herein is for informational purposes only does not constitute legal advice nor form an attorney client relationship.


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