LANSING, Mich. — A published Michigan Court of Appeals ruling has closed a coverage-gap argument for drivers who used the Medicare personal-protection opt-out: they cannot turn to the state assigned claims plan for PIP medical benefits after a crash, even if they were outside their car when hurt.
The unanimous panel reversed a trial court and sent the case back for summary disposition in favor of the Michigan Automobile Insurance Placement Facility, which runs the assigned claims plan. The injured driver carried an Auto-Owners policy on a Honda CR-V but had used the Medicare medical waiver in MCL 500.3107d, based on his Part A and Part B enrollment.
After a December 2022 multi-car pileup left him with a broken leg and a pulmonary embolism while standing outside the vehicle, he sought benefits from the placement facility as a nonoccupant. MAIPF turned him down, arguing the Auto-Owners contract was still an identifiable PIP policy even after the medical piece was waived.
Judges held that a Medicare opt-out policy is still personal protection insurance under MCL 500.3101(1). Dropping the medical component does not erase the policy identity, so none of the four statutory doorways into the assigned claims plan under MCL 500.3172(1) opened. The court noted that while another statute expressly bars occupant opt-outers from the plan, silence in the nonoccupant section did not create a new eligibility path.
Insurers processing Medicare or qualified-health-coverage waivers now have a published guidepost: the assigned claims plan will not fill the medical hole when an identifiable PIP policy exists, including for pedestrians injured in the same crash chain.
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