No-fault insurance

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In its broadest sense, no-fault insurance is any type of insurance contract under which the insured party is indemnified by their own insurance company for losses, regardless of the source of the cause of loss. In this sense, it is similar to first-party coverage. The term "no-fault" is most commonly used in the United States, Australia, and Canada when referring to state or provincial automobile insurance laws where a policyholder and their passengers are reimbursed by the policyholder's own insurance company without proof of fault, and are restricted in their right to seek recovery through the civil-justice system for losses caused by other parties.[ citation needed ] No-fault insurance has the goal of lowering premium costs by avoiding expensive litigation over the causes of the collision, while providing quick payments for injuries or loss of property. [1]

Contents

However, there are other forms of no-fault insurance. For example, in the United States, most workers' compensation funds typically are run as no-fault systems. This is supposed to simplify the injured worker's claim, since they do not need to prove that someone's negligence caused their illness or injuries. [2]

Mechanics of No-Fault Coverage

In no-fault states, if you find yourself in an accident, you typically turn to your own insurance company for compensation. The advantage is that you don’t need to prove the other driver’s fault to access benefits. Your insurer will cover your medical bills, lost wages, and other specified expenses.

No-Fault vs. Traditional Liability Coverage

To gain a better understanding of no-fault coverage, it’s essential to draw a comparison with traditional liability coverage. In a traditional liability system [3] , the insurance of the at-fault driver pays for the damages incurred by the other driver. However, in no-fault states, each driver’s insurance pays for their own injuries and losses.

Description

Motor Vehicle Insurance

No-fault systems generally exempt individuals from the usual liability for causing bodily injury if they do so in a car collision; when individuals purchase "liability" insurance under those regimes, the insurance covers bodily injury to the insured party and their passengers in a car collision, regardless of which party would be liable under ordinary legal tort rules. Some no-fault systems often grant "set" or "fixed" compensation for certain injuries regardless of the unique aspects of the injury or the injured party, but this is not universally true.

Proponents of no-fault insurance argue that automobile collisions are inevitable and that at-fault drivers are not necessarily higher risk and should not necessarily be punished; moreover, they note that the presence of liability insurance insulates reckless or negligent drivers from financial disincentives of litigation; also, uninsured motorists often can't and won't end up paying for their liability, so in regions with many uninsured motorists, no-fault systems may make more sense; furthermore, traditional insurance is regressive because drivers of inexpensive cars are liable for damage to any car, no matter its value, even though they themselves add only a small amount of liability to the pool with their less valuable cars.

Critics of no-fault argue that dangerous drivers not paying for the damage they cause encourages risky behavior, with only raised premiums and a higher risk rating as the potential consequence, and no jury awards or legal settlements. Detractors of no-fault also point out that legitimate victims with subtle handicaps find it difficult to seek recovery under no-fault. Another criticism is that some no-fault jurisdictions have among the highest automobile-insurance premiums in the country, but this may be more a matter of effect than cause: the financial savings from no-fault may simply make it more popular in areas with higher automobile-collision risk, or high insurance rates may cause more drivers to go uninsured, increasing the attraction of a no-fault system.

Origins

The number of traffic accidents causing fatalities and debilitating injuries had become by the mid-1960s the source of a litigation explosion that was "straining (and in some areas overwhelming) the judicial machinery." [4] Much legal thinking in academia was devoted to the question of whether the tort system should be replaced with another method of allocating risks of loss from accidents. [5] Empirical analyses were published showing the financial impact of automobile accidents. [6] The first comprehensive legislative proposal was put forward by Professors Robert E. Keeton of Harvard Law School and Jeffrey O'Connell, then of the University of Illinois, in a law review article published in the Harvard Law Review, [7] which consisted of two chapters of the book that they would publish the following year. [8] The Keeton-O'Connell plan provided that all automobile owners would be required to purchase a new form of insurance, called "basic protection coverage," under which a victim has recourse for his net economic loss against the insurer of his own car, his host's car or, if the victim is a pedestrian, any car involved. Fault is not required to be shown except for of damages in excess of $10,000 for bodily injury, the deductible of $100 for bodily injury and property damage. Recoverable loss under this type of policy does not include pain and suffering and is reduced by damages recovered from other sources. The proposal generated immense discussion in legal and insurance publications with some concluding it was too "revolutionary." [4]

In 1967 Massachusetts state representative Michael Dukakis, a 1960 graduate of Harvard Law School, introduced a modified version of the Keeton-O'Connell plan in the Massachusetts legislature. The scheme was adopted in 1970. [9] The law was challenged in court for claimed violations of numerous state and federal constitutional provisions. The scheme was defended by the state attorney general and also Harvard Law School professors Archibald Cox and Philip Heymann in an amicus curiae brief. The Supreme Judicial Court of Massachusetts overruled the objections in a unanimous decision. [10] The decision opened the way for widespread adoption of no-fault automobile insurance schemes, a development that was encouraged by the federal Department of Transportation. [9]

Overview in United States

Most U.S. states have a "traditional tort" liability system for auto insurance in which recovery is governed by principles of provable negligence. However, twelve U.S. states and the Commonwealth territory of Puerto Rico require policyholders to operate under a "no-fault" scheme in which individuals injured in automobile collisions are limited in their ability to seek recovery from other drivers or vehicle owners involved in a collision. [11] An additional 8 states have an "add-on" system in which the insured party retains the right to sue. [11] In 2012, RAND Corporation published a study which found that costs were higher in no-fault systems. [12] In the case of economic (medical and wage-loss) damages, most no-fault systems permit injured parties to seek recovery only for damages that are not covered by available first-party insurance benefits. In the case of non-economic (pain-and-suffering) damages, most no-fault systems permit injured parties to seek compensation only in cases of exceptionally "serious" injury, which can be defined in either of two ways:

In terms of damages to vehicles and their contents, those claims are still based on fault. No-fault systems focus solely on issues of compensation for bodily injury, and such policies pay the medical bills for drivers and their companions no matter whose fault the collision was.

In three U.S. states – Kentucky, New Jersey, and Pennsylvania – policyholders are permitted to choose between traditional tort and no-fault recovery regimes. Under such systems, known as "choice" or "optional" no-fault, policyholders must select between "full tort” and "limited tort" (no-fault) options at the time the policy is written or renewed; once the policy terms are set forth an insured party may not change his/her mind without rewriting the policy. In both Kentucky and New Jersey, policyholders who do not make an affirmative choice in favor of either full tort or limited tort are assigned the no-fault option, while in Pennsylvania the full-tort option is the default. In states where there is a choice of coverage, most consumers choose traditional tort regimes because the cost of the no-fault regime is more expensive.

24 states originally enacted no-fault laws in some form between 1970 and 1975; several of them have repealed their no-fault laws over time. Colorado repealed its no-fault system in 2003. Florida's no-fault system sunsetted on 1 October 2007, but the Florida legislature passed a new no-fault law which took effect 1 January 2008.

Michigan

Michigan's no-fault system is relatively unique. Before 2019, drivers had to purchase personal injury protection insurance that included unlimited, lifetime medical coverage. While this system protected people with catastrophic injuries, many consumers complained about the high insurance premiums associated with this system. [13]

In 2019, the Michigan Legislature changed the state’s no-fault auto insurance law so that drivers will no longer be required to purchase unlimited medical coverage. [14] Instead, under the PIP Choice system that was enacted, drivers have the choice of selecting medical coverage with limits of $50,000 (for drivers on Medicaid), $250,000, $500,000 and unlimited. Drivers on Medicare may be eligible to forgo all No-Fault medical coverage.

The goal of the no-fault changes was to lower premiums for drivers and, thus, make car insurance more affordable. However, Michigan’s average annual auto insurance rates are still the highest in the country - and Detroit has the highest rates of any city in the U.S. [15] Additionally, Michigan's no-fault reforms reduced compensation to some caregivers, which made it difficult for some catastrophically injured crash victims to access care from their auto insurance policy. Health insurance also covers the care of accident victims if auto insurance is either not existent or doesn't have enough coverage to pay claims. [16]

In addition to loosening its coverage rules and changing compensation for caregivers, the 2019 laws also made widespread changes to medical reimbursement rates, commonly referred to as the "fee schedules." The law did not expressly address whether the new few schedules should be applied retroactively. In 2019, a group of stakeholders filed a lawsuit, arguing that the 2019 no-fault law's fee schedule should not be applied retroactively. [17] Attorneys have argued that the failure to include a "grandfather clause" in the 2019 law “punishes car accident victims and medical providers by leaving them subject to restrictions they never agreed to such as coverage limitations and a medical fee schedule whose reductions on reimbursement rates will deny them access to necessary medical care and treatment.” [18] As of January, 2023, the case was currently pending before the Michigan Supreme Court. [19]

US states and Canadian provinces with no-fault laws

See also

Related Research Articles

A tort is a civil wrong that causes a claimant to suffer loss or harm, resulting in legal liability for the person who commits the tortious act. Tort law can be contrasted with criminal law, which deals with criminal wrongs that are punishable by the state. While criminal law aims to punish individuals who commit crimes, tort law aims to compensate individuals who suffer harm as a result of the actions of others. Some wrongful acts, such as assault and battery, can result in both a civil lawsuit and a criminal prosecution in countries where the civil and criminal legal systems are separate. Tort law may also be contrasted with contract law, which provides civil remedies after breach of a duty that arises from a contract. Obligations in both tort and criminal law are more fundamental and are imposed regardless of whether the parties have a contract.

<span class="mw-page-title-main">Workers' compensation</span> Form of insurance

Workers' compensation or workers' comp is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence. The trade-off between assured, limited coverage and lack of recourse outside the worker compensation system is known as "the compensation bargain.” One of the problems that the compensation bargain solved is the problem of employers becoming insolvent as a result of high damage awards. The system of collective liability was created to prevent that and thus to ensure security of compensation to the workers.

Vehicle insurance is insurance for cars, trucks, motorcycles, and other road vehicles. Its primary use is to provide financial protection against physical damage or bodily injury resulting from traffic collisions and against liability that could also arise from incidents in a vehicle. Vehicle insurance may additionally offer financial protection against theft of the vehicle, and against damage to the vehicle sustained from events other than traffic collisions, such as keying, weather or natural disasters, and damage sustained by colliding with stationary objects. The specific terms of vehicle insurance vary with legal regulations in each region.

Liability insurance is a part of the general insurance system of risk financing to protect the purchaser from the risks of liabilities imposed by lawsuits and similar claims and protects the insured if the purchaser is sued for claims that come within the coverage of the insurance policy.

Personal injury protection (PIP) is an extension of car insurance available in some U.S. states that covers medical expenses and, in some cases, lost wages and other damages. PIP is sometimes referred to as "no-fault" coverage, because the statutes enacting it are generally known as no-fault laws, and PIP is designed to be paid without regard to "fault," or more properly, legal liability. That is, even if the person seeking PIP coverage caused the accident, they are entitled to make a claim under the PIP portion of their policy. "No-Fault" does not mean that insurance premium of the person making the claim will not increase. Typically a PIP claim is made by the insured driver to their own insurance company, however, there are several exceptions that allow persons who have been injured in an accident to make a PIP claim if they do not own a vehicle. The particular state law and policy language of the insurer should be reviewed to see what exceptions exist in that state.

<span class="mw-page-title-main">Personal injury</span> Legal term for an injury to a person

Personal injury is a legal term for an injury to the body, mind, or emotions, as opposed to an injury to property. In common law jurisdictions the term is most commonly used to refer to a type of tort lawsuit in which the person bringing the suit has suffered harm to their body or mind. Personal injury lawsuits are filed against the person or entity that caused the harm through negligence, gross negligence, reckless conduct, or intentional misconduct, and in some cases on the basis of strict liability. Different jurisdictions describe the damages in different ways, but damages typically include the injured person's medical bills, pain and suffering, and diminished quality of life.

A claims adjuster, desk adjuster, field adjuster, or general adjuster investigates insurance claims by interviewing the claimant and witnesses, consulting police and hospital records, and inspecting property damage to determine the extent of the insurance company's liability. Other claims adjusters who represent policyholders may aid in the preparation of an insurance claim.

<span class="mw-page-title-main">Insurance Corporation of British Columbia</span> Provincial crown corporation in British Columbia

The Insurance Corporation of British Columbia (ICBC) is a provincial Crown corporation in British Columbia providing insurance. ICBC was created in 1973 by the NDP government of Premier Dave Barrett.

An uninsured motorist clause is a provision commonly found in United States automobile insurance policies that provides for a driver to receive damages for any injury he or she receives from an uninsured, negligent driver. The owner of the policy pays a premium to the insurance company to include this clause. Although not exclusive, this coverage is typically added to an automobile insurance policy. In the event of a qualifying accident, the insurance company pays the difference between what the uninsured driver can pay and what the injured driver would be entitled to as if the uninsured motorist had proper insurance.

A car rental, hire car or car hire agency is a company that rents automobiles for short periods of time to the public, generally ranging from a few hours to a few weeks. It is often organized with numerous local branches, and primarily located near airports or busy city areas and often complemented by a website allowing online reservations.

<span class="mw-page-title-main">Tort reform</span> Legal reforms aimed at reducing tort litigation

Tort reform consists of changes in the civil justice system in common law countries that aim to reduce the ability of plaintiffs to bring tort litigation or to reduce damages they can receive. Such changes are generally justified under the grounds that litigation is an inefficient means to compensate plaintiffs; that tort law permits frivolous or otherwise undesirable litigation to crowd the court system; or that the fear of litigation can serve to curtail innovation, raise the cost of consumer goods or insurance premiums for suppliers of services, and increase legal costs for businesses. Tort reform has primarily been prominent in common law jurisdictions, where criticism of judge-made rules regarding tort actions manifests in calls for statutory reform by the legislature.

Public auto insurance is a government-owned and -operated system of compulsory automobile insurance used in the Canadian provinces of British Columbia, Saskatchewan, Manitoba, and Quebec. It is based on the idea that if motorists are compelled to purchase auto insurance by the government, the government ought to ensure motorists pay fair premiums and receive high-quality coverage. Governments across the country have used various insurance schemes from full tort to full no-fault in pursuit of that goal.

Atiyah's Accidents, Compensation and the Law (2006) is a legal text, which marked the first of Cambridge University Press's "Law in Context" series. It was originally authored by English legal scholar, Patrick Atiyah in 1970 and has been taken over by Professor Peter Cane since the 4th edition in 1987. The thrust of the book is that the law of tort should be abolished, especially as relates to the law on personal injuries, and should be replaced with a no fault state compensation system. Its arguments are in tune with the establishment in the 1970s of such a system in New Zealand, with the Accident Compensation Commission.

Diminished value or diminution in value are the terms generally used to describe the loss in a property's market value after it was damaged in an accident and repaired. Diminished value is most often associated with automobiles but it is applicable to other property of value including real estate or collectibles such as jewelry and artwork. If a property was damaged and repair failed to restore it to its original market value then said property has suffered diminished value.

Vehicle insurance in the United States is designed to cover the risk of financial liability or the loss of a motor vehicle that the owner may face if their vehicle is involved in a collision that results in property or physical damage. Most states require a motor vehicle owner to carry some minimum level of liability insurance. States that do not require the vehicle owner to carry car insurance include Virginia, where an uninsured motor vehicle fee may be paid to the state, New Hampshire, and Mississippi, which offers vehicle owners the option to post cash bonds. The privileges and immunities clause of Article IV of the U.S. Constitution protects the rights of citizens in each respective state when traveling to another. A motor vehicle owner typically pays insurers a monthly fee, often called an insurance premium. The insurance premium a motor vehicle owner pays is usually determined by a variety of factors including the type of covered vehicle, marital status, credit score, whether the driver rents or owns a home, the age and gender of any covered drivers, their driving history, and the location where the vehicle is primarily driven and stored. Most insurance companies will increase insurance premium rates based on these factors, and less frequently, offer discounts.

Full tort and limited tort automobile insurance options were instituted by the state of Pennsylvania in an attempt to decrease the number of pain and suffering lawsuits in Pennsylvania courts. Concerned about the high rates of automobile insurance, Pennsylvania enacted mandatory personal injury protection (PIP) insurance coverage in the attempt to reduce the number of lawsuits resulting from automobile accidents. PIP insurance covers the medical bills of drivers involved in an accident, regardless of who is at fault. The idea behind the creation of PIP insurance was that it would reduce the number of ‘pain and suffering’ or ‘loss’ lawsuits, thereby reducing insurance company payouts and ultimately reducing insurance premiums.

Jeffrey Thomas O'Connell was an American legal expert, professor, and attorney. In 1965, O'Connell and Harvard Law School professor Robert Keeton co-authored the book Basic Protection for the Traffic Victim: A Blueprint for Reforming Automobile Insurance, which created the theoretical underpinnings of no-fault law. His specialty was product liability, and he wrote numerous books about this, advocating no-fault insurance for automobiles and other products.

Increases in the use of autonomous car technologies are causing incremental shifts in the responsibility of driving, with the primary motivation of reducing the frequency of traffic collisions. Liability for incidents involving self-driving cars is a developing area of law and policy that will determine who is liable when a car causes physical damage to persons or property. As autonomous cars shift the responsibility of driving from humans to autonomous car technology, there is a need for existing liability laws to evolve to reasonably identify the appropriate remedies for damage and injury. As higher levels of autonomy are commercially introduced, the insurance industry stands to see higher proportions of commercial and product liability lines, while personal automobile insurance shrinks.

<span class="mw-page-title-main">Ontario Automobile Policy 1</span>

The Ontario Automobile Policy is a regulation under the Ontario Insurance Act enacted by the Parliament of Ontario to cover financial damages to persons and property after a car crash. All private companies registered to sell auto insurance in Ontario, are required to use the OAP for their private car insurance policy. The OAP is the legal contract that connects an Ontario driver with every Ontario based insurance company.

<span class="mw-page-title-main">Vehicle insurance in France</span> Compensation-based insurance for policyholder land vehicles in France

Vehicle insurance in France is an compensation-based insurance policy for terrestrial motor vehicles that are insured in France and circulate on French territory, as well as in the European Economic Area and the Green Card zone.

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