Michigan PIP Claim Denied or Cut Off: Deadlines and Next Steps

You were hurt in a Michigan crash, and now your own auto insurer has denied your PIP claim, stopped paying your bills or lost wages, or cut the hours of care your family provides. That’s a hard letter to get while you’re still healing.

The short answer: a denial or cutoff is often the start of a dispute, not the end of your claim, but the clock is short. To recover an unpaid bill or lost wages, you generally must sue within one year after that loss was incurred, though the clock can pause while a specific claim waits for a formal denial (MCL 500.3145). Overdue benefits earn 12% interest a year (MCL 500.3142). If a court finds the insurer unreasonably refused or delayed payment, the insurer also pays your lawyer’s reasonable fee (MCL 500.3148). This guide reflects Michigan law as of September 2026.

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Why do Michigan insurers deny or cut off PIP benefits?

PIP, short for personal protection insurance, is the no-fault coverage every Michigan auto policy must include (MCL 500.3101(2)). It pays for reasonably necessary medical care, some lost income and help at home after a crash, no matter who caused it (MCL 500.3105, 500.3107). New to how it works? Start with what Michigan no-fault PIP pays after the 2019 reform, or browse our vehicle accident guides.

Denial letters and explanations of benefits (EOBs) usually cite one of these reasons. Each one is answered differently.

Disputes over whether care is necessary or crash-related turn on medical evidence, which can be answered. It helps to know how insurers evaluate injury claims.

Injured before the 2019 reform?

For care after July 1, 2021, the 2019 reform capped paid in-home attendant care by family, household members and people you knew before the injury at 56 hours a week, and limited payment for care Medicare has no set rate for. In Andary v USAA Casualty Insurance Co (July 31, 2023), the Michigan Supreme Court held that neither limit (MCL 500.3157(7) and (10)) applies to people injured while covered by a policy issued before June 11, 2019. If your care was cut under those rules, have a lawyer review it.

What deadlines apply after a PIP denial?

Michigan’s no-fault deadlines are short, and they run from different dates. For every other injury deadline, see Michigan personal injury deadlines in one place.

The one-year notice rule

If the insurer never got written notice and never paid you PIP benefits, you can’t sue for them more than a year after the crash (MCL 500.3145(1)). The notice must give the claimant’s name and address and the injured person’s name, plus the time, place and nature of the injury (MCL 500.3145(4)). Keep a copy and proof of the date.

The one-year-back rule

After notice or a payment, you can sue any time within one year after the most recent expense or loss, but you can’t recover any loss incurred more than a year before you file (MCL 500.3145(2)). In effect, each unpaid bill has its own clock. If you sue on September 1, 2026, a therapy bill from June 2025 is generally barred, unless tolling applies.

The 2019 tolling rule

A 2019 amendment pauses, or tolls, the one-year-back rule’s time limits (not the one-year notice deadline) from the date you make a specific claim for payment until the insurer formally denies it. The pause doesn’t apply if you fail to pursue the claim with reasonable diligence (MCL 500.3145(3)).

Two cautions. A formal denial starts the clock running again, so treat a written denial as a deadline notice. And section 3145 doesn’t define a “formal” denial or “reasonable diligence,” so count from the date each loss was incurred and let a lawyer judge whether tolling can save older bills.

How fast does the insurer have to pay?

PIP benefits are payable as the loss accrues, meaning as bills come in and wages are lost (MCL 500.3142(1)). A benefit is overdue if it isn’t paid within 30 days after the insurer receives reasonable proof of the fact and amount of the loss, and that applies to any part of a claim you’ve proven (MCL 500.3142(2)). If a medical bill reaches the insurer more than 90 days after the care, the insurer gets 60 extra days (MCL 500.3142(3)), so ask your providers to bill promptly.

Overdue payments carry simple interest at 12% a year (MCL 500.3142(4)). A $2,000 bill paid six months after it became overdue would add about $120.

DIFS says your insurer must tell you, within 30 days of learning of the loss, what information it needs to handle your claim. If a claim stalls, ask in writing what is still missing.

Do I have to see the insurance company’s doctor?

Usually, yes. If your physical or mental condition matters to the claim, you must attend an exam by physicians when the insurer asks, and your policy can add reasonable terms for those exams (MCL 500.3151(1)). It’s often called an independent medical exam (IME).

The examining doctor must (MCL 500.3151(2)):

• Be licensed as a physician in Michigan or another state.
• If a specialist is treating you, practice the same specialty, and be board certified in it if your specialist is.
• In the year before the exam, have spent most of their professional time treating patients or teaching in an accredited medical school, residency or clinical research program (in that specialty, if the specialty rule applies).

Think the examiner doesn’t qualify? Raise it in writing before the exam.

The report. If you ask, the insurer must give you the written exam reports. But then the insurer can ask for your other reports on the same condition, your treating providers’ names and access to relevant records, and, for this claim, you waive any privilege over testimony from everyone else who has examined you, or later examines you, for that condition, including your own doctors (MCL 500.3152). Ask a lawyer first.

Skipping it. If you refuse, a court can treat your condition as the insurer describes it, bar your evidence, enter judgment against all or part of your claim, or make you pay the insurer’s attorney fees. It can’t order your arrest (MCL 500.3153).

At the exam. Bring a list of your medications and doctors, and answer honestly, without exaggerating or downplaying. Afterward, write down how long it lasted, what you were asked and which tests were done.

What is utilization review, and can I appeal it?

Utilization review is the insurer’s first look at whether the level and quality of care meet “medically accepted standards” (MCL 500.3157a(6)). It covers care provided after July 1, 2020 (Mich Admin Code, R 500.62). The insurer can require your provider to explain unusual care in writing. If the insurer then decides the provider overused care, ordered inappropriate care or charged an inappropriate amount, the provider can appeal to DIFS (MCL 500.3157a(4)-(5)).

• Only the provider can appeal. DIFS won’t accept the appeal form (FIS 2356) from an injured person, so ask your provider to file.
• The deadline is 90 days from the insurer’s decision, and late appeals aren’t accepted (R 500.65(1)).
• The timeline is set. DIFS notifies the insurer and you within 14 days of receiving the appeal, the insurer may reply within 21 days, and DIFS decides within 28 days after that, with one possible 28-day extension (R 500.65).
• You have no active role. DIFS says the notice you receive needs no action from you, and it shares the appeal’s status only with the provider and the insurer.
• If the provider wins, it is entitled to 12% interest on overdue payments (R 500.65(6)). A party unhappy with the order can seek review in circuit court (R 500.65(7)).

DIFS won’t use this process for coverage disputes, coordination with health insurance, billing and coding errors, or crashes not reported within a year. It also can’t review a dispute while you’re suing over PIP benefits, so talk with your providers about pending appeals before you file.

Insurer still saying no? Get a free case review. Four quick questions, no cost, no obligation.

How do I file a complaint with DIFS?

DIFS’s Office of Consumer Services investigates insurance complaints, including claims people think are being unfairly delayed or denied. It asks you to try your insurer or agent first. If that fails:

• File through DIFS’s auto insurance complaint page, or call 877-999-6442, Monday through Friday, 8 a.m. to 5 p.m. For auto insurance questions, DIFS also answers 833-ASK-DIFS (833-275-3437).
• Include the denial letter, claim number and key records. DIFS reviews a complaint based on what you send.
• DIFS asks the insurer for a written response, checks whether it’s doing what your policy and the law require, and helps you understand your options. You get copies of the correspondence and a letter explaining its findings.

Michigan’s insurance code treats some claim conduct as unfair when it’s a pattern, not an isolated incident, such as refusing to pay without a reasonable investigation or failing to promptly explain the basis for a denial (MCL 500.2026(1)(d), (n)).

A complaint isn’t a lawsuit, and nothing in MCL 500.3145 pauses the one-year deadlines while DIFS reviews it.

Will the insurer have to pay my lawyer?

Sometimes. A lawyer is entitled to a reasonable fee for representing you in a lawsuit over overdue PIP benefits. The fee is charged to the insurer, on top of the benefits recovered, if the court finds the insurer unreasonably refused to pay the claim or unreasonably delayed proper payment (MCL 500.3148(1)). The 12% interest rule has no such condition.

The rule cuts both ways. A court can make you pay the insurer’s attorney fees if your claim was in some respect fraudulent or so excessive that it had no reasonable foundation (MCL 500.3148(2)).

Ask any lawyer how their fee works in a PIP case, including how a fee award against the insurer affects what you pay, and get the agreement in writing. See how personal injury lawyers get paid.

What if your benefits ran out instead?

Some cutoffs are limits, not disputes: the policy’s PIP medical limit, or the end of three years of work loss and replacement services. Check two things:

• An attendant care rider. Insurers must offer a rider covering attendant care above the limit on policies with a $50,000, $250,000 or $500,000 limit (MCL 500.3107c(8)).
• A claim against the at-fault driver. You can sue the at-fault driver for medical and care costs, work loss and survivor’s loss above your PIP limits and beyond the three-year period (MCL 500.3135(3)(c)), generally within three years of the injury (MCL 600.5805(2)). Pain and suffering is a separate claim that requires death, a serious impairment of body function or permanent serious disfigurement (MCL 500.3135(1)).

See how a PIP claim and a lawsuit against the at-fault driver work together and Michigan’s serious impairment threshold.

What should you gather?

• The denial letter or EOB, and proof of when you received it.
• Your claim number, the adjuster’s name and a log of every call.
• The policy’s declarations page and any PIP coverage selection form, which shows the medical limit (MCL 500.3107c(2)).
• Every bill, with the date of care and the date it went to the insurer. These dates drive the payment and one-year rules.
• Medical records, work restrictions and prescriptions, especially any note from your doctor on why treatment is still needed.
• Proof of lost income: pay stubs, tax returns and any sworn earnings statement your employer gave the insurer (MCL 500.3158(1)).
• Logs of household help and attendant care: who helped, when and for how long.
• The exam appointment letter, the examining doctor’s name and your notes.

What to do next

1. Get the decision in writing and list your dates. Ask for the denial and its reason in writing. On one page, list the crash date, each unpaid bill or lost paycheck, when you sent it and the date of any written denial.
2. Keep your care on track. Follow your doctor’s advice and ask them to document why ongoing care is needed. If a bill was denied in utilization review, ask whether the provider will appeal within the 90 days.
3. Answer requests for proof. Ask exactly what’s missing, send it, and keep proof of what you sent and when.
4. Get a free case review before your oldest unpaid bill is a year old. Get a free case review or compare Michigan injury lawyers. Bring your date list and the denial letter, use these questions to ask a personal injury attorney, and get any fee agreement in writing.
5. File a DIFS complaint if the insurer won’t respond or explain. DIFS will ask the insurer for a written response, but your deadlines keep running.

What waiting can cost

• Unpaid bills can age out. A PIP lawsuit can’t recover losses incurred more than a year before it’s filed, unless tolling applies (MCL 500.3145(2)-(3)). Each month you wait can push another month of bills out of reach.
• Your provider’s appeal window closes 90 days after the insurer’s utilization review decision (R 500.65(1)).
• The at-fault driver claim has its own clock, generally three years from the injury (MCL 600.5805(2)).
• Details fade. Write down now who drove you to appointments, which days you needed help and what the exam doctor asked.

What a good outcome looks like

The insurer pays what it owes, with 12% interest on anything overdue, and your providers are paid for reasonably necessary care. If a court finds the refusal unreasonable, the insurer also pays your lawyer’s reasonable fee. If a limit ran out, a good outcome is a clear plan, with any claim against the at-fault driver filed on time. Either way, you decide with the facts and the dates in front of you. For the bigger picture, see our plain-English guide to Michigan personal injury law.

Updated September 24, 2026

This guide is general information, not legal advice, and laws change. For advice about your situation, talk to a lawyer licensed in your state. Reading this page or contacting us does not create an attorney-client relationship.