Opted Out of PIP Medical in Michigan? What Happens If You Are Hit Outside Your Car

Short answer: If you opted out of PIP medical coverage in Michigan because you have Medicare, the Michigan Assigned Claims Plan will not pay your medical bills when a car hits you while you are walking, biking or standing outside your vehicle. The Michigan Court of Appeals decided that question for the first time on October 15, 2026, in a published opinion, Van Heusen v Michigan Automobile Insurance Placement Facility (Docket No. 373182). Your medical bills go to Medicare first. What Medicare does not cover can be claimed from the at-fault driver, and Michigan law lets you claim those medical expenses without the usual PIP caps. The remaining parts of your own PIP policy still apply, and the one-year notice rule still applies to them.

Who can opt out of PIP medical in Michigan

Since the 2019 no-fault reform, a driver no longer has to buy unlimited lifetime medical coverage. For policies issued or renewed after July 1, 2020, MCL 500.3107d lets the named insured "elect to not maintain coverage" for PIP medical benefits if two things are true:

1. The named insured has Medicare Parts A and B. The statute calls this person a "qualified person."
2. The spouse and every relative living in the household have either qualified health coverage or PIP medical coverage from another auto insurer.

The election is broad. Under subsection (5) of the same statute, it applies to the named insured, the spouse, a relative of either living in the same household, "and any other person who would have had a right to claim personal protection insurance benefits under the policy but for the election."

The opt-out lowers the premium, and the choice is made on a selection form at purchase or renewal. Most people who sign it are thinking about a crash while they are driving. Few are thinking about being hit while crossing the street.

The opt-out removes only the medical part of PIP. The policy can still carry other PIP benefits, such as replacement services and survivor's loss. In Van Heusen, the policy kept both. If you want the tiers and the other choices explained, our Michigan PIP insurance guide walks through them.

Why this matters for older Michigan pedestrians

The people who can take the Medicare opt-out are, almost by definition, older. Older people are also hit as pedestrians at a rate that should get anyone's attention.

According to Michigan Traffic Crash Facts for 2024, 2,281 pedestrians were involved in 2,131 motor vehicle crashes in Michigan. Of them, 156 were killed and 1,809 were injured. Of the 156 pedestrians killed, 32 (20.5 percent) were 65 or older. Of the 1,809 injured, 199 were 65 or older.

Being "outside the car" is also not limited to walking. The facts in Van Heusen are a common scene: a rear-end crash, both drivers step out to look at the damage, and a third car plows into the stopped cars and pushes one of them into the people standing next to it. Cyclists, people loading groceries in a parking lot, a driver changing a flat on the shoulder: all of them can be hit while not an "occupant" of a vehicle.

What the Van Heusen ruling decided

A person hurt while not in a vehicle normally claims PIP through a specific route. MCL 500.3115 says such a person "shall claim personal protection insurance benefits under the assigned claims plan," except as provided in the section that sends people to their own household policy first.

The injured man in Van Heusen had opted out of PIP medical under the Medicare opt-out. He argued that because his own policy paid nothing for medical care, the Assigned Claims Plan should. The trial court agreed. The Court of Appeals reversed.

The court relied on the eligibility rules of the Assigned Claims Plan itself. Under MCL 500.3172(1), a person can claim through the plan only if, among other things, "no personal protection insurance is applicable to the injury" or none "can be identified." The court held that a policy with a medical opt-out is still a PIP policy. It still "applies to accidental bodily injury to the person named in the policy" under MCL 500.3114(1). So PIP insurance was "applicable to the injury," and the Assigned Claims Plan was closed to him.

The court also leaned on the purpose of the 2019 reform. In its words, letting people who opted out "in exchange for paying a lower premium to then claim benefits through the MACP for which they previously declined coverage, runs counter to the centrality of individual choice enshrined by the 2019 reform legislation."

Two points about the ruling are worth knowing:

• It closes a gap that was already closed for occupants. MCL 500.3114(4) already says, in so many words, that the Assigned Claims Plan route for injured occupants does not apply to someone who made the 3107d election. Van Heusen reaches the same result for pedestrians and other people outside a vehicle, through a different statute.
• It is binding but may not be final. A published Court of Appeals opinion binds trial courts across Michigan. The losing side can still ask the Michigan Supreme Court to hear the case. If you are affected, ask a lawyer whether that has happened before you rely on either outcome.

What still pays your medical bills

The ruling closes one door. It does not leave an injured person with nothing.

1. Medicare. Medicare becomes your primary source for hospital and doctor bills. That is the coverage you certified you had when you opted out. Medicare has its own deductibles, coinsurance and limits, and it does not pay for everything a serious crash injury can require, such as long-term custodial care at home or changes to the house itself. Medicare also has a right to be repaid from an injury recovery for what it paid, so any settlement has to account for it.
2. The at-fault driver. Michigan's tort exemption has an exception for economic loss. Under MCL 500.3135(3)(c), you can sue the at-fault driver for allowable expenses, work loss and survivor's loss beyond what PIP pays, "or without limit for allowable expenses if an election to not maintain that coverage was made under section 3107d." In plain terms: because you opted out, your unpaid medical expenses are claimable against the at-fault driver without the PIP caps. You do not have to meet the serious-impairment threshold for this economic claim.
3. The at-fault driver's policy limit. That claim is only as good as the coverage behind it. Since July 1, 2020, the default bodily injury liability policy limit in Michigan is $250,000 per person and $500,000 per crash, but many drivers chose lower limits, and some carry none. We look at the actual liability coverage before deciding what else to pursue, including any underinsured motorist coverage on your own policy. Our page on uninsured and underinsured motorist claims explains how that coverage works when it exists.
4. Pain and suffering. A separate claim for noneconomic damages against the at-fault driver is still available if your injury meets Michigan's serious-impairment threshold. That claim is not affected by your opt-out.

Whether a separate policy in your household that does carry medical coverage can pay is a harder question. The 3107d election reaches the spouse and relatives in the household, and the opt-out itself required them to have their own medical coverage. The answer turns on whose policy it is, who is named on it, and how the household is set up. It is one of the first things we check.

The deadlines that still apply

The opt-out does not change the clock on the PIP benefits you kept. Under MCL 500.3145(1), a lawsuit for PIP benefits must be filed within one year of the accident unless written notice of injury reaches the insurer within one year or the insurer has already paid something. Once notice is given, subsection (2) still limits recovery to losses incurred within one year before the suit is filed. That is the one-year-back rule.

So if you opted out and were hit outside your car:

1. Give written notice to your own auto insurer anyway, within one year. Replacement services and survivor's loss may still be payable under your policy.
2. Tell every provider to bill Medicare and keep every Medicare Summary Notice.
3. Get the crash report and the other driver's insurance information.
4. Keep a running list of costs Medicare did not pay: copays, equipment, help at home, mileage to appointments.
5. Do not sign anything from the other driver's insurer until you know how much coverage exists and what Medicare will claim back.

Our Michigan injury deadline calculator lays out the separate deadlines for a lawsuit against the at-fault driver.

Should you keep the opt-out?

This is a coverage decision, not a legal claim, and it is yours to make. Van Heusen changes the math. When you opted out, you may have assumed the Assigned Claims Plan was a safety net if you were hit as a pedestrian. After this ruling, it is not. Ask your agent three questions at your next renewal:

1. What would PIP medical cost at each coverage level, compared with the opt-out?
2. Does everyone in my household still meet the coverage condition the opt-out requires?
3. How much bodily injury liability and underinsured motorist coverage do I carry?

If you walk, bike or spend time on the shoulder of busy roads, the answer may be different than it was in 2020.

FAQ

Does Van Heusen apply if I was driving when I was hit? No new rule was needed for that case. A driver or passenger who made the 3107d election was already shut out of the Assigned Claims Plan by the text of MCL 500.3114(4). Van Heusen extends the same result to people outside a vehicle.

I opted out but my wife did not. Does her policy pay my medical bills? Possibly, but it is not automatic. Your election reaches household members, and the answer depends on the policies, who is named on them, and the household. Bring both declarations pages to a lawyer.

Does Medicare have to be paid back? Generally, yes. Medicare can recover what it paid for crash-related care from an injury settlement or judgment. A settlement that ignores Medicare's claim can come back on you.

Can I still sue the driver who hit me for my medical bills? Yes. MCL 500.3135(3)(c) allows a claim for allowable expenses without limit when the 3107d election was made. How much you can actually collect depends on the at-fault driver's insurance.

What if the driver who hit me fled or had no insurance? The Assigned Claims Plan medical route is closed under Van Heusen. Uninsured motorist coverage on your own policy, if you bought it, may help. Our pedestrian accident page explains how these claims work.

Talk to a Michigan no-fault lawyer

If you opted out of PIP medical and a car hit you while you were walking, biking or standing outside your vehicle, a free consultation can sort out four things quickly: which parts of your own policy still pay, how Medicare's claim works, what the at-fault driver's coverage is, and which deadlines are running. Our Michigan no-fault PIP claims practice handles exactly these coverage fights.

Call (313) 800-0000 or request a free consultation. We have offices in Detroit, Dearborn Heights and Marquette, and we speak English, Spanish and Arabic.