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IMPORTANT NO-FAULT UPDATE FOR MEDICAL SERVICE PROVIDERS AND MVA VICTIMS WHO ARE MINORS AND/OR SUSTAIN TRAUMATIC BRAIN INJURY

Yesterday, the Michigan Supreme Court did away with the long-held rule of protecting minors and the infirm in no-fault claims.   This legal issue has literally been a political ping-pong match with the balance of the court changing so much since 1999.   Since 1973 — when the no-fault act was enacted — it had always been the rule to protect this class of persons.

In 2006, however, AAA of Michigan got its request granted when the new court created a new rule that no longer protected minors and the infirm.  This directly impacted medical providers because their unpaid claims approaching one year were now at risk.  If not paid or a lawsuit filed, those unpaid claims became barred under no-fault.  Resorting to Medicare or Medicaid or writing off as bad debt were the only remaining options.

The old no-fault law protecting this class of persons was restored in 2010 when the U of M Hospital challenged the new rule.  But now the political ping pong has been hit back in Joseph v ACIA .  Once again, children, the infirm and their medical service providers must adhere to the one-year-back-rule for no-fault claims.

Authored by L. Page Graves

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A Camping Trailer No Longer Qualifies for No-Fault Insurance Coverage Once It Is Parked At The Camp-Site And Is Being Used As Accommodations

A family towed their camping trailer and set it up at their designated camp site.   After the camper was set up, one of the family members entered it to retrieve her glasses for reading.  While exiting the camper, she slipped on the steps and suffered bodily injury requiring medical care.  She applied for no-fault benefits under the no-fault law allowing coverage for no-fault benefits when one is injured while entering or exiting a parked motor vehicle.  MCL 500.3016(1)(c).  Her auto insurer denied her claim.  The Michigan Court of Appeals held that no-fault insurance did not apply reasoning that once the trailer was set up at the camp site, it no longer met the no-fault act’s definition of “trailer” (MCL 500.3101) and was not being used in its intended, transportational function.  Instead, it had converted into an accommodation and therefore, lost its nexus to being a motor vehicle under the act.  MCL 500.3105(1).

What this means for injured persons and medical providers:

This case is important to Michiganders and medical providers because of our proud heritage of recreating and enjoyment of our natural resources.  Camping is inherently part of our proud history.  Thus, this case importantly illustrates when a camping trailer loses its transportational function as a motor vehicle and becomes a stationary object not related to transportation.   And as a consequence, when no-fault insurance ceases to apply when injuries occur while using the camper as a camper.  In this instance, an injured person’s other health or accident medical coverage becomes primary.

(NOTE:  This case does not address the factual scenario of suffering bodily injury while setting up or breaking down the camper at the camp site.  More than likely, that type of fact setting would trigger no-fault liability because the camper is still in its/or is returning to its motor vehicle status.).

You can read this Opinion here.

Authored by L. Page Graves

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The battle to save Northern Michigan jobs and to preserve Michigan’s Auto No-fault Insurance resumes in 2012

In the 1992 and 1994 Michigan statewide elections, many remember the no-fault insurance industry’s ballot initiatives (Proposals C and D) which sought to dramatically convert Michigan’s auto no-fault insurance system into managed care funded by tax payers.  These efforst were resoundingly defeated by the people of Michigan.  See the Official election results here.

After 17 years of dormancy, the no-fault insurance industry viewed Michigan’s current political landscape and climate ripe again to institute its wish list to keep more premium dollars while shifting the burden of paying for accident victims’ medical care to the taxpayers, i.e., the state and federal treasury (Medicaid and Medicare).  Instead of asking and involving the people of Michigan directly at the ballot booth, the no-fault industry has used its political influence to package its desired goals into Michigan House Bill 4936.

For a thorough summary and analysis of the bill’s current devastating impact on patient and provider rights and our local economy, see Part 1, Part 2, Part 3, by Tim Smith, of Smith & Johnson, Attorneys, P.C.

To understand the real life impact that our current no-fault system provides for and how it would drastically change, meet and listen to Katie’s and Katlin’s stories about how our no-fault system has changed their lives for the better.

Fortunately for now, HB 4936 has stalled thanks primarily to the efforts of the Michigan Health & Hospital Association and the Brain Injury Association of Michigan who have educated Michigan legislators about this important issue.  Locally, Munson Medical Center has similarly contributed to educating the public and northern Michigan legislators (Senator Howard Walker and Representative Wayne Schmidt) too, on how changes in the bill will impact both injured persons and the local economy.

The battle is not over, however.  The effort to pass HB 4936 will begin again with the opening of the 2012 Michigan legislative session.  That is why your voice needs to be heard.   To assist you, Munson Medical Center has further created a sample letter for you to adopt and send to your local legislator here.  Make a difference and be heard: save people and save Northern Michigan jobs.

Authored by L. Page Graves

 

 

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You and Your Michigan No-Fault Car Insurance Rights

Michigan consumers are shocked when they learn that their auto insurer is not their advocate but instead is their primary adversary. Despite responsibly paying those costly premiums for mandatory no-fault insurance, injured accident victims are repeatedly dismayed when they learn that their very own no-fault insurer’s/adjuster’s strategic goal in handling their claim is to find (or many times, manufacture) an excuse to deny paying medical bills and lost wages. Michigan consumers need to know what their legal rights are and how to fight back to recover the benefits they paid for, for all those years without having to make a claim.

Your No-Fault Rights and What You Must Do to Protect Them

Introduction

This article provides you a general understanding of your rights under the Michigan No-Fault Insurance Law. It also provides you helpful suggestions to protect your potential benefit claims. This article is not all-inclusive because there are several exceptions and exclusions to No-Fault benefits which may be applicable to your claim or case; therefore, you should not rely on this post as legal advice.
Your Legal Rights
When you are involved in an automobile accident, you are entitled to certain benefits under the Michigan No-Fault Insurance law, regardless of fault. Your basic no-fault benefits potentially available to you include coverage for your medical expenses, wage loss, household services and survivor’s loss.

Your auto insurance company is required to pay these benefits to you within 30 days from when it receives reasonable proof of your claim, e.g., copies of your medical records validating your injury and temporary disability from work. If your insurance company does not pay your benefits after 30 days, it is also required to pay you 12% interest per annum as to each claim. If your auto insurer unreasonably denies your claim, you may also be able to recover reasonable attorneys fees.

Also recognize that because you were injured, you may have a separate legal claim against the at-fault driver, the owner of the vehicle involved and/or your own insurance company (if the at-fault driver was not insured) for fair compensation for your injury, disfigurement, pain and suffering.
What Should You Do If Your Auto Insurance Company Does Not Pay or
Denies Your Claim?

You must file a lawsuit within 12 months from the date that you incurred the particular expense not paid or denied; otherwise, you will lose all rights to be reimbursed for that particular expense. While you have 12 months to file a lawsuit, it is advisable to seek legal representation as soon as you are experiencing difficulty with your auto insurance company so that your lawsuit/claim is properly documented and preserved.

Your No-Fault Benefits

Medical expenses: all reasonable charges for products, services and accommodations reasonably necessary for your care, recovery or rehabilitation for injuries caused by the auto accident. These benefits are available to you for as long as you live. Common examples include hospital care, doctor visits, physical therapy, and prescriptions and family provided attendant care; related expenses may also include mileage to and from the medical care providers or handicapper modifications to your home and/or vehicle.

Importantly, your no-fault insurer cannot direct or dictate where, when or why you receive medical care. You should resist any attempt by it or a nurse case manager it assigns to you, to manage your care. And regarding nurse case managers, you can choose your own too and not accept the person “assigned to you”. The assigned case manager typically has one motivation and that is to please the no-fault insurer’s ultimate goal: reduce payments.

Wage loss: you are entitled to a minimum of 85% of your lost wages for time off due to your injuries caused by the auto accident. This benefit is available to you for up to 3 years from the date of the accident but is subject to a maximum monthly benefit, adjusted every year by the Michigan Insurance Bureau.

Replacement services: you are entitled up to $20.00 dollars a day for up to 3 years from the date of the accident, for reasonably incurred expenses for ordinary services performed by family or friends, that you traditionally performed but now cannot because of your injuries. Examples of such services include, but are not limited to, ordinary household tasks like mowing the lawn, cleaning, laundry, etc.

Survivor’s loss: the dependents (spouse and children) of a deceased individual who is killed in an automobile accident are entitled to a survivor=s loss benefit for up to 3 years from the date of the accident, subject to the same maximum monthly benefit formula applied to wage loss.
Coordinated Benefits & Setoffs
If you have other health or accident coverage through you employer or spouse, you may have purchased coordinated auto no-fault coverage for a lesser premium. If so, then your health coverage is primary and your auto coverage only pays for expense not covered by your primary health coverage.

Whether you have purchased coordinated no-fault coverage, your auto insurer is able to reduce your benefits that are available to you under state of federal law. A critical exception is that neither Medicare nor Medicaid is responsible for medical expenses when no-fault coverage is available. In that instance, no-fault is always primary.
What Should You Do?
A. If injured, immediately seek legal counsel regarding your potential claim for injury, disfigurement and suffering against the other driver.

B. Immediately file an Application for No-Fault Benefits with your insurance company. Failure to do so within 12 months of your automobile accident will prevent you from ever obtaining those benefits that you are entitled to receive.

C. Monthly, submit a claim letter for reimbursement of medical expenses, wage loss and replacement services. Always include your name, claim number and date of the accident. Always submit, if available, copies of your receipts, work releases or notes from your doctors or your employer, and summaries of household jobs done on your behalf (see below).

Medical Expenses:

A. Inform all medical providers (hospitals, doctors, etc.) of your insurance company name and claim number.
B. Submit copies of all receipts for medical expenses incurred (e.g., prescriptions) to your insurance company.
C. Keep a log or diary of all miles driven to and from medical providers.
D. Request letters from physicians/therapists recommending needed expenditures for rehabilitation devices or equipment.
E. If requested to submit to an independent medical exam set up by your insurance company, take a family member or friend with you and time the duration of the entire exam.

Wage loss:

A. Request letters or notes from your doctor(s) who have placed you on work restrictions with the applicable dates; diary or log each and every day missed from work (if an hourly employee, calculate hours for potential overtime loss).

Replacement services:

A. Orally or in writing agree to pay family members or friends up to $20.00 dollars a day for help around the home.
B. Diary or log all services performed on your behalf identifying the nature of the service performed and who performed it.
C. Request letters or notes from your doctor(s) who have placed you on general restrictions (e.g., no lifting).

Authored by L. Page Graves

 

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