No-Fault Attendant Care and Reasonable Reimbursement

While the Michigan No-Fault Act was reformed in June of 2019, questions lingered as to payments stemming from losses that occurred before the change.

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Before the changes, provider reimbursement was only limited to reasonable and customary charges. There was also no cap on hours that families could charge for attendant care.

The reform introduced a fee schedule with limited reimbursement and caps on physician charges.

A recent case made it to the Court of Appeals. In the case, the plaintiffs were injured prior to the changes made to the No-Fault Act. They did not want their care to be subject to the fee schedule and limitations.

The Court held that the date of the accident determined whether or not payment needed to be pursuant to the No-Fault Act or the reformation.

This case will likely make its way to the Michigan Supreme Court.

However, as it stands, it has added to confusion for insurance carriers. Insurance carriers have been handling claims as though limitations were in place, no matter when the accident occurred.

Payors have been paying claims according to the fee schedule for the past three years, regardless of the accident date.

It is likely this decision will impact insurance carriers, medical providers, and attendant care agencies.

Experts hope that the Michigan Supreme Court will take this case quickly to provide guidance.

If dealing with injuries from an old accident, you may need to review the old No-Fault Act.

If you need help with your polices, compliance, training and more, contact Rickard & Associates today.

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