Recently, in Centria Home Rehab., LLC v. Allstate Ins. Co., ____ Mich. App. _____, Mich Ct. App. Docket No. 363699, unpublished citation 2023 Mich. App. LEXIS 7744 (October 26, 2023), approved for publication December 14, 2023, the Michigan Court of appeals clarified that Covenant Med Ctr, Inc. v. State Farm Mut Auto Ins Co, 500 Mich. 191, 895 NW2d 490 (2017) still applies to automobile accidents that occurred prior to the No-Fault amendments which took place on June 11, 2019. Further, it also reaffirmed the language contained in MCL 500.3107 and long-established case law that allowable expenses must be “incurred” to be recoverable.In Covenant, the Michigan Supreme Court held that a medical provider did not have an independent cause of action against an insurance company for no-fault benefits it provided to its underlying patient. Therefore, under the prior no-fault act that was in place prior to the June 11, 2019 amendments the only way a medical provider had standing to maintain an independent cause of action against an insurance company was if they received an assignment of rights from its patient.In Andary v. USAA Cas. Ins. Co., 343 Mich. App. 1, (Mich Ct. App. 2022) the Michigan Court of Appeals held that the fee schedule provisions, and attendant care (56 per week cap) provisions contained in MCL 500.3157 did not apply to automobile accidents that occurred prior to the June 11, 2019, amendments. As part of the Michigan Court of Appeals reasoning they stated, “Given the presumption against retroactive application of s

First, the No Fault insurer has an obligation to pay for case manager “services” so long as they’re “reasonably necessary” to the auto accident victim’s “care, recovery or rehabilitation.” (MCL 500.3107(1)(a)) Second, there is nothing in the No Fault law granting insurers the right to dictate who medical care the providers will be, or to put their own opinion of what “services” are reasonably necessary to be covered and paid for by No Fault insurance benefits.‘Use our case manager or we won’t pay!’

In Agnone v. Home-Owners Insurance Co., No. 320196, the Michigan Court of Appeals held that the statutory limit on work loss benefits in MCL 500.3107(1)(b) applies to an injured person’s total combined income following an accident in addition to the work loss benefit. If the income an injured person actually earns for work performed during the relevant period after an accident exceeds the statutory maximum monthly benefit, the work loss benefit is reduced to zero.

In Bulletin 2018-13-INS, entitled “Disputes Between No-Fault Automobile Insurers and Health Care Providers,” which was issued on June 6, 2018, former Michigan Insurance Commissioner Patrick McPharlin gave official approval to auto insurers’ slash-and-pay approach to medical bills – putting medical providers on notice that the road to payment would be a bumpy one for the indefinite future. Specifically, the Bulletin stated: “Together, these sections of the Code [MCL 500.3107(1)(a), MCL 500.3157] ‘clearly indicate that an insurance carrier need pay no more than a reasonable charge and that a health care provider can charge no more than that.’

The Court of Appeals agreed. Under the Michigan No-Fault Act, insurance benefits are payable to cover lawfully rendered and reasonably necessary medical expenses for an insured, MCL 500.3107, subject to an exception, which provides, “[r]reimbursement or coverage for expenses within personal protection insurance coverage . . . is not required for any of the following: (b) A practice of chiropractic service, unless that service was included in the definition of practice of chiropractic under section 16401 of the public health code . . . as of January 1, 2009.” MCL 500.3107b(b).

Third, Spectrum failed to have Klein or those acting on her behalf to assume responsibility for the expenses in writing. As for Farm Bureau, the Court concluded that the insurer was not responsible for Klein’s medical expenses due to the fact that Klein did not “incur” the charges for her medical treatment as required by MCL 500.3107(1)(a). The Court reasoned, that because Klein had no legal responsibility for the medical expenses, those expenses were not “incurred” by Klein within the meaning of the statute.

IN THIS ISSUE:- Governor Appoints New Insurance CommissionerOn April 16, 2011, Michigan Governor Rick Snyder appointed Kevin Clinton as the new Commissioner of the Office of Financial and Insurance Regulation (“OFIR”).....- HHS Finalizes Rules on Health Insurance Rate Review ProcessOn May 19, 2011, the United States Department of Health and Human Services (“HHS”) released its final rule regarding the disclosure and review of unreasonable premium increases for health insurance issuers under Section 2794 of the Public Health Service Act (“PHS Act”), one of the changes made by the Patient Protection and Affordable Care Act.....- Conserverator's Fees are Compensable as "Allowable Expenses" Under the Michigan No Fault ActIn May v Auto Club Ins Ass’n, 2011 Mich App LEXIS 746 (April 26, 2011), the Michigan Court of Appeals held that a conservator’s fees were compensable as “allowable expenses” under the Michigan No Fault Act. MCL 500.3107(1)(a).....- Denial of Insured's Claim for Failure to Timely File Proof of Loss Upheld Despite Insured's Asserted Lack of AwarenessIn Durall v Home-Owners Ins Co, 2011 Mich App LEXIS 591 (March 29, 2011) (unpublished), the Michigan Court of Appeals held that an insurer’s (“Insurer”) denial of its insured’s (“Insured”) claim for benefits under a homeowner’s insurance policy was proper based upon the Insured’s failure to timely submit a sworn proof of loss statement (“POL”) as required by the policy, regardless of whether or not the Insured was aware of this requirement......- Federal Court Holds New York Life Agents are "Outside Salesmen" Despite Additional Qualifications; Wage Deduction Claims Continue The District Court for the Southern District of New York recently dismissed collective and putative class claims brought by commissionpaid financial products sales agents who sought to challenge the New York Life Insurance Company’s (the “Company”) classification of those agents as “outside s