Regulator claims some insurers do not meet no-fault law’s intent

Regulator claims some insurers do not meet no-fault law’s intent

On Behalf of | Oct 25, 2021 |

Michigan passed a no-fault auto reform law that took effect on July 2. But the director of Michigan’s Department of Insurance and Financial Services issued two bulletins in Oct. containing clarification of insurance companies’ responsibilities under this new law because some companies are not following that law’s intent.

Reforms

Under the new law, any medical service not covered under Medicare, including in-home caregivers and transportation to medical services, will be reimbursed at 55 percent of the 2019 reimbursement rate for those services. The reform also places a 56 hour per week limit on the number of hours that family members may provide.

In Michigan, there are approximately 18,000 people receiving medical benefits from their no-fault auto policies. Advocates for survivors of catastrophic motor vehicle accidents claim that the new law, however, makes it extremely difficult to find medical services they need to survive.

State issues two bulletins

The director of the state’s Department of Insurance and Financial Services issued a bulletin on Oct. 5. It notified insurance companies that they must timely reimburse care providers. The department also told insurers they must work in a concerted manner with care providers for a billing system to timely process reimbursements.

This notification also contained a description of insurance companies’ legal responsibilities and the penalties that could be imposed upon them for untimely payment of bills. Companies could face administrative action if, for example, they repeatedly reject invoices without offering to assist a medical provider.

The department issued another bulletin on Oct. 11. It contained a list of services that should not fall within the 55 percent reduced rate according to the department’s interpretation of this law. The director said that the modified fee schedule was not intended to apply to services that catastrophically injured accident victims need such as a modified van and home modifications.

More reforms sought

Advocates said that these bulletins were encouraging. However, they want Michigan lawmakers to consider more far-reaching corrections to the fee schedule.  These problems require a legislative remedy, according to advocates.

Submitting claims after a vehicle or pedestrian accident can be complicated and puzzling. An attorney can help you pursue your claims and rights to benefits.