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Miller & Tischler, P.C. 

28470 W. 13 Mile Rd. Ste. 300
 
Farmington Hills, MI 48334
(248) 945-1040
www.millertischler.com  

  

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No-Fault News

  


 

LONG DREADED CHANGES TO THE NO-FAULT LAW 
FINALLY ARRIVE
   
To our friends of many years: we have long worked together under our wonderful Michigan no-fault auto insurance law. As we all know by now, that law is changed dramatically. Many of the changes will be damaging to those who have worked so long in the service of the catastrophically injured.  You have turned to us in troubled times before and we continue to be here to analyze the new law and answer questions. We continue to digest the malignant new law. There is so much to discuss but so as not to overwhelm, here are some of the major "low" lights of the new law: 

1.  Choice of Insurance Limits/Caps.   As you know, currently there is no choice, all must purchase the wonderful unlimited no-fault coverage. The new law provides for 5 options, though not everyone will be eligible for all 5. Here are the options:

A. No coverage so long as you have qualified health coverage, including Medicare.  
B.  $50,000 if you are Medicaid enrolled.  
C.  $250,000. 
D. $500,000. 
E. Unlimited.  

The effective date for these new changes is  July 1, 2020 . That is, people will be able to make their choices as of July 1, 2020. Until then, we will be governed by the existing lifetime coverages.
 
2.  Fee schedules. Effective July 1, 2021. In addition to the Medicare based 190-250% fee schedules for various hospitals, there are additional limitations for those who provide services that are not Medicare covered. This includes residential rehabilitation programs for brain injured people. These fee schedules reduce payment down to 55% from your 2019 rates. There's no way to sugar coat this. We expect this fee schedule to be ruinous, an industry destroyer and a job killer.

3.  Insurance reforms.   There are mandated rate reductions for your PIP coverage that are dependent on the coverage ("cap") that you elect.  These range from 10% if you select the unlimited coverage, down to 45% if you qualify for and select the Medicaid coverage, down to ZERO if you qualify to opt out of coverage altogether. At best, these rate reductions are only mandated for 8 years. However, there are a number of serious problems with these rate reductions. There are several "escape" clauses that appear to allow insurers to avoid reduced premiums altogether and insurers can apply to the Department of Insurance and Financial Services (DIFS) to abate the rate reductions.  The rate reductions ONLY apply to PIP coverage and thus other lines of insurance (bodily injury, comprehensive, etc) can be increased.  Incredibly, we are already seeing insurers raise rates NOW, in anticipation of expected revenue loss when the new law goes into effect. We also anticipate insurers raising rates for other auto coverages (e.g., collision/comprehensive) to make up for this loss. Rate setting changes are included such that specific kinds of rating factors are disallowed (i.e., age, race, gender, marital status, credit score, zip code) and cannot be used as factors for determining your rate.  That said, these changes are illusory given insurers cannot use zip codes but can create "territories" and rate by territory; insurers cannot use credit scores but can use "credit history." 

4.   Priority issues with resulting coverage changes. Examples:

A.   Uninsured pedestrians continue to claim from the insurer of the vehicle that hit them.  They will be subject to the coverage limitations chosen by the vehicle owner.
B.    Uninsured pedestrians who are hit by uninsured vehicles (or by hit and run vehicles) will claim from the Assigned Claims Plan at the statutory mandated level of $250k.
C.  Motorcyclists. Motorcyclists will continue to claim from the insurer of the vehicle that hit  them. As with uninsured pedestrians, the motorcyclist will claim at the level maintained by the vehicle owner.

5.   Miscellaneous important changes.

A.     Covenant fix.  As we all well know, the Supreme Court's decision in Covenant v State Farm in May 2017 took away service provider rights of direct action. For the last two years we've had to resort to getting assignments from our patients with a lot of delay, aggravation, expense, and uncertainty. The new law finally provides a "fix" for this and reinstates a right of direct action. For all dates of service on and after 5/30/19, no assignment is needed in order for the provider to have standing. This is one of the few good changes contained in the law.

B.   One year back rule. This is the stringent rule that bars claim for any bills incurred more than one year prior to the date on which the lawsuit was filed. The new law provides for an exception to the harshness of this rule: the one year back rule is "tolled", i.e., suspended from the time the claimant submits the claim until the claim is "formally denied" by the insurer. This overrules the Supreme Court's (2005) decision in the Devillers case and reinstates the older rule from the Lewis decision. Another good change in the law.

C.   Attorney fee changes. The new law has significant changes in our ability to obtain no-fault penalties for our clients. These will merit much more discussion. But one change that is worth talking about here is that t he ability of attorneys for an injured person to place liens on insurance benefit payments is now restricted: "An attorney advising or representing an injured person concerning a claim for payment of personal protection insurance benefits from an insurer shall not claim, file, or serve a lien for payment of a fee or fees until both of the following apply:
(A) a payment for the claim is authorized under this chapter.
(B) a payment for the claim is overdue under this chapter."
This will help prevent attorneys for injured persons from obstructing the flow of payment from insurer to service provider, especially when the payments are voluntary. This has been a huge problem under the old law.

D.   IME reform. Insurers have always been empowered to force claimants to undergo Insurance Medical Examinations (IMEs). These IME doctors make extraordinary incomes servicing the insurance industry instead of treating patients. As a result, they can be counted on to reach opinions that favor the insurers. The new law actually has an important reform: "During the year immediately preceding the examination, the examining physician must have devoted a majority of his or her professional time to either or both of the following: (i) The active clinical practice of medicine and, if subdivision (a) applies, the active clinical practice relevant to the specialty." This will immediately disqualify those doctors who have retired from the active practice of medicine to perform mostly or only IMEs.  

E.    Non-resident disqualification. Under the current law, many non-residents injured in Michigan motor vehicle accidents are still eligible for no-fault benefits, though some are disqualified. Under the new law, virtually all non-residents will be disqualified. The only exceptions will be those non-residents who owned a motor vehicle that was registered and insured in this state.

F.    Attendant Care.  Benefits for family provided attendant care are capped at 56 hours per week.  The attendant care cap is only related to care provided by a family member, a person living in the same household as the injured person, or a person who had a pre-accident business or social relationship with the injured person.  So, if a person requires more than 56 hours/week, a non-family member or agency is still available under the new law. Though this change is effective on July 1, 2021, it appears to apply to people who were injured before that effective date, and even going back to all currently injured people. There is no protection for those who were injured before this change in law.  This appears to violate the Constitution. We expect vigorous legal challenge to this aspect of the new law in particular. 

G.    Negligence policy limits. This coverage (also called Residual Bodily Injury, or RBI coverage) is separate from no-fault insurance. This coverage renders people who are at fault for their crashes financially responsible to their victims.  Since 1967 (even before the no-fault law!) all vehicle owners have been required to have a minimum liability coverage of $20,000/individual and $40,000/occurrence. There has never been an adjustment for inflation. The new law finally changes that. The new mandatory minimum liability coverage is now $250,000/$500,000. This is so unless the insured selects (after signing a state approved form) a lower limit down to $50,000/$100,000. There are a few of interesting implications to this (at least!):
  1. Under the old law, those injured through the fault of others were not permitted to sue the at-fault party for medical bills because all medical bills were covered by no-fault. However, under the new law, many people will choose lower no-fault coverage options. They may therefore have medical bills that are beyond the level of the no-fault option that they chose. Those people will now be able to sue for the "excess" medical bills; that is, the medical bills beyond their no-fault coverage option. This means that the higher RBI coverage will often be used to pay medical bills and/or other insurance carriers, rather than for the pain and suffering of the injured person. The injured person is not likely to be "made whole".
  2. Of course, those who are at fault for their own injuries, and who also have selected lower no-fault coverage limits, will have no recourse for the payment of medical bills beyond their no-fault limits.
  3. An interesting quirk in this part of the law relates to its effective date. The law as a whole is effective as of the date it was signed into law, May 30, 2019. This means that all persons who buy auto insurance after May 30th must have the new RBI coverage. The quirk is that the no-fault "PIP choice" option does not go into effect until July 1, 2020. This means that for the next 13 months, customers must buy the old unlimited no-fault, but insurers must sell the higher RBI limits. We anticipate that many insurers will not recognize this change and will challenge this effective date.
H.   Mini-tort increase. "Mini-tort" allows us to sue for collision damage to our cars, to the extent not covered by insurance, i.e., a deductible. The maximum that we could sue for used to be $1,000. Now the limit has been increased to $3,000.   
     
This is a summary of just some of this new law. As the law changes almost EVERYTHING there is much more. As always, we will keep you updated as we continue through this most troubling transition.


May, 2019

About Our Law Firm

   

Miller & Tischler, P.C.,  represents survivors of catastrophic brain and spinal injuries, their families and their professional service providers who are having difficulty pursuing their entitlement to receive No-Fault benefits for injuries sustained in motor vehicle accidents.  We help our clients understand how their No-Fault insurance may coordinate with other kinds of insurances they have whether it be private health insurance, Medicaid, Medicare, Workers' Compensation, or Veterans benefits. We assist our clients in learning about and obtaining all of the benefits to which they are entitled, whether they be individuals or service providers.  We also represent our clients with their auto negligence and wrongful death claims.  In other words, we are a full service auto No-Fault law firm. 

 

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