How Michigan Automobile No-Fault Reforms Affect In-Home Care
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Car accident victims who get in-home attendant care from a family member may see those benefits limited by a No-Fault rule that took effect July 1, 2021. Insurers generally must pay no more than 56 hours a week for family-provided attendant care.
The cap does not apply to care from a professional agency. Many injured people still prefer family caregivers they know and trust. Fifty-six hours a week is not enough for someone who needs around-the-clock help.
The reforms also limit what many medical providers can charge No-Fault insurers.
Here is how those rules can affect your accident claim.
Do You Have a Case?WHAT IS IN-HOME ATTENDANT CARE?
Attendant care is help with daily living when injuries make bathing, dressing, meals, medication or getting to the doctor unsafe to do alone. Under Michigan No-Fault, it is care in the injured person’s home, not in a hospital or rehab facility. Some people need help only at morning and bedtime. Others need 24-hour care.
DOES MICHIGAN NO-FAULT COVER IN-HOME ATTENDANT CARE PROVIDED BY A FAMILY MEMBER?
Attendant care is part of PIP “allowable expenses”: reasonable charges for reasonably necessary products, services and accommodations for care, recovery or rehabilitation.
As of July 1, 2021, insurers are generally required to pay only 56 hours a week of in-home attendant care from:
- A relative of the injured person
- Someone who lives in the same household
- Someone who had a business or social relationship with the injured person before the injury
The hourly cap does not apply to professional or agency caregivers. It also does not apply to family care billed for periods before July 2, 2021.
Insurers may contract with family members for more than 56 hours a week. They are not required to. That is a case-by-case decision.
DOES MY PIP MEDICAL COVERAGE LEVEL AFFECT ATTENDANT CARE BENEFITS?
It can. With unlimited PIP medical coverage, the main extra limit on family care is the 56-hour cap.
With $50,000, $250,000 or $500,000 PIP medical, attendant care counts against that cap along with other treatment. Long-term full-time care can exhaust the limit. You may then look to a claim against an at-fault driver, if the law allows.
HOW CAN I MAKE SURE I’M COVERED FOR ATTENDANT CARE IF I’M INJURED IN AN AUTO ACCIDENT?
The broadest protection is a policy with unlimited PIP medical benefits. That can include hospital care, therapy, equipment, home and vehicle modifications and attendant care, subject to the family-hour cap and medical necessity.
Insurers must also offer a rider for attendant care above a limited PIP medical cap. Anyone who chooses $50,000, $250,000 or $500,000 PIP medical may buy that rider. Ask your agent. See PIP medical options.
HOW DOES THE PROVIDER FEE SCHEDULE AFFECT MY ACCIDENT CLAIM?
MCL 500.3157 also limits what many providers can charge.
For services Medicare covers, charges are generally tied to a percentage of the Medicare amount (currently up to 190% of Medicare for many providers after the phase-in). For services Medicare does not cover, such as much attendant care, the statute uses a percentage of what the provider charged on January 1, 2019.
Those cuts have put pressure on some specialized rehab programs for spinal cord and brain injuries.
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