How Michigan Automobile No-Fault Reforms Affect In-Home Care

WHAT IS IN-HOME ATTENDANT CARE?

Attendant care is assistance provided to accident victims whose injuries prevent them from independently performing basic daily living activities such as bathing and dressing. Services may also include taking a person to the doctor, dressing and wound care, assisting at mealtime and dispensing medication. Under Michigan No-Fault insurance law, attendant care benefits apply to services provided in the injured person’s residence rather than in a hospital or assisted living or rehabilitation facility. Some people may need help during certain hours such as morning or bedtime while others require round-the-clock help.  

DOES MICHIGAN NO-FAULT COVER IN-HOME ATTENDANT CARE PROVIDED BY A FAMILY MEMBER?

Attendant care is included in Personal Injury Protection (PIP). These benefits cover “allowable expenses consisting of reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person’s care, recovery, or rehabilitation.” This includes assistance provided in the home for seriously injured accident victims.

As of July 1, 2021, insurance companies are only required to pay for 56 hours a week of in-home attendant care provided by a family member or other personal acquaintance.

According to the Michigan No-Fault law, the 56-hour limit applies to caregivers in the following categories:

• An individual who is related to the injured person
• Someone who lives in the same household as the injured person
• An individual with whom the injured person had a business or social relationship before the injury

The limitations do not apply to in-home attendant care that has been provided prior to July 2, 2021. There are also no limits on in-home attendant care provided by an agency or other professional caregiver under the reform.  

However, insurance companies have the option of contracting with family members or personal acquaintances for in-home care exceeding 56 hours a week. While not required to do so, insurers may choose to exercise this option on a case-by-base basis.

DOES MY PIP MEDICAL COVERAGE LEVEL AFFECT ATTENDANT CARE BENEFITS?

It may. For those who opted to retain their lifetime unlimited Personal Injury Protection (PIP) medical coverage, the only limits on attendant care will be the 56-hour cap for services provided by a family member or personal acquaintance.

However, for individuals covered by No-Fault policies with one of the lesser PIP medical coverage options ($50,000 $250,000 or $500,000), attendant care will be reimbursed according to the limits of the policy.  If full-time attendant care is needed for several months or years, it is possible the individual may accrue devastating medical bills, for attendant care and other necessary treatment and services.

In these unfortunate instances, the victim may be able to seek recourse by filing suit against the party responsible for the accident. 

HOW CAN I MAKE SURE I’M COVERED FOR ATTENDANT CARE IF I’M INJURED IN AN AUTO ACCIDENT?

The only way to ensure coverage of all reasonable and necessary accident-related expenses is to choose a Michigan No-Fault policy with unlimited lifetime Personal Injury Protection (PIP) medical benefits. This coverage includes surgeries, hospitalization, doctor visits, prescriptions, rehabilitative therapy, durable medical equipment, home and vehicle modifications and in-home attendant care.

In addition, insurance companies are legally required to offer a rider that provides additional coverage for in-home attendant care that exceeds the insured person’s policy limit for Personal Injury Protection (PIP) medical coverage. Any vehicle owner who chooses a No-Fault policy with PIP medical benefits of $50,000, $250,000, or $500,000 may purchase a rider.

HOW DOES THE PROVIDER FEE SCHEDULE AFFECT MY ACCIDENT CLAIM?

Michigan’s No-Fault law caps family-provided in-home attendant care at 56 hours a week. This law requires certain health care providers to follow a medical fee schedule. In many cases, this pricing plan significantly reduces the fees health care providers can charge for accident-related medical services.

As of July 1, 2023, this law dictates that services covered by Medicare, doctors, hospitals and other providers and facilities can charge up to 190% of the amount Medicare allows for a given service. 

For services not covered by Medicare, such as in-home attendant care, facilities and medical professionals may bill 52.5% of the amount they charged on January 1, 2019, before the new laws took effect. 

As a result, several facilities, especially those that treat patients with serious spinal cord and traumatic brain injuries, have indicated they may not be able to survive a 45% fee reduction.

PUT OUR EXPERIENCED CAR ACCIDENT LAWYERS TO WORK FOR YOU TODAY

If you or a loved one is injured in an auto accident, we can help. Our knowledgeable legal team knows what it takes to build a winning case, and we have the expertise and resources to win the compensation you and your family deserve.

Car accident law is complicated, but finding the right car accident lawyer is simple.

Don’t let the legal clock run out. To get your case started, fill out the brief form below or contact us for a free, no-obligation remote consultation from the safety and comfort of your home.