A Comprehensive Guide to Michigan Car Insurance Attendant Care
Legally Reviewed and Edited by: Terry Cochran
When the new Michigan No-Fault reform was passed through the state legislature in May, there were quite a few changes made to the current No-Fault car accident and health care insurance laws. Among those changes was a change in attendant care or the care that is provided in the home by family members or friends in the home to someone who has suffered from injuries sustained in a car accident. An auto accident attorney at Cochran, Kroll & Associates, P.C. can help ensure your daily living needs after your brain injury or other personal injuries are taken care of with attendant care, even under the new laws.
If you are already receiving in-home attendant care, it’s essential to familiarize yourself with the new law and then prepare to fight it in court with your auto accident attorney. The new law does not provide information for those who are injured before taking effect in July 2021. If you’re concerned about losing your coverage or having it limited to only 56 hours per week, contact an auto accident attorney at our law firm.
What is attendant care?
Under Michigan law MCL Section 500.3107(1)(a), attendant care is defined as, “Allowable expenses consisting of all reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person’s care, recovery or rehabilitation.” The interpretation of “care” in this definition includes attendant care services.
Attendant care is assistance given to a person who has suffered injuries and can no longer attend to their own daily living needs. In auto accident cases, some injuries are so severe that they may leave an individual severely injured for several months, or even permanently disabled. The post car crash care provided to the injured person helps them take care of their basic daily needs. The services an attendant care provider gives to an injured person can include:
- medication administration and management
- using the restroom
- wound care
- financial management
- movement about the house, including from a bed to a wheelchair, or repositioning in a bed
- walking assistance
- meal preparation and feeding
- supervision of other care attendants and providers
- transportation services
- oversight of occupational and physical therapies
- communication management
- general monitoring and supervision
- household chores directly related to patient care, including laundry and light cleaning
- on-call/standby status
Under the previous Michigan No-Fault laws, the car accident victim’s No-Fault (Personal Injury Protection, or PIP) insurance would pick up the tab for attendant care up to 24 hours a day. Usually, these services are provided by a family member, friend, or someone living in the same household of the injured party, mainly because 24-hour care requires someone to be living with the victim or spending long hours at their home. Usually, it’s someone the victim can trust and feels comfortable with. Furthermore, attendant care provided by family and friends is much cheaper than care provided by agencies.
In-home attendant care, which has been changed by the new No-Fault laws, defines in-home attendant care as someone who is either related, living in the same household, or a friend.
Many times, the spouse, parent, or child of a car accident victim can stay home and care for the injured person. Their hourly pay from attendant care becomes their income. Combined with compensation for lost wages and future medical expenses, this system has worked well to prevent car accident victims and their families from losing their homes after a catastrophic injury. It also prevents many victims from having to enter an expensive facility, where family members often have to worry about abuse and neglect.
As long as a doctor prescribes 24/7 attendant care, the accident victim is entitled to receive these services to assist their care, recovery, or rehabilitation, as outlined by the law. Attendants must also document their hours and services to submit their time to the insurance company for reimbursement.
What has changed in the law about attendant care?
In the new No-Fault laws signed into Michigan state law in May 2019, attendant care is now limited to 56 hours per week, unless provided by an agency, this is meant to help the auto accident victim. This is the same hourly limitation set in place for workman’s compensation.
Additionally, the unlimited PIP No-Fault protection schedule will be changed to a $50,000, $250,000, $500,000, or no-limit PIP coverage. Most people will likely fall in the $250,000-$500,000 range, receiving a 20-35% rollback of PIP costs in their policy. This means that the PIP will no longer cover attendant care costs for an unlimited amount of time, and the injured party will likely have to sue the other motor vehicle driver and/or their insurance company for the remainder of future care costs.
Many people will be encouraged to opt-out of their PIP coverage if their health insurance covers auto-related accidents. This will make finding attendant care costs more difficult for victims who are catastrophically injured and do not carry PIP or auto-related health insurance.
A new Medicare-based fee schedule will be used to submit the cost of medical charges and services provided by in-home attendant care providers. This fee schedule will be phased in over four years beginning in 2019 and ending in July 2023, resulting in 190% of the Medicare-schedule fees.
What does this mean for attendant care in Michigan?
In-home attendant care provided by someone who is related to the victim lives in the same household or is a friend of the victim. They are now limited to providing a maximum of 56 hours per week of direct care to the victim. If the victim is catastrophically injured and needs round-the-clock care, they may have to contract with an agency, a home health aide, or other commercial-care providers.
For people who were injured previously to when the law takes effect on July 1, 2021, they will likely have to battle out their round-the-clock care services in court. The law is poorly written, meaning that there is no clear definition for people to be “grandfathered” in under the old laws.
Some insurance companies have already been difficult when it comes to approving compensation for in-home attendant care. Not only must attendants carefully document their hours and services, but their compensation runs between $20-40 per hour. Auto accident attorneys help ensure that the insurance companies adequately compensate doctor-ordered in-home attendant care.
Rise in tort cases
Many law experts are warning of the potential impacts of the new No-Fault laws on the Michigan legal system. Not only are there going to be several layers of bureaucracy that will dominate insurance claims, but the prompt-payment-of-benefits statute in the old law seems to be gone from the new law. This means that insurance companies no longer have to pay out benefits within 30 days of a claim with proof of those costs.
Furthermore, excess benefits from lost wages and medical costs that are no longer covered under the no-limit PIP schedule will have to be pursued in court from the other driver. This will lead to a flurry of litigation and tort cases that will have to move their way through the Michigan legal system. Not only will this back up many cases significantly, but it will also cost more in legal fees for insurance companies and consumers.
While initially, these benefits seem like they will lower insurance costs for consumers, experts worry that the high legal fees will eventually need to be worked back into the insurance policy costs.
Additionally, there is a new definition of “serious impairment of body function” which must be met and satisfied before a car accident victim can sue for pain and suffering damages. The impairment, “is objectively manifested, meaning it is observable or perceivable from actual symptoms of conditions by someone other than the injured person.” It is also “an impairment of an important body function, which is a body function of great value, significance, or consequence to the injured person.”
In general, this impairment must affect the injured person’s quality of life and ability to care for themselves. It must take away from a “normal manner of living.” There are no time limits on the impairment. Independent medical examinations by doctors hired by the insurance company may be used to verify the serious impairment of body function before the case can move forward.
How can an auto accident attorney help ensure I receive attendant care?
Because of the high cost of agency-provided care, a car accident attorney at Cochran, Kroll & Associates, P.C. can be helpful in getting your in-home attendant care approved instead. Round-the-clock in-home care provided by agencies can quickly run into thousands of dollars each month, whereas in-home care provided by a family member or friend can be much more reasonable.
In cases where in-home attendant care is denied or limited, an auto accident attorney at our law firm can help appeal your claim by using medical records, doctors’ orders and testimony, and other documentation to show that your medical needs require extensive attendant care. Our firm can also show the insurance company how much more beneficial in-home attendant care by a family member or friend is financially, which will improve the odds of approval.
Your auto accident lawyer will work tirelessly on your behalf to ensure that your medical expenses and future care are a priority. No one goes out driving expecting to be unable to walk, eat, or attend to their basic needs by the time they get home. However, catastrophic injuries occur from car accidents every day. You should not suffer because the insurance laws have changed.
Additionally, it’s important to advocate for an in-home care attendant, you know and trust. In elder studies, home care is favored over facility care because of the positive impacts on the well-being of the patient. In an environment where the car accident victim is already comfortable and knows their caregiver, along with other in-home interventions such as occupational and physical therapy, their health outcomes are likely to be much better than they would be in a long-term care facility.
While Michigan’s auto insurance costs have historically been the highest in the country, mainly due to the no-limit PIP coverage costs, this new law puts Michigan on-par with most other states in terms of their auto insurance coverage and benefits. However, for those with catastrophic injuries which resulted from a car accident, these changes are very concerning.
Many victims wonder how they will continue to receive round-the-clock care if it is only limited to 56 hours per week. If insurance companies deny this care or the amount of compensation for caregivers, families are wondering how they will afford the cost of an in-home care attendant out-of-pocket. For family members who have left their jobs to take care of an injured loved one, they are wondering how they will go back to work, pay for a care attendant, and afford the rest of the household expenses.
Furthermore, many are worried about what the new Medicare-based fee schedule will mean for compensation of services. Lawyers in the state of Michigan are preparing to fight this particular angle of legislation, as it seems that compensation for selected services will cap out at around 55% of the total expense.
It will soon become even more crucial to contact an auto accident attorney at Cochran, Kroll & Associates, P.C. as quickly as possible after a car accident. An attorney from our law firm can deal with the inevitable litigation many Michigan accident victims will need to receive compensation for their severe body impairments.
At Cochran, Kroll, & Associates, P.C., we know that being in an auto accident is stressful, and your in-home attendant being limited to only 56 hours per week is unreasonable and unrealistic. If you or a loved one has been catastrophically injured in a car accident and need round-the-clock care from an in-home care attendant, contact us today and let us fight for your rights.
Call us now at 866-MICH-LAW. We can help you file your claim and petition your insurance company so that you can receive the doctor-ordered care you need and deserve.
Disclaimer : The information provided is general and not for legal advice. The blogs are not intended to provide legal counsel and no attorney-client relationship is created nor intended.