08 September 2023

Called It: The Michigan No Fault Act’s Utilization Review Medical Provider Administrative Appeal Process is Not Mandatory

The 2019 amendments to Michigan’s No-Fault Act changed the landscape for medical providers.  One change was to vest medical providers with a statutory cause of action against an insurer who wrongfully denies or delays payment of a claim for motor vehicle accident related medical charges.  see MCL 500.3112.  That change was a huge win for […]

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15 August 2023

ERISA Update: Sixth Circuit Decision Reminds To Review Plan Documents Carefully

On August 1, 2023, the United States Court of Appeals for the Sixth Circuit issued its decision in Patterson v. United HealthCare Insurance Company.  The Court’s decision serves as a reminder to carefully scrutinize health plan provisions when dealing with plan reimbursement claims. Eric Patterson was injured in an auto accident.  United HealthCare paid for […]

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01 December 2022

One-Year Back Deadline? Not So Fast: Formal Denial Of Claims Required Before The Clock Starts Ticking.

On November 17, 2022, the Michigan Court of Appeals issued a decision in Encompass Healthcare, PLLC, v. Citizens Insurance Company, which clarified the tolling provision of the no-fault act and the timelines that medical providers have to file a lawsuit to recover their unpaid charges. For nearly two decades it has been the law, under […]

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18 November 2022

Motorcycle Accidents that Involve a Motor Vehicle: Unintended Consequences of the 2019 Amendments to the Michigan No Fault Act

According to the Michigan State Police, 282,640 traffic crashes happened in Michigan in 2021 – 1068 of those accidents resulted in a fatality.  Accidents involving a motorcycle accounted for 1.1% (3,271).  But motorcycles were involved in 16% (171) of the traffic crashes that resulted in a fatality.  From a potential for injury standpoint – motorcycle […]

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04 November 2022

Choose Wisely: Select Uncoordinated (Primary) Unlimited Pip Coverage

In the new world of “PIP choice,” consumers can now choose how much PIP (primarily medical coverage) to carry on their no-fault insurance policies.  Depending upon eligibility, some are choosing only $50,000; others are selecting $250,000 or $500,000; and many have wisely continued with unlimited lifetime coverage.  Still others have decided to exclude medical coverage […]

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20 October 2022

ERISA Health Plan Claims Update: Claims Review Poised To Change

On September 29, 2022, the U.S. House of Representatives approved passage of the Employee and Retiree Access to Justice Act, a bill that if enacted into law has significant implications for providers seeking payment of health plan claims governed by the Employee Retirement Income Security Act, commonly known as ERISA. Currently, ERISA authorizes benefit plan […]

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06 October 2022

Michigan Supreme Court to Decide if Fee Schedule Applies to Accidents that Occurred Before June 11, 2019

As expected, the Michigan Supreme Court has agreed to review the court of appeals’ decision in Ellen M. Andary et al v. USAA Casualty Insurance Company et al. In Andary, the court of appeals ruled that the new No-Fault Fee Schedule, which was a part of the 2019 changes to Michigan’s No-Fault Act, did not […]

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22 September 2022

Get it While its Hot! – Four Year Time Limit Applies to Lawsuits for Double Damages Under the Medicare Secondary Payor Act

On August 10, 2022 the United States Court of Appeals for the 11th Circuit ruled that private parties have four years to file suit to recover double damages under the Medicare Secondary Payor Act (“MSPA”).  MSPA Claims 1, LLC v Tower Hill Prime Insurance Co, 11th Circuit Case No. 21-1135.  This is the first time […]

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08 September 2022

No Fault’s 1-Year Timing Rules and Tolling: Can a Medical Provider Even Stop the Clock From Running?

The Michigan no-fault act contains many important deadlines.  If any of these deadlines are missed, a medical provider may be unable to collect payment for the services provided to a patient eligible for no-fault benefits. First, written notice of the injury must be provided to the responsible no-fault insurer within 1 year of the date […]

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25 August 2022

Michigan Court of Appeals Decides: Fee Schedule Doesn’t Apply to Accidents Before June 11, 2019

On August 25, 2022, the Michigan Court of Appeals issued its decision in Ellen M. Andary et al v. USAA Casualty Insurance Company et al., a case with significant implications for medical providers seeking payment of legacy no-fault claims. The bottom line of the Court’s ruling:  the No-Fault Fee Schedule rules that went into effect […]

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