Know the Law – Case managers & auto accidents

As part of Michigan’s no-fault insurance system, persons who are injured in auto accidents are entitled to the services of a “case manager.”

What are case managers? Typically, they are nurses or vocational rehabilitation counselors who have an understanding of Michigan’s no-fault law and medicine. Basically, they help car accident victims coordinate their medical care. For example, a case manager will schedule doctor appointments for the injured person, make referrals to other doctors, arrange transportation for the person, and so forth.

Case management services are provided through the injured person’s auto no-fault policy. Under the no-fault system, the services must be “reasonable” and “necessary” for the injured person’s care, recovery and rehabilitation. Case management services are lifetime benefits, or may be used for as long as the services are needed.

In many cases, the injured person’s auto insurer will assign a case manager. However, if you’ve been injured in an auto accident, you have the absolute right to choose your own case manager. Accident victims must have a case manager who has their best interests in mind – not the interests of the insurance company.

Another crucial thing to remember is this: case managers do not “pre-approve” medical treatment before no-fault benefits are paid. In other words, case managers are not the “gatekeepers” of no-fault coverage.

Unfortunately, some insurance companies lead injured persons to believe they must use the case manager selected by the insurance carrier, or else risk jeopardizing their claim for benefits. This simply is not true. There is nothing in Michigan’s no-fault law that:

• authorizes a no-fault insurer to insist on the use of case managers as a pre-condition to paying benefits.
• obligates a no-fault claimant to work with a case manager as a pre-condition to receiving no-fault benefits.
• requires a medical provider to deal with a case manager as a pre-condition to receiving payment for medical services.

Remember: auto accident victims have the right to hire – and fire – their own case manager. If your insurance company tell you or leads you to believe otherwise, the insurer is engaging in unscrupulous conduct.

 

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