LANSING, Mich. — The Michigan Supreme Court issued an opinion Monday with major implications for thousands of catastrophically injured auto crash survivors who have been struggling to get certain medical services covered since changes to the State’s no-fault insurance law in 2019.
The court affirmed a previous decision made by the Michigan Court of Appeals.
This decision means that the restrictions put in place as part of Michigan no-fault auto reform law cannot apply to crash survivors who bought policies and were injured before the new law took effect.
Friday’s opinion comes in a case brought by crash survivors Ellen Andary of East Lansing, Philip Krueger of Ann Arbor, and the Eisenhower Center, a brain injury rehabilitation clinic, against USAA Casualty Insurance.
The case questioned how Michigan’s no-fault auto reform law is meant to be applied, specifically in regards to crash survivors who purchased policies and were injured before the new law took effect.
“This is been a horrible nightmare for so many people who were injured years ago, and were insured under policies issued years ago,” George Sinas told FOX 17 Monday.
Sinas was lead counsel on the Andary case. He is also general counsel for CPAN, a group dedicated to restoring the state's previous no-fault system.
He continued, "right now, this is the law. Those legacy patients had been transported back in time to where they were under the policies that control their claims."
Under the new law, which took effect on July 2, 2021, any medical service not already covered under our federal Medicare law, which includes in-home caregivers and transportation to medical services, will now only be reimbursed by insurance companies at 55% of what they were back in 2019. The law also caps the number of hours that family members can provide care to just 56 hours a week.
The Michigan Court of Appeals previously decided in August of last year that the changes to the law should not apply retroactively to people who purchased policies and were injured prior to the law being signed in 2019.
The old policy will now apply to everyone who bought policies and were injured before 2019— the previous system required insurance companies to cover "all reasonable charges for reasonably necessary products, services and accommodations for an injured person's care, recovery, or rehabilitation."
Sadly, just hours before the Michigan Supreme Court released their opinion in the case, a crash survivor named Brian Woodward passed on.
"Brian, before the law, was living semi-independently. He had care and support from in-home nurses to allow him to live at home, to work, he was productive, and he lived lived a high quality of life," Tom Judd, president of the Brain Injury Provider Council of Michigan, told FOX 17 Monday.
"His nurses couldn't continue to come to his home. He was displaced from his home. He was re-hospitalized several times, and his body just gave up on him."
According to CPAN, there have been at least eight people who have died since the changes went into effect because of losing access to some care.
There are roughly 18,000 Michiganders currently receiving medical benefits from their auto no-fault policies.
A report released at the beginning of August 2022, conducted by the Michigan Public Health and commissioned by the Brain Injury Association of Michigan, found that 6,857 crash survivors have been discharged from local care providers, and 4,082 health care workers have lost their jobs.
They found that 10 care companies have had to close their doors completely since the changes took effect, while 14 more companies expect to close in the next 12 months.
President of the Insurance Alliance of Michigan, Erin McDonough, issued a statement Monday regarding the decision, voicing concerns of the auto insurance industry.
“A medical fee schedule for auto insurance, similar to private health insurance, Medicare and Medicaid has been a huge benefit to consumers because it reins in rampant overcharging by medical providers and brings fairness, common sense and transparency to the broken auto no-fault system," McDonough said in part.
"Today, the court let down consumers across Michigan and opened the floodgates for overcharging for medical procedures and higher rates. You can’t reasonably expect to save Michigan drivers money while obliterating a key cost control measure like the fee schedule. What medical providers charge for services and prescribe for care, above and beyond what’s medically necessary, can be controlled and has proven to reduce the cost of auto insurance."
This opinion does not apply to anyone who purchased policies and were injured after the bill was signed in 2019.
Advocates say the only way to properly address that side of the issue is through a legislative fix.
"This narrow decision by the Supreme Court brings justice and fairness to some, but we need it for all," Judd said.
"No more excuses, no more delays... the legislature needs to adopt this, the Governor needs to sign it, and it needs to have immediate effects, so that we can just end this crisis for care."
FOX 17's Coverage of No-Fault Auto Reform Care Crisis
May 17, 2021 — New Law Could Have Devastating Consequences
June 2, 2021 — "We're Paying the Price With Our Lives": FOX 17 Extended Coverage
June 9, 2021 — Hundreds of Survivors Protest at Capitol
June 10, 2021 — Rep. Berman Introduces Bill to Prevent Cuts
June 23, 2021 — Advocates Rally Again at Capitol
June 26, 2021 — House Approves $10M Fund
June 30, 2021 — Advocates Say $25M Isn't Enough
July 7, 2021 — Family Scared to Lose Caregivers
July 23, 2021 — Providers Begin Closing their Doors
Aug. 4, 2021 — Patients Continue to Lose Care
Sept. 24, 2021 — Changes Causing Chaos for Survivors
Sept. 27, 2021 — 'We Can't Wait' ArtPrize Entry Highlights Care Crisis
Oct. 4, 2021 — Protest Outside Business of SML Shirkey
Oct. 14, 2021 — Some Insurers Not Following Intent of Law
Oct. 27, 2021 — New Round of Bills Announced
Jan. 11, 2022 — Report Says No Fault Reform Created Crisis of Care
July 1, 2022 — 1 Year Under the New Auto No-Fault Law
Aug. 11, 2022 — 2nd Report Released on Impact of No-Fault
Aug. 25, 2022 — 35 Counties Sign Resolution Urging Legislative Changes
Aug. 26, 2022 — Court of Appeals Says Law is Not Retroactive
Nov. 14, 2022 — No-fault auto reform advocates hopeful 'fix' will happen after Election Day
