The Michigan Court of Appeals just issed an opinion that is favorable to Michigan car accident injury victims who require attendant care services.  These are services provided to the injued person during the period of recovery and rehablitation.   Under the Michigan no-fault insurance laws, the auto insurance company must pay a resonable amount for these services.

Attendant care services can be provided by a staffing agency, a private individual, or even a family member.  Quite often, it involves supervision, monitoring, and other activities for the safety and well-being of the patient.  It also includes bathing, providing medications, changing PICC lines, and other services.

Insurance companies routinely deny paying these claims for a variety of unlawful reasons.  They either claim that the services are not needed, that the rate for the services is too high, or even that claim forms were not properly submitted.  They also deny claims by arguing that the person who provided the services did not expect to be paid.

Well, the Michigan Court of Appeals rejected many of those arguments when it issued Salman v. Amica on December 17, 2009 (Docket No. 286923)   In that case, a family member provided attendant care services and submitted claims to the insurance company.  The company refused to pay the claims because it argued that the family member did not submit the claim forms in time and that the person did not expect to be paid.

The Court rejected the insurance companies defense and  held that “there is no requirement that these forms be filled out contemporaneously. Rather, there is a permissible inference that the family member had a reasonable expectation of payment because she filled out the forms going back to the day of the accident.”  Moreover, the Court held that there is no requirement that the care provider assign a dollar amount to the care provided in order to satisfy the incurred requirement. In this regard, it was permissible to request “whatever the jury thought was reasonable.”

This new decision confirms that insurance companies cannot avoid payments on technical requirements that were not included in the Michigan No-Fault statute.  Although they will continue to deny legitimate claims, this case makes it much harder for them do so and holds them accountable for improperly denying claims.  This is a great victory for victims of serious injuries in Michigan car accicdents.

If you would like more information about your rights after a Michigan car accident, you can order our FREE book, “The Ultimate Michigan Car Accident Handbook” by clicking on the book link. We will send it out immediately along with other important information.

For more information about Michigan car accident cases, visit our law firm web site at www.BuckfireLaw.com. If you would like to speak with one of our Michigan car accident attorneys about your case, feel free to call us anytime at (800) 606-1717 or simply submit this contact form and we will get back to you quickly.

Michigan attendant care benefits are a tremendous benefit available to car accident victims through the Michigan No-Fault System.  Oftentimes, a person sustains serious injuries as a result of an auto accident, which renders him or her unable to do things that he or she was able to do prior to being injured. Many times, the injured person requires professional agencies to care for him or her at home. 

However, more often, the injured person is cared for by family and friends. This type of care is referred to as “attendant care.”  Attendant Care services commonly include, but are not limited to:

• Preparing meals and feeding
• Assistance with personal hygiene, such as dressing and bathing
• Attending to wounds
• Assistance with medication
• Providing transportation to and from medical appointments
• Supervision and monitoring,

          Section 3107(1)(a) of the Michigan No-Fault Act is the specific statutory section that entitles auto accident victims to be compensated for “attendant care” rendered by family members.  Courts in Michigan have held that the word “services” in this section of the No-Fault statute includes both skilled and unskilled attendant care as well as supervision.  The courts have also held that attendant care can be provided by family members as long a physician deems the services are reasonable and necessary. 

Once it is established that a person requires and is provided attendant care, the insurer is obligated to pay for the attendant care regardless of whether it is being provided by family or friends. The moral obligations of family members to care for one another are completely irrelevant to an insurer’s liability for payment of attendant care provided by family and friends.

          In order to submit a claim for attendant care you must provide the insurer with “reasonable proof of the fact and of the amount of loss sustained.” This is usually done by submitting a claim, in the form of written documentation, to the insurer with: (1) the name of the injured claimant; (2) the name and address of the care provider; (3) the days and number of hours the care was provided; (4) the specific types of care provided; and (5) a note from a physician stating that the care is necessary, including the number of days/hours needed (See e.g. Attending Physicians Report).

          Once the claim is documented, the claimant must then demand an amount to be reimbursed by the insurer, by establishing an hourly rate and then multiplying that rate by the number of hours provided. There is no “rate schedule” of how much an insurer must pay for in-home attendant care.  However, sometimes No-Fault insurers improperly  advise claimants that attendant care is limited to $20.00 per day.  This is wrong and is an attempt by the insurer to limit attendant care to the rate at which Replacement Service Expenses [hyperlink to my Replacement Services Article] are compensable.

The only legal criteria is that the hourly rate must be “reasonable.” The hourly rate that the law deems reasonable, can vary greatly depending on the type of care being provided. As a general rule, family provided attendant care is commonly paid at a rate of anywhere between $10.00 - $30.00 per hour, depending on the nature and extent of the person’s injuries, the level of care be provided, the skill and expertise of the care provider, geographic location etc.

          If you, or someone you know, require(s) attendant care because of an auto accident related injury, and are not being reimbursed or are being reimbursed at a rate that seems unfair, feel free to contact our office to discuss your rights.