Grand Traverse County Circuit Court; Docket No. 93-10992-CK;
Honorable Philip E. Rodgers, Jr.; Unpublished
Official Michigan Reporter Citation: Not Applicable; Link to Opinion 
STATUTORY INDEXING:
Allowable Expenses: Reasonable Charge Requirement [§3107(1)(a)]
Providers Entitled to Charge Reasonable Amount for Services [§3157]
Use of Fee Schedules to Determine Reasonable Charges [§3157]
TOPICAL INDEXING:
Legislative Purpose and Intent
CASE SUMMARY:
In this apparent case of first impression, the Grand Traverse Circuit Court considered whether a no-fault insurer may utilize workers' compensation reimbursement schedules as the basis of payments for no-fault first party allowable expense benefits.
It appears that an insured of defendant insurer had incurred medical expenses associated with an automobile accident at plaintiff hospital that were covered under a policy of no-fault automobile insurance. The defendant insurer claimed the extent of its liability for the allowable expenses was limited to the amounts payable for the medical expenses under workers compensation reimbursement schedules. The insured apparently assigned his no-fault claim to the hospital which, in turn, filed suit against the defendant insurance company.
In a verbal opinion delivered from the bench, the court granted summary disposition to the plaintiff hospital, holding that allowable expenses were payable for the usual and customary charges of the institution, without regard to the workers' compensation schedules. The court noted that under §3107(a), full payment is due for reasonable charges incurred for reasonably necessary medical services. Under §3157, reimbursement for allowable expenses is not to exceed the amount of the provider's usual charges. Reading the two sections together, the court concluded that the provider's customary and usual charges for these services involved were reasonable, and, therefore, covered pursuant to § 3107(a).
The defendant insurance company submitted evidence that the medical institution accepted as payment in full an amount less than the total charges from certain reimbursement programs, such as Medicaid and Blue Cross. Evidence was also presented to suggest that patients paying the full amount of charges subsidize those patients who are covered under programs that do not pay the full amount. Despite the disparity in coverage, the court found the charges for a given service to be uniform, and, therefore, reasonable in amount.
As no evidence was presented that the plaintiffs charges were unreasonable, the court granted summary disposition in favor of the hospital.
