The Director of the Department of Insurance and Financial Services (DIFS) issues bulletins throughout each year on how auto insurance companies should conduct their business, procedures insurance companies must follow, and significant changes in the Michigan Auto No-Fault Law. All DIFS bulletins that are available and remain in effect regarding the Michigan Auto No-Fault Law are provided below. A brief summary of each bulletin is also provided to help you find the information you are looking for.
This bulletin confirms that the fee schedule under MCL 500.3157 does not apply to products, services, and accommodations that are not provided by healthcare workers or hospitals, but compensable as “allowable expenses” nonetheless. Examples of such products, services, and accommodations explicitly identified in this bulletin include: guardianship and conservatorship services, vehicle and home modifications; computer equipment and supplies; generators; non-emergency medical transportation; non-prescription drugs; over-the-counter medical supplies; and “certain” case management services (the opinion provides in a footnote that, “whether a case management service is subject to MCL 500.3107(1)(a) instead of MCL 500.3157 will depend on whether it is payable under Medicare).
This bulletin links to resources made available by DIFS for applying the new fee schedule set forth in MCL 500.3157.
This bulletin affirms no-fault insurers’ duty to reimburse providers upon receipt of reasonable proof of loss, even if the provider does not use an insurer’s preferred billing format. This bulletin also provides that an insurer may request a charge description master or “average amount” from a provider in order to calculate the amount owed pursuant to MCL 500.3157(7), but that the insurer must request this information as quickly as possible and reimburse the provider promptly upon receipt. Lastly, this bulletin provides that insurers are expected to assist providers if the insurer believes that the providers have not properly coded the services for which they are requesting reimbursement, and that, upon receipt of bills resubmitted with correct codes, the insurer must expedite reimbursement.
Upon receiving notice that auto insurers are delaying in reimbursing health care providers and others for products, services, and accommodations rendered to insureds, DIFS released this bulletin to affirm its expectation that providers and insurers find a way to work together to ensure timely and appropriate payment of benefits. Specifically, DIFS reiterated its expectation that providers and insurers try to resolve billing and coding disputes informally before filing an appeal with the Department’s Utilization Review program.
This bulletin adds the University of Michigan Hospitals to the list of “Hospitals with Indigent Volume Entitled to Enhanced Auto Insurance Reimbursement” pursuant to MCL 500.3157(4)(a) and MCL 500.3157(5), in the category of providers that have between 20% and 29.99% indigent volume.
In this bulletin, the Department of Insurance and Financial Services clarified that, while it has performed a limited review of contracts for family-provided attendant care in excess of 56 hours per week, it has only done so to ensure compliance with applicable law; it has not approved any particular contract, contract language, or terms.
This bulletin confirms that, while the 2019 no-fault reforms provide that an insurer is only required to pay for up to 56 hours of “family-provided” attendant care per week, consumers and their insurance companies can contract with one another for more than that amount.
The Director adjusted the maximum work loss and survivor loss benefit: from October 1, 2021 through September 30, 2022, the maximum work loss and survivor loss benefit shall not exceed $6,065 per single 30-day period.
This bulletin provides notice to insurers that they are not allowed to factor in “zero-dollar claims” when underwriting, and that insurers who do will be subject to administrative discipline.
This bulletin informs interested parties that indexes are available on the DIFS website which list all the hospitals that are entitled to enhanced reimbursement under MCL 500.3157(4)(a), MCL 500.3157(5), and MCL 500.3157(6) based on their indigent volume.
This bulletin outlines the procedure individuals with qualified health coverage must follow in order to make an “effective selection” of their PIP coverage limits, pursuant to MCL 500.3107c(1). Moreover, it instructs insurance companies on how to proceed in the event that an applicant or named insured fails to follow the exact procedure for making an “effective selection.”
This bulletin designates Mary Free Bed Rehabilitation Hospital and DMC Rehabilitation Institute of Michigan as freestanding rehabilitation facilities pursuant to MCL 500.3157(b)(4), which requires that the Director select not more than two such facilities on an annual basis to qualify for enhanced reimbursement pursuant to MCL 500.3157(3).
This bulletin addresses the recent trend of automobile insurers requiring that their insureds choose the same PIP benefit limits that other members of their household chose in their own, separate policies. The Department emphasized that multiple members of a single household can purchase separate policies and choose differing PIP benefit limits.
This bulletin confirms that auto rate and rule filings submitted by insurers must remain on file for a waiting period of 90 days before coming effective. Moreover, it is up to the Director’s sole discretion whether or not to grant an insurer’s request for a shorter review time.
This bulletin establishes the maximum amount an automobile insurer can charge in copying fees to an individual (its insured or an applicant for insurance) who believes he or she was charged an incorrect premium or was improperly denied coverage and exercises his or her right to obtain documentation related to the charge or denial.
This bulletin clarifies that the 4.11% annual rate increase under the new fee schedule applies to all amounts payable under MCL 500.3157(7) and MCL.5157(8) in effect on January 1, 2019.
This bulletin establishes the rate increase (4.11%) for services provided under the new medical provider fee schedule for the period from July 2, 2021 through July 1, 2022.
This bulletin notifies automobile insurers of their obligations with respect to rate, rule, and form filings submitted on or after February 1, 2021. Additionally, this bulletin serves notice to insurers that they must inform their policyholders of the new limitations on various forms of attendant care (e.g. attendant care provided by members of an injured person’s family) set to take effect on July 2, 2021.
This bulletin makes clear that eligibility to receive healthcare from the US Department of Veterans Affairs (VA) is not “qualified health coverage” for purposes of the no-fault act, but enrollment in a TRICARE plan does qualify as “qualified health coverage.”
The Director adjusted the maximum work loss and survivor loss benefit. From October 1, 20120 through September 30, 2021, the maximum work loss and survivor loss benefit shall not exceed $5,755 per single 30-day period.
This bulletin reiterates the option for individuals with “qualified health coverage” to choose to limit their PIP coverage beyond what would otherwise be the statutory minimum. This bulletin also provides instruction to insurance companies to collect sufficient documentation from individuals with “qualified health coverage” who choose to opt-out or limiting their PIP coverage. Lastly, this bulletin reminds Michigan drivers who choose to opt-out or limit their PIP coverage because they have “qualified health coverage” to contact their auto insurer if they lose their “qualified health coverage” at any point during the term of their auto policy. If they get in an accident in the 30-day interim period between losing their “qualified health coverage” and notifying their insurer, they will be eligible to receive PIP benefits through the MACP. If they fail to notify their insurer that they no longer have “qualified health coverage,” however, and they get injured in a motor vehicle accident after the 30-day period has expired, they will not be entitled to benefits from any policy or the MACP.
This bulletin informs insurance companies that they must offer their customers who are in the middle of their policy term but would like to make changes to their coverage in light of the new no-fault reforms either (1) mid-term endorsements or (2) the option to cancel and reissue their policy consistent with the new law.
This bulletin explains the responsibility of licensed insurance agents, solicitors, and counselors to explain the choices available under the new no-fault reforms to prospective consumers. Specifically, this bulletin explains that agents, solicitors, must provide accurate quotes for all types of coverage offered by the insurance companies they represent, not merely, for example, only unlimited PIP coverage or the lowest level of PIP coverage.
This bulletin explains that under the new no-fault reforms—MCL 500.3157(12), specifically—in order to be eligible for reimbursement for treatments provided to patients injured in motor vehicle accidents, neurological rehabilitation facilities will be required to be accredited by the Commission on Accreditation of Rehabilitation Facilities or by a “similar organization” recognized by the Director. One such similar organization is The Joint Commission.
This bulletin explains the filing requirements for automobile insurers planning to issue refunds or premium waivers to their customers due to the COVID-19 pandemic.
This bulletin clarifies that, under the new no-fault reforms, Medicare enrollees may opt-out of PIP coverage altogether (1) if they are enrolled in Medicare Parts A and B, and (2) if their spouse or any relative of either who resides in their house has qualified or PIP coverage under another insurance policy.
This bulletin contains the Choice of Bodily Injury Liability Coverage Limits Form and the Michigan Selection of Personal Injury Protection (PIP) Medical Coverage Form, both of which must be included by insurers in any form filings.
This bulletin explains the requirement that insurers develop a document to explain to its insureds and prospective insureds whether they have “qualified health coverage” such that they may limit their no-fault coverage beyond what is otherwise statutorily required, and also identifies the information that must be included in any such document in order to be compliant.
This bulletin sets forth the manner in which insurance companies shall record their transactions with the MCCA in their statutory financial statements.
This bulletin explained that under the new no-fault reforms—MCL 500.3157(10), specifically— insurance companies are only required to pay a maximum of 56 hours of attendant care per week if the care is rendered in an injured person’s home and provided by the injured person’s relatives, by individuals domiciled in the injured person’s home, or by individuals, the injured person had a business or social relationship with prior to the injury. The Director noted, however, that the effective date for the new attendant care limitation is July 1, 2021, and that insurers are not to apply the provision prior to that date.
This bulletin explained that, under the new no-fault reforms, insurance companies no longer need to provide no-fault PIP benefits to non-resident policyholders. Public Act 21 of 2019 amended MCL 500.3163 to require that insurance companies provide no-fault PIP benefits to their non-resident policyholders only if the policyholders own a motor vehicle registered and insured in Michigan.
This bulletin clarified that the Michigan Catastrophic Claims Association may, pursuant to MCL 500.3104(7)(d), as amended by Public Act 21 of 2019, charge member insurance companies “for the portion of the total premium attributable to an adjustment for a deficiency in a previous period.”
The Director exercised her discretion in choosing to enforce a July 2, 2020, effective date for the amendments made to Chapter 21 of the Insurance Code by Public Acts 21 and 22 of 2019. Section 2105(6) provided that the amendments will “apply beginning July 1, 2020,” while several sections in Chapter 21 were amended to apply “after July 1, 2020”—i.e. July 2, 2020. For consistency, the Director decided to enforce the latter date.
This bulletin clarified the circumstances under which an attorney may assert a lien in relation to overdue benefits pursuant to MCL 500.3148(1), as amended by Public Act 21 of 2019. Under MCL 500.3148(1), an attorney may only assert a lien in relation to overdue benefits in “instances in which the payments for the claims are both authorized by, and overdue under, Chapter 31.”
This bulletin provided instruction to members of the Michigan Catastrophic Claims Association regarding fee calculation.
This bulletin affirmed that, under the new no-fault reforms, Public Acts 21 and 22 of 2019, health care providers may now pursue direct causes of action against no-fault insurers for unpaid or overdue no-fault PIP benefits, thus overturning Covenant Medical Center, Inc. v. State Farm Mut. Auto. Ins. Co., 500 Mich. 191 (2017) and rendering Bulletin 2018-13-INS obsolete. Public Act 21 also allows health care providers to file direct actions against no-fault insurers if there is a dispute over the reasonableness of specific charges.
This bulletin clarified an insurer’s obligations to its insured. Following Covenant, the insurer still has a duty to defend a suit if there are any theories of recovery that fall within the policy. Moreover, Covenant did not alter insurers’ obligation to pay “reasonable charges” for “reasonably necessary” products, services, and accommodations for an injured person’s care.
This bulletin outlines the requirements and procedures for the use of named driver exclusions in Michigan and for the filing of named driver exclusion endorsements for approval by the Director.
This bulletin explains that insurance policies that provide for termination or rescission without notice in the event of fraud are unenforceable.
This bulletin explains that there are two types of deductibles available: a general deductible and a deductible that is “reasonably related” to other health and accident coverage (“penalty deductible”). The second type -the penalty deductible- requires prior approval from the Commissioner.
This bulletin explains that Michigan allows insurers to offer “pay as you drive” insurance, which is determined primarily or solely on the number of miles that an insured person drives.
This bulletin superseded bulletins 1979-10-INS and 1982-16-INS. This bulletin established reporting procedures for the Michigan Catastrophic Claims Association.
This bulletin set the maximum work loss and survivor loss benefit. This bulletin was superseded ultimately by Bulletin 2018-19-INS.
This bulletin reminds insurers that an applicant may certify that his vehicle has not been moved for the past six months. If the applicant so certifies, then the insurer cannot deny the applicant for lack of prior insurance.
This bulletin reminds insurers that “misrepresenting pertinent facts or insurance policy provisions relating to coverages at issue” violates the Uniform Trade Practices Act, MCL 500.2026(a). Specifically addressed are no-fault providers who tell their customers that referral from a network physician may be necessary for coverage or that no-fault insurance will not cover medical needs that are not covered by an individual’s health insurance.
This bulletin informs no-fault providers that the Michigan Catastrophic Claims Association voted to return $1.2 billion of surplus to the companies. Further, the no-fault providers who receive the funds should be returned to the insurance holder immediately.
This bulletin explains that a named non-owner coverage endorsement to a Michigan no-fault auto insurance policy provides auto liability coverage for someone who does not own an automobile but has an automobile owned by someone else available for his or her use. However, when attached to a no-fault policy, these endorsements provide only residual liability coverage. The other mandatory no-fault coverages, personal protection insurance, and property protection insurance are not provided by these endorsements.
This bulletin informs insurance companies that the Commissioner has decided to allow them to use two new factors in deciding insurance premiums. The factors are “years accident-free” and “years insured by the insurer.” Further, these factors were found to be consistent with Chapter 21 and the no-fault statutory scheme in general.
This bulletin summarizes the Michigan Supreme Court’s holding in Great American Insurance Company v. Queen. If a successful claim for workers’ compensation benefits has been made on behalf of an individual injured in an automobile accident, the workers’ compensation benefits shall be subtracted from the no-fault benefits as provided in Section 3109(1).
This bulletin explains the provisions of Section 2105(2) and provides guidelines for review of group, franchise, and blanket policies by the Commissioner.