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Medical Providers & No-Fault Law

Medical Providers & the Michigan No-Fault Law

PIP Benefits and Managed Care Concepts

When the Michigan Legislature enacted the No-Fault Automobile Insurance Act in 1973, it did not draft a statute that utilizes managed-care concepts, as have other states that enacted a no-fault system. On the contrary, the Michigan No-Fault Act is purely a fee-for-services system obligating a no-fault insurer to pay all “allowable expenses” as defined in the statute.  
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Legal Actions by Medical Providers

Medical care providers who are not promptly paid by auto no-fault insurance companies have several powerful legal remedies which allow them to recover their expenses.
Several years ago, the Michigan Court of Appeals issued two decisions that gave some powerful legal weapons to medical providers who are not promptly paid by auto no-fault insurance companies. These legal rights allow medical care providers to pursue claims against the no-fault insurer directly, and grant the providers significant enforcement power of their rights. The legal decisions granting these rights were a great victory for medical providers and their auto accident patients and will go a long way to making the playing field more level in no-fault insurance payment disputes.
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Fee Schedules and Medical Bill Auditing

Many insurance companies have refused to pay the full amount of a doctor bill or hospital charge because the insurance company claims the charges are not “reasonable” within the meaning of Subsection 3107(1)(a).
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