Allowable Medical Expenses

Michigan PIP Benefits: Allowable Medical Expenses

If you’ve been in a car accident, sustained bodily injury and can meet the requirements to be entitled to no-fault insurance benefits, then under the Michigan No-Fault Insurance Act, you will be allowed to recover a subtantial group of PIP benefits. The main no-fault insurance benefit is the allowable medical expense benefit.

M.C.L. 500.3107(1)(a) governs allowable medical expense benefits, requiring payment of personal protection insurance benefits that are both unlimited and uncapped for:

Allowable expenses consisting of all reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person’s care, recovery, or rehabilitation. Allowable expenses within personal protection insurance coverage shall not include charges for a hospital room in excess of a reasonable and customary charge for semiprivate accommodations except if the injured person requires special or intensive care, or for funeral and burial expenses in the amount set forth in the policy which shall not be less than $1,750.00 or more than $5,000.00.

As you can see, the “allowable expenses” language in the statute is very broad, entitling a car accident victim who sustained bodily injury to any product, service or accommodation that is “reasonably necessary” for care, recovery and rehabilitation.So two questions: Is it a reasonable expense? Is it a necessary expense? If you’ve been recently injured in a car accident, it’s best to speak with an expert Michigan car accident lawyer to understand if what expenses will be coverd under the allowable medical expenses benefit.

Medical and Hospital Treatment:

According to the statutory language cited above, a car accident victim cannot recover allowable expenses for a hospital room for charges that exceed a “reasonable and customary charge for semi-private accomodations,” unless the injured person requires “special or intensive care.”

Other than this, the language is pretty silent with regard to specific charges and services. However, Michigan courts have dealt with such issues, such as whether telephone and television charges are covered or whether certain brain imaging services are covered, etc. To find out if your specific medical and hospital treatment expenses are recoverable under PIP benefits, please contact an expert Michigan car accident attorney.

Rehabilitation Services:

The statutory language for allowable medical expenses does states that it applies for rehabilitation, however, it is vague with regard to specifically what type of rehabilitation services are recoverable through no-fault insurance benefits. Questions also arise as to who can render services. Therefore, it is best to consult with an expert Michigan car accident lawyer since the Michigan courts are continuously interpreting what is covered.

In-Home Attendant Care:

Section 3107(1)(a) also provides for in-home attendant and nursing care benefits, especially for those accident victims that have suffered a catastrophic injury. This is a major component of allowable medical expenses, and most of the litigation surrounding this category of recoverable expenses has to do with recovering expenses for in-home attendant care by a family member at home. Questions also arise as to who can render services. An expert Michigan car accident lawyer can advise you whether you can recover for such expenses, as it is an issue that has been heavily analyzed by Michigan courts.

Accomodations:

This has become an important benefit for those who have suffered a catostrophic injury and cannot return to their home or need to have their home subtantially modified to accomodate them. The language in Section 3107(1) specifically provides for the recovery of reasonable and necessary accomodation expenses. This is another category of recoverable expenses through PIP benefits that has been further interpreted by the Michigan courts. An expert Michigan car accident attorney can answer whether your specific accomodation expenses will be recoverable or not.

Room & Board:

Although room and board expenses are not specifically addressed by Section 3107(1), it has become an allowable expense by the Michigan courts. Because this is another category that is continually being interpreted on a factual basis, to find out if you can recover for room and board expenses, it is best to ask an expert Michigan car accident attorney.

Medical Mileage:

You can recover your expenses for the transportation costs of medical care and treatment. However, according to a decision by the Michigan Court of Appeals in 1989, Neumann v. State Farm Mutual Auto Ins Co, a no-fault insurer is not obligated to create any specific formula or method of determining transportation expenses. Therefore, it is best to consult with an expert Michigan car accident lawyer to find out how medical mileage will be calculated in your case.

Special Transportation:

Although not specifically mentioned in Section 3107(1), Michigan courts have ruled that in certain circumstances, recoverable allowable expenses can include the costs of providing special transportation for those who suffered a catastrophic injury. Speak to an expert Michigan car accident attorney to find out whether you are entitled to recovering such expenses.

Guardian Expenses:

The Michigan Court of Appeals ruled in Heinz v. Auto Club Ins Ass’n, a 1995 decision, that expenes of guardianship and/or convervatorship for those who suffered a catastrophic injury as a result of a car accident are recoverable under Section 3701(1)(a). This issue has been revisited by the Michigan courts and probably will continue to be interpreted. Therefore, it is important to consult with an expert Michigan car accident attorney to learn if you are entitled to recover guardian expenses.

If you or someone you know was recently injuried in a car accident and you would like to know your rights and what you are entitled to collect, please set up a free case review with one of the leading expert car accident law firms in Michigan.