THURSDAY, NOVEMBER 3, 2011
If passed, HB-4936 will reform the Michigan No-Fault auto insurance law that was first created in the 1970’s. Under the current No-Fault law, all Michigan auto insurance policies contain a coverage called Personal Injury Protection, or PIP. PIP includes several provisions, including unlimited medical benefits and up to 85% of the insured’s lost income from work, subject to a monthly maximum amount. Michigan is the only state that mandates unlimited medical coverage.
The crux of the issue is the rate at which the cost of catastrophic injury claims are increasing in combination with the way our No-Fault Law currently works. At present, PIP benefits within the auto insurance policy must pay medical providers the full amount of fees they deem to be “reasonable and customary”. Other medical insurance sources are able to pay reduced fees because of PPO or HMO agreements or, in the case of workers compensation, a fee schedule that is part of Michigan’s Workers Compensation Statute.
At present, there is no dollar limit on the amount of PIP benefits payable for an injury stemming from an automobile accident. There are two charges within a Michigan auto insurance policy that pay for this benefit: One is the premium paid for PIP coverage. This money is retained by the insurance company and is used to cover the first $500,000 of a claim for PIP benefits. Another charge is the MCCA assessment. The assessment, which will increase slightly to $145.00 per vehicle in 2012, is a fee the insurance companies are required to collect and pass on to the Michigan Catastrophic Claims Association (MCCA). The MCCA fully reimburses the insurance company for the portion of an injury claim that exceeds $500,000. According to the MCCA, the highest percentage of people whose PIP claim costs exceed $500,000 are between the age of 16-20 (12.4%).
According to a report presented by Sharon Tennyson Ph.D. as testimony before the Michigan House Insurance Committee on October 4, 2011, the average amount paid for a Michigan PIP claim during 2010 was $35,446. The report also states that only 1% to 2% of all PIP claims in Michigan exceed $500,000. The problem is that the few claims (1% to 2%) that exceed $500,000 account for 47% of all PIP claims costs. In other words, once the claim cost exceeds $500,000, chances are that it may be huge.
The goal of the proposed legislation is to help curb the rising cost of auto insurance in Michigan. According to a legislative analysis summary from the House Fiscal Agency, there are six key provisions to the proposed change in our No-Fault Law:
No-fault policies would no longer automatically cover unlimited lifetime medical and rehabilitation benefits. Instead, drivers could choose personal injury protection (PIP) coverage with (1) a maximum of $500,000; (2) a maximum of $1,000,000; or (3) a maximum of $5,000,000. The default amount would be $500,000.
The current Michigan Catastrophic Claims Association (MCCA), which currently pays medical and rehabilitation claims once they exceed $500,000, would be divided into two accounts: (1) the MCCA Account, which would only apply to losses attributable to accidents before July 1, 2012; and (2) an Excess PIP Account, which would apply to losses attributable to accidents on or after July 1, 2012. Each account would be self-supporting and assets and liabilities could not be transferred between them.
Under the bill, for loss occurrences attributable to accidents on or after July 1, 2012, each auto insurance company would pay for 100% of the ultimate loss under PIP coverage up to $500,000. The MCCA would reimburse the auto insurance company 90% of the ultimate loss from $500,000 and $1,000,000 and 100% of the loss in excess of $1,000,000.
The fee schedule used in the Workers’ Compensation system would be applied to payments made by auto insurers to physicians, hospitals, and other providers treating an injured person or providing rehabilitation. (The fee schedule would not apply to emergency medical services provided by ambulance operations.)
Individuals injured on a motorcycle involved in an accident with a motor vehicle could claim PIP benefits only up to a maximum of $250,000.
Specific limits would be placed in statue on attendant care or nursing services provided in an injured person’s home, including limits on hourly payment for the provision of basic services and skilled services.
If passed, how would claim costs be covered if they exceeded the limit of insurance chosen on the auto insurance policy? Likely, they would become the responsibility of other insurance sources such as private medical insurance, VA Benefits or Medicaid.
The airwaves are alive with radio ads from both those who favor this change and those who oppose this change. Insurance companies and many consumers favor the change as it would help contain spiraling medical costs resulting from auto accidents and help to keep auto insurance premiums reasonable. Health care providers oppose the change.
Change to the Michigan No-Fault Law will affect every driver in the State of Michigan. It is important to stay informed and determine how this major change might affect you.
For more details on Michigan No-Fault reform may affect you, visit the Michigan Legislature’s website. You can also contact us at 800.225.5582 for more information about Michigan auto insurance, or to get a free Michigan auto insurance quote.
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