Ramps, lifts, equipment and bathroom modifications which total $30,000 or less do not require pre-approval from the MCCA
Sadly, home modifications have become a part of many of the serious automobile accident cases I handle. People who suffer severe orthopedic injuries or spinal injuries often need extensive home modifications made to their existing homes.
In many cases, I have had to work with the No Fault insurance company and builders to have entirely new homes built, because the existing homes at the time of a car accident are inadequate and cannot be modified.
Perhaps there is no area of the Michigan No Fault law that has been more difficult than home modification cases. Most plaintiff personal injury lawyers are loathe to become involved in these on their own, because there is so much detail and revisions to contracts back and forth with the insurance company adjusters. They’re also weary because the risk of committing legal malpractice is so high, so many auto lawyers just feel the risk/reward just isn’t worth it.
But a new change may make these cases easier for both sides, so that the horribly injured accident victim can get the necessary modifications made as quickly as possible. That is the point, after all.
My reason for hope?
The Michigan Catastrophic Claims Association (MCCA) has just announced and recently released a pre-approval checklist for insurers. The checklist is a guideline for the types of documents that are usually requested from a No Fault PIP claims file in order to obtain the MCCA’s approval of a proposed home modification reimbursement. And it includes a big change in the MCCA’s policy regarding its pre-approval of home modifications.
In its new checklist, the MCCA stated that home modifications for “ramps, lifts, equipment, and bathroom modifications” which total $30,000 or less do not require pre-approval from the MCCA.
For those of you who are unfamiliar with the MCCA, it’s a private, nonprofit association made up of a five-person board (unfortunately, comprised from the insurance industry) who manage the fund that compensates auto insurance companies when a No-Fault claim exceeds $500,000. Auto insurance consumers populate the fund by paying an MCCA assessment, which is a small part of your No Fault insurance premium.
Home modifications are defined as changes to an accident victim’s home or living space that accommodate the victim’s accident-related physical, mental or functional limitations and, thus, permit the victim to live and move about freely. They are paid for by your own No Fault insurance company because home mods are considered an allowable medical expense under the Michigan No Fault Law.
In case you are wondering why the MCCA is involved at all, remember that if an auto accident has caused someone to suffer injuries that require things like ramps, lifts, and bathroom modifications, the medical bills for hospitalizations and surgeries have already approached or exceed $500,000.
But modifications to other rooms in the house are also not included in the list. Therefore, if the home modifications recommended by an occupational therapist include any other modifications – like those to the kitchen, living room and bedrooms, for instance – even if the estimate for all of the work is $30,000 or less, the MCCA must approve for reimbursement.
I’ve written before about the MCCA board, and the members from the insurance industry who run it, and refuse to disclose its financial workings to the public – even though they’re raising our rates at a time when the insurance industry is trying to dismantle our entire No Fault system.
I contacted the MCCA to try and obtain a copy of its new checklist, but to no avail. The MCCA said they’re not able to release a copy, as it’s only for the member carriers.