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Make Michigan insurance companies think twice before denying payment to auto accident victims

August 14, 2008 by Steven M. Gursten

The Michigan Court of Appeals has clarified the test for medical causation under the no fault act in a recent published opinion, Scott v. State Farm. Our team of Michigan personal injury attorneys believes the test might make Michigan insurance companies think twice before denying payment to victims of serious auto accidents.

In Scott, The plaintiff sustained a traumatic brain injury in a 1981 car accident. A decade later, she was diagnosed with hyperlipidemia (high cholesterol). At issue was whether the plaintiff’s high cholesterol was related to the car accident. Two of her doctors reported that there was a causal relationship. They said after the accident, the plaintiff couldn’t do as much exercise and due to the brain injury, her lack of self-control made it difficult to maintain a reasonable diet. Still, State Farm denied payment for her cholesterol medication, contending the need was not related to the car accident.

Let the jury decide medical causation

In a unanimous opinion, the Court of Appeals concluded that because “[T]here is no objective test that can distinguish between a case of hyperlipidemia caused genetically and one caused by independent factors… the trier of fact must decide whether the high cholesterol problem is one ‘arising out of’ the accident.”

In other words, the Court charged the question of medical causation with the trier of fact — typically a jury. Therefore, a jury could decide for the plaintiff whether there was any causal relationship between the high cholesterol and the auto accident, if medical testimony supports such a finding.

Burden of proof — “Arising out of” defined

What’s significant about Scott is that the Court clarified to what degree the plaintiff must prove the causal relationship between the accident and the injury. Citing Bradley V. DAIIE, the Court stated the use of the motor vehicle need only be one of the causes of the injury, and that there may be other independent causes. Almost any causal connection of relationship is sufficient, as long as it’s more than an incidental, fortuitous or but-for causal connection, the Court continued.

Meanwhile, State Farm has appealed to the Michigan Supreme Court.

Michigan insurance companies must be accountable

Personal Injury Protection (PIP) insurance provides coverage for all reasonable and necessary medical expenses arising out of an auto accident. But like in the Scott case, many no fault insurance companies fail or outright refuse to pay for treatment when they should. Therefore, lawyers at Michigan Auto Law are often forced to file suit against the client’s no fault insurance company. If Scott is upheld by the Supreme Court, Michigan no fault insurance companies may think twice before denying benefits in similar cases, keeping in mind they’ll have to explain themselves to discerning juries.

Traumatic brain injury linked to depression and more

Scientific research dealing with traumatic brain injuries, such as the injury in the Scott case, is constantly evolving. Many qualified physicians claim that traumatic brain injuries are substantially linked to severe depression. Our car and truck accident attorneys have seen countless clients undergo intense personality changes and mood swings following brain injuries and head trauma. These changes are not only extremely devastating for the accident victims, but are tremendously frustrating for their friends and family.

Yet many no fault insurers continue to take the position that depression has nothing to do with other injuries caused by auto accidents, and refuse to pay for the necessary medications and therapies.

Michigan lawyers could use Court precedent to make insurance companies pay

With that, there is a very positive potential outcome for Michigan car accident victims if Scott is upheld by the Supreme Court. Michigan auto accident lawyers, armed with supporting medical documentation, could rely on the Court’s precedent to make insurance companies pay for treatment of additional medical problems causally related to an auto accident that they might otherwise deny, such as depression.

If you’re having difficulties obtaining insurance coverage for medical problems stemming from a Michigan car or truck accident, please call the lawyers of Michigan Auto Law for a free consultation.

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