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Medical care under Medicare will not protect injured senior drivers like Michigan No Fault insurance does

October 8, 2013 by Steven M. Gursten

Excluding senior drivers over age 65 from No Fault insurance punishes those injured in car accidents, as HB 4959 would deny essential medical care under No Fault

elderly driver

Michigan drivers and residents should steer clear of House Bill 4959.  It is a reckless proposal to exclude senior drivers over the age 65 from Michigan’s No Fault auto insurance system.

Although it was introduced to curry favor with older drivers who may not be familiar with their own legal rights under No Fault, as an insurance lawyer, I know the difference is glaring.

The most devastating change will be that senior citizens injured in car accidents will no longer have a legal right to all reasonably necessary and reasonably priced lifetime No Fault medical benefits, as they currently do under Michigan PIP (No Fault insurance).   HB 4959 takes that away, and replaces it with Medicare.

The problem is that Medicare does not cover what No Fault covers.  It also will ensure that senior drivers unlucky enough to be seriously injured will receive inferior medical care for their injuries that are covered by Medicare.

Specifically, by excluding senior drivers over age 65 from No Fault, HB 4959 replaces Michigan No Fault with Medicare.  And under Medicare,  the coverage for auto accident-related injuries does not include huge areas of medical area. The treatment that is available is clearly sub par compared to similar medical care  covered by No Fault.

For instance, John G. Prosser III of Michigan-based Health Partners Homecare, which is a steadfast and forceful proponent of preserving Michigan’s current No Fault auto insurance system, has compiled the following list of medical services for auto accident victims that No Fault regularly covers, but which Medicare will not cover, including:

  • Whole home modifications,
  • Aggressive/persistent therapies,
  • Electric wheelchairs,
  • Modified vans,
  • 24-hour in-home nursing.

The list above appears in Prosser’s online flyer, “Seniors Need PIP Benefits (HB 4959),” which is posted on the Health Partners Homecare website.

Prosser also noted that, even when Medicare’s coverage overlaps with what would’ve been covered by No Fault, Medicare’s coverage is “severely limited.” He used physical therapy benefits as an example:

Under No Fault, there are no “preset limits” in terms of “dollar amount or number of visits,” which is critical because some auto accident victims “need to see physical therapists 3 times per week.”

*    *    *

Yet, under Medicare, the annual “cap on physical therapy and speech therapy combined is $1,900.”

The House Fiscal Agency reached the same conclusion about the limitations on Medicare coverage for auto accident victims:

“Medicare provides coverage for … limited skilled nursing facility and limited nursing home care, and limited home health services … Medicare does not provide coverage for long-term custodial care or in-home attendant care …”

 – Source: House Fiscal Agency Legislative Analysis, No Fault Auto Insurance Amendments

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