There is no uniform or legally-mandated hourly rate for attendant care in Michigan. “Reasonableness” is the determinative factor. The amount is based upon the injury and the assistance required, and is either litigated or voluntarily agreed upon by the insurance company and the provider. The new fee schedule takes effect in 2021 and will now largely determine future rates.
To learn more, please check out our page on “Michigan Attendant Care – FAQs.”
What is attendant care?
This service is one of the No-Fault PIP benefits available to seriously injured car accident victims. It pays for a family member, a caregiver or a nurse to provide necessary care to help victims with his or her activities of daily living that they are too injured to do on their own.
What is the hourly rate for attendant care in Michigan?
There is no set hourly rate for attendant care in Michigan. Instead, the amount is based on what is a reasonable amount for the assistance required based on the underlying injuries. The key is that the amount paid per hour must be reasonable. Historically, it has been whatever the insurance companies and attendant providers agree upon and it is often litigated if a rate cannot be voluntarily agreed upon.
Starting in 2021, it will be largely determined by the new No-Fault law’s Medicare-based fee schedule.
What is a reasonable hourly rate for attendant care in Michigan?
Michigan’s No-Fault law requires that all charges for these services must be “reasonable,” but it does not define what reasonable is. Instead, reasonableness is inherently fact-based and specific to the injuries that require the assistance and the degree of treatment that is provided. The amount cannot exceed what a provider “customarily charges” for like care, nor can it exceed the new limits that will be set by the Medicare-based fee schedule that takes effect in 2021. (MCL 500.3107(1)(a); 500.3157(1) and (2))
What factors determine the hourly rate for attendant care in Michigan for family members?
The Michigan Supreme Court in Douglas v. Allstate Insurance Company (#143503, July 30, 2012) said the factors include: (1) The rates charged by “individual caregivers” on the open market; and (2) the rates at which “health care agencies compensate their employees,” but not what they “charge their patients.”
How does the Medicare-based fee schedule affect the hourly rate for attendant care in Michigan?
The No-Fault law’s Medicare-based fee schedule will apply to the hourly rate for attendant care in Michigan provided after July 1, 2021. It applies to rates charged by agencies and victim’s family members. It will be a percentage of the Medicare reimbursement rate or the provider’s previous average rate.
For services that are covered by Medicare, the provider will be paid between 200% and 190% of the Medicare reimbursement rate. (MCL 500.3157(2))
However, if the attendant services are not covered by Medicare, the provider will be paid between 55% and 52.5% of his or her “charge description master in effect on January 1, 2019” or “the average amount the person charged for [attendant care] on January 1, 2019.” (MCL 500.3157(7)(a))
Examples of these services that will likely not be fully covered by the new Medicare-based fee schedule include: (1) 24/7 assistance at home; (2) assistance provided by a family member; and (3) personal assistance that involves assisting a car accident victim with bathing, dressing, and using the bathroom.
Can you challenge the hourly rate for attendant care in Michigan?
Initially you or an attorney hired on your behalf can negotiate with the auto insurance company about what is a reasonable hourly rate for attendant care in Michigan. If an amount cannot be voluntarily agreed upon, your attorney can file a Michigan No-Fault insurance lawsuit where the reasonableness of the payment would be litigated.
When negotiating with the auto insurance company, it is important to remind the claims adjuster that if a reasonable rate for family-provided, in-home assistance cannot be agreed on, then a commercial agency will likely have to be hired. Commercial agency provided assistance is considerably more expensive.
What does the hourly rate for attendant care cover in Michigan?
It compensates a caregiver, nurse, or family member who provides a car accident victim with assistance with “activities of daily living.” Activities of daily living include such things as providing assistance with bathing, dressing, eating, and even with using the toilet. These are all activities of our daily life that someone who is seriously injured in an auto accident may not be able to perform independently because of his or her accident-related injuries or limitations. These services can also include monitoring and supervision when someone has a serious brain injury or psychiatric disorder that makes such supervision necessary to protect the safety of an accident victim.
These services involve providing a car accident victim with assistance with the activities including: (1) administering and/or taking medication; (2) walking; (3) moving about both inside and outside a victim’s home; (4) carrying and lifting items for the victim; (5) wound care; and (6) helping a victim get in and out of bed. There are dozens of other examples of these services. It is always specific to the individual, his or her needs and the level and the level of sophistication of the assistance and treatment that is required.
In many cases involving catastrophic injury after an auto accident, assistance is provided on a 24/7 basis.
Who pays for the care?
The “priority” rules in the No-Fault law will always determine whether your own auto insurance company or another insurer will pay for these No-Fault benefits. Generally, it will be your own insurer or that of your spouse or a relative who lives in your home. It could also be the Michigan Assigned Claims Plan.
Who is paid the hourly rate for attendant care in Michigan?
It is paid to the people who provide the assistance to seriously injured car accident victims. The providers could be nurses or home-health aides. Also, the providers can be family members, close friends and/or legal guardians of the car crash victim.
Need help finding the right lawyer? Call Michigan Auto Law first
If you have been injured in a car crash and would like to speak with an experienced car accident attorney, call toll free anytime 24/7 at (800) 777-0028 for a free consultation with one of our No-Fault attorneys. You can also get help from an experienced attorney by emailing [email protected] or you can use the chat feature on our website.