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No-Fault Law Requires Reasonable Medical Expenses

Lawyer Commentary on No-Fault Statute: 500.3157

Charges for medical treatment and care for injured persons; limitation on eligibility for payment or reimbursement

This No-Fault statute sets the guidelines and limitations on what medical providers can charge for the medical treatment and care they provide to Michigan car accident victims.

It was substantially overhauled by the new No-Fault law that took effect on June 11, 2019 (as Public Act 21 of 2019),

Reasonable and customary charges

Medical providers such as hospitals, doctors and clinics who bill No-Fault auto insurance companies for the medical treatment and care they provide to car crash victims are limited as follows:

  • They “may charge a reasonable amount” for the medical treatment and care they provide.
  • Their charges “must not exceed the amount” that they “customarily charge[] for like treatment or training in cases” where an insurance company is not paying the bill.

Fee schedule for medical providers

In addition to the limitations above, doctors, hospitals, clinics, rehabilitation facilities and any medical provider who cares for and/or treats car accident victims will have their charges subject to and governed by a No-Fault fee schedule that is based on the Medicare fee schedule.

Depending on the type of facility involved – whether a substantial portion of its patients are indigent, whether it is a freestanding rehabilitation facility or whether it is a Level I or II Trauma Center – reimbursement to medical providers under the No-Fault fee schedule set forth in this statute will range from 190% to 250% of the amount payable under Medicare.

Under the new Michigan No-Fault Law, the new Medicare-based, No-Fault medical-provider fee schedule will apply to “treatment or rehabilitative occupational training” rendered after July 1, 2021.

No-Fault Lawyers of Michigan Auto Law

The lawyers of Michigan Auto Law have been specializing in auto No-Fault litigation for more than 50 years. If you have been injured in a car accident, truck accident or motorcycle accident and need help navigating through your No-Fault insurance policy, please call one of our experienced attorneys for a free case evaluation at (800) 777-0028. Or you can fill out our consultation form. There is no fee or obligation.

We are here to help you.

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