Attendant Care Services In Michigan: A No-Fault PIP Benefit

In Michigan, attendant care is a No-Fault PIP benefit that ensures that car accident victims have the nursing assistance they need to recover from their injuries and begin rebuilding their lives. It pays for a nurse or a family member to help victims with the “activities of daily living” they are too injured to do on their own.

It covers assisting a car accident victim with the “activities of daily living” that he or she can no longer perform independently because of injuries he or she suffered in the accident. These activities include: bathing; dressing; eating; administering medication; and using the toilet.

Whether it is provided 24/7 or on a more limited basis, these services may involve assisting a car accident with the following activities in addition to those mentioned above: (1) monitoring and supervision for safety reasons; (2) grooming; (3) walking; (4) moving about inside and outside the home; (5) driving to medical appointments; (6) carrying and lifting things; (7) wound aid; and (8) getting in and out of bed.

Attendant care services in Michigan can be provided by a certified or registered nurse or home health aide from a commercial agency or by a family member or a legal guardian of the car accident victim.

It can be provided in a car accident victim’s home or in a residential facility.

The “priority” rules in the Michigan No-Fault law will determine which auto insurance company will pay for your attendant care services. (MCL 500.3114(1)) Generally, it will be your own insurer. Alternatively, it could be the insurer for your spouse or family member or an insurer assigned by the Michigan Assigned Claims Plan.

If a car accident victim’s attendant services costs exceed the No-Fault PIP medical benefits coverage level in the policy through which coverage is claimed, then the victim may sue the at-fault driver whose negligence caused the car accident for his or her “excess” costs. (MCL 500.3135(3)(c))

Generally, the Medicare-based fee schedule in Michigan’s No-Fault auto insurance law will apply to all rates for these services whether the assistance is provided in a facility or in a victim’s home or by a nurse or home health aide or by a family member of the car accident victim.

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, for services that aren’t 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) and (b))

Examples of services that will likely not be covered by Medicare 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.

For purposes of determining what a reasonable rate is for family members providing in-home assistance, the Michigan Supreme Court provided the following guidance in Douglas v. Allstate Insurance Company (#143503, July 30, 2012) :

• “[I]t is appropriate for the [court] to consider hourly rates charged by individual caregivers when selling their services (whether to their employers that commercially provide those services or directly to injured persons) . . . because it helps the fact-finder to determine what the caregivers could receive on the open market.”
• “[W]e hold that a [court] may base the hourly rate for a family member’s provision of attendant care services on what health care agencies compensate their employees, but [not on] what health care agencies charge their patients . . .”

Like other benefits covered by Michigan No-Fault Personal Protection Insurance, the amount of attendant care services that will be paid by an auto insurance company will be limited to the amount of the No-Fault PIP medical benefits coverage level in the policy through the car accident victim is claiming.

Importantly, if the policy has any level of No-Fault medical coverage other than “unlimited,” then it might also have an “attendant care rider” that would provide coverage for these services “in excess of the applicable” No-Fault PIP medical benefits coverage level selected in the policy. (MCL 500.3107c(8))

In Michigan, for in-home, family-provided attendant care services, auto insurance companies will only be required to pay for 56 hours per week. (MCL 500.3157(10); 418.315(1)) This limitation does not apply to services provided in a facility or by a nurse or home health aide from a commercial agency.

This limitation on in-home, family-provided services was created by the new No-Fault law that took effect on June 11, 2019 (Public Act 21 of 2019).

Specifically, the 56-hours-per-week limitation on in-home, family-provided services for car accident victims only applies if the assistance is “provided directly, or indirectly through another person, by any of the following” people:

• “An individual who is related to” the car accident victim. (MCL 500.3157(10)(a))
• “An individual who is domiciled in the household of” the car accident victim. (MCL 500.3157(10)(b))
• “An individual with whom the [car accident victim] had a business or social relationship before the injury.” (MCL 500.3157(10)(c))

The Michigan Supreme Court ruled that the attendant care limitation does not apply retroactively to any insured who was injured while covered by an insurance policy issued before June 11, 2019.

In Michigan, a car accident victim and/or his or her provider can “contract” with the auto insurance company “to pay benefits for attendant care for more than” the 56-hours-per-week limitation on in-home, family-provided assistance. (MCL 500.3157(10), (11) and (14))

Some auto insurance companies may find this “contract” option appealing as in-home, family-provided services are often significantly less expensive than the commercial rate charged by agencies.

If you were injured in a car accident in Michigan and need help with your attendant care services claim, call now (800) 968-1001 for a free consultation with one of our experienced car accident lawyers. There is no cost or obligation. You can also visit our contact page or use the chat feature on our website.

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