When the Michigan Assigned Claims Plan (MACP) was transferred from a government agency to a non-profit organization of insurance providers, it seemed to shift control over the claims away from vulnerable Michigan residents. But a recent Michigan Court of Appeals decision, Spectrum Health Hosp v MACP, says that the Michigan Automobile Insurance Placement Facility (MAIPF) can’t deny medical providers’ claims for technical errors or omissions on the forms. It must assign the claims and let the assigned insurance company sort things out.
Michigan Legislature Puts Last-Resort Personal Injury Protections in the Hands of Insurance Companies
When the Michigan legislature passed the No-Fault Act in 1973, its goal was to create a safety net to make sure everyone injured as a result of a motor vehicle accident had access to coverage for medical expenses, lost wages, and replacement services. It created a process of elimination for residents and medical providers to figure out which insurance company would pay the benefits, starting with the person’s own no-fault policies (in most cases) and working its way down to the policy covering any vehicle involved in the accident. When even that system is not enough to find coverage, the last order of priority is the Michigan Assigned Claims Plan.
Until more recently, the MACP was run by the Michigan Secretary of State’s office. Then, in 2012, the legislature shifted the job of screening applications and assigning them among the state’s insurance companies to the newly formed Michigan Automobile Insurance Placement Facility (MAIPF). This is a non-profit organization made up of the insurance companies who are assigned the claims under state law. The 2012 adjustment to the Michigan No-Fault Act gave the MAIPF the authority to make rules for how MACP claims were filed. However, a recent Michigan Court of Appeals case, Spectrum Health Hosp v MACP, says that the MAIPF can’t add requirements or make it harder for injured persons or their medical providers to get assigned under the plan.
MACP Denies Medical Provider’s Claim for Missing Signature on Application
On August 30, 2016, Robin Benoit was seriously injured as a passenger in a one-car motor vehicle accident. She was taken to Spectrum Health, which provided over $129,000 in medical services between August 30 and September 19, 2016. Benoit told Spectrum she did not have auto insurance and gave verbal consent for the medical provider to pursue benefits on her behalf, but was “unable to sign”. Then, after she was released from the hospital, Benoit disappeared.
With the “One Year Back Rule” looming, on August 16, 2017, Spectrum Health filed a medical provider’s claim with the MACP, relying on the police report that said that the driver of the vehicle was uninsured. Spectrum used the MACP’s form, filling in many blanks as “unknown” where it did not have information about Benoit or her insurance situation. The Spectrum representative signed the application as “preparer”, but the patient’s signature line was blank. The MACP denied the claim with a form letter.
Spectrum then hired a private investigator who tracked Benoit down and got her to sign an affidavit that she wasn’t insured and her then-boyfriend’s car was not insured either. On the last day of the one-year statute of limitations, Spectrum sent that affidavit to the MACP asking that the case be assigned to an insurance provider. The MACP refused again and Spectrum filed a lawsuit.
On appeals, the Court of Appeals said that the MACP had overstepped its authority. The law requires the MACP to assign any claim received unless it was “obviously ineligible.” Since Spectrum had provided proof of the accident, the fact that there was no insurance policy to cover Benoit’s injuries, and the loss sustained, the MACP was legally required to assign the case.
The court specifically said that even when the MACP and the MAIPF exercised its authority to create rules about how claims are filed it was not allowed to create new requirements to qualify. While Spectrum would eventually need to get Benoit’s signature on the application, this technical error was not enough to disqualify the claim and cut off Spectrum from its reasonable medical billing.
The Macomb Law Group, is a personal injury law firm in Clinton Township, MI. Our auto insurance claims attorneys can help you protect your no-fault benefit rights and get your accounts paid. If you have outstanding no-fault provider claims, contact Macomb Law Group and get our team working for you.
