www.advomas.com michigan no fault douglas a. firth with knight & firth, p.c

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Michigan No Fault

Douglas A. Firth with Knight & Firth, P.C

Overview of No-Fault

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Why is no fault important to hospitals ?

Why is no fault important to

hospitals now ?

Basics

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Compensates injuries arising out of “ownership, operation,

maintenance, or use of a motor vehicle.”

Basics

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Exclusions:• Car thief (without

permission).• Driving own uninsured

vehicle.• Out of state motorist insurer

not certified in Michigan.

Basics

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Health insurance often has priority over no fault insurance unless it has an auto accident exclusion.

Basics – First Party Benefits

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Paid without regard to fault with regard to economic loss.• Cap on wage loss – 3 yr.

maximum.• Cap on replacement services.• Must sue within one(1) year.

Basics – Third Party Benefits

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Non-economic case:• Limited in amount by insurance

limits, minimum 20/40, most 100/300.

• In order to sue there must be a “serious impairment of bodily function”.

• Comparative negligence. Reduces the amount of recovery.

• 3 year Statute of Limitations.

Focus on First-Party

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Medical ReimbursementThree major changes:

Before most law suits were third party – fault cases.

Now more first-party because of changes in the law.

Changes in law:• Case law – judge determines

serious impairment as a matter of law.

• Recovery limited by insurance limits and comparative negligence.

• Providers can sue directly.• Attorneys can claim a lien on

insurance payments of medical charges.

• Fault not an issue.

Focus on First-Party

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Medical Reimbursement • Attorneys realized they

have a better opportunity to recover first party benefits and take 1/3 of the amount received.

• Added reasons for providers to pursue claims:• Better rates of recovery.• Don’t need the patient to sue. A

greater chance of payment rather than waiting for patient.

New Environment

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Traditionally-simply monitor patient suits, because less costs and not available.

Proactive with assigned claims.

How to avoid attorney’s fees

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1. When receiving any information of attorney involvement send letter denying representation.

2. Actively work case with insurer.3. File separate suit or intervene in

existing case as necessary.4. Ensure any check issued has

providers name on it, either singularly or as co-payee.

5. Gather as much information on case as soon as possible – know the problem areas holding up resolution.

6. Cannot wait for insurer to pay if under investigation for more than 3 months.

Problems With Representation Solely by

Patients Attorney

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1. Inherent conflict of interest representing patient & hospital.

2. Sometimes trying to get more for patient at expense of provider.

3. Taking fee and giving rest to patient.4. Difficulty negotiating with attorney,

without information on case, or litigation.

5. Whether threat to bill patient for difference is effective.

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