CPAN’s 8 guiding principals strive to ensure the protection of benefits and healthcare services auto accident victims receive today under Michigan’s Auto No-Fault system, without interruption.
Maintain Full Medical Coverage for Auto Accident Victims
The main feature of Michigan’s no-fault system is the guarantee of lifetime medical coverage in exchange for reasonable limitations on the right of survivors to sue at-fault drivers. The hallmark of our auto no-fault system, full medical coverage, must be maintained.
Say No to Managed Care
Trauma can result in lifetime disability, such as a brain injury or spinal cord injury. Patients should have the right to choose providers – including physicians and medical case managers – who are local or regional, and who provide individualized service that meet their needs and expectations. Patients want the right to change their providers as their conditions change and should have the right to choose where they will live based on quality of life decisions, rather than by limited managed care options.
Fair Attendant Care Reimbursement
Patients and families should have the choice on who will provide temporary or lifelong attendant care, in cases of severe injury. If a family member, friend, or neighbor can be trained to provide the care, they should be entitled to reimbursement that is fair.
Shed Light on the MCCA Fund
The Michigan Catastrophic Claims Association’s board is composed of only insurance industry representatives and meetings are not subject to the “open meetings act.” We propose that this be changed and that the board includes patient and provider representation. The public deserves the right to know how the MCCA surcharge is calculated and the actuarial and economic assumptions used to set the rate.
Adopt Meaningful Sanctions When Insurers Do Not Pay Bills
Deny, delay, defend; this is the model of the insurance industry yet the no-fault statute requires that insurance companies pay medical expenses and other no-fault benefits within 30 days after receiving reasonable proof of the claim. Oftentimes, insurers do not honor this obligation and improperly deny claims. Sometimes, the denial forces the patient or provider to incur substantial expenses to litigate the claim. If litigation results in a judgment against the insurer, the patient or provider who prevails on the claim should also be entitled to recover actual legal costs from the insurer as part of the recoverable no-fault benefits. In addition, if the insurance company is found guilty of “bad faith” in the processing of a no-fault claim, the insurance company should also be responsible for any general damages suffered by the patient or provider as a result of the bad faith denial of the claim.
Maintain a Threshold Injury Standard That is Fair and Balanced
Under the Michigan no-fault law, only injured persons who have suffered “serious impairment of body function, permanent serious disfigurement or death,” can make a tort claim for noneconomic loss damages. The legislature defined “serious impairment of body function” in a 1995 amendment, which has recently been interpreted by the appellate courts in such a way as to disqualify many innocent accident victims who suffer significant bodily injuries. Some of these victims have suffered traumatic brain injuries, but were denied compensation because their injuries did not affect their normal life in a manner that was “serious enough.” As a result of these court decisions, the important balance between guaranteeing payment of medical and wage loss benefits for all victims while insuring the right to recover noneconomic damages for those victims who suffered serious injury as a result of the negligence of careless drivers has been lost. This important balance must be restored.
Adjust RBI Liability Limits
The RBI liability limits are especially important because they compensate innocent accident survivors for loss of income incurred after the third anniversary date of the accident or during the first three years following the accident in excess of no-fault wage loss benefits. Therefore, the RBI liability limit is crucial to protecting the future financial security of accident survivors who suffer a loss of income that is not compensable by no-fault PIP benefits. The mandatory minimum residual bodily injury insurance limits have not changed since their establishment in 1967. This should be adjusted to a realistic present day amount, based on cost of living increases.
Underinsured/Uninsured Motorist Coverage
Persons required to purchase no-fault automobile insurance coverage should have the right to purchase underinsured and uninsured motorist coverage from any insurer authorized to write no-fault insurance in Michigan. Moreover, any insurance policy containing underinsured and/or uninsured motorist benefits should conform to certain uniform standards regarding the substance and conditions of such coverage.