Michigan law does not set attendant care rates for car accident victim providers. Michigan uses the “Reasonableness” standard the determine the proper wage rate for attendant care services you provide to someone injured in a car accident. The amount is primarily based upon the doctor’s prescription and the assistance required. The attendant care rate claim is either litigated or voluntarily agreed upon by the insurance company and the service provider. In Michigan, the new fee schedule took effect on July 1, 2021 and will now be the way future rates are determined.
If you want to learn more, please visit our page on “Michigan Attendant Care FAQs” or call 866-HIRE-JOE to speak to a no-fault insurance lawyer.
Attendant care is the service available through the No-Fault PIP benefits auto insurance to seriously injured car accident victims. The no-fault insurance company is required to pay for a family member or friend, a caregiver, or a nurse to provide necessary nursing care services to help victims with their activities of daily living that they are unable to perform on their own.
What services does the hourly rate for attendant care in Michigan?
Michigan law does not set any hourly rate for attendant care. Instead, the amount is based on what is a reasonable amount for the assistance provided based on the underlying service activities and injuries. The key is that the amount payable per hour must be reasonable. Historically, insurance companies have looked at published labor statistics or whatever the insurance company and attendant provider agree upon, and it is often litigated if a rate cannot be voluntarily agreed upon.
As of July 2021, can be determined by the new No-Fault law’s Medicare-based fee schedule, but only if the family provided attendant care rate is published by Medicare.
Michigan’s No-Fault law requires that all attendant care rate charges must be “reasonable and customary,” but the law does not define what a reasonable and customary rate is. Instead, reasonableness and customary are based on the facts of each case and specific to the injuries that require the assistance and the degree of treatment that is being provided. The amount cannot exceed what a provider “customarily charges” for like care, nor can it exceed the new limits that will be set by the Medicare-based fee schedule that took effect in July 2021. (MCL 500.3107(1)(a); 500.3157(1) and (2))
The Michigan Supreme Court in Douglas v. Allstate Insurance Company 492 Mich 241, July 30, 2012) stated the factors to be considered are: (1) The rates charged by “individual caregivers” on the open market; and (2) the rates at which “health care agencies compensate their employees,” but not what they actually “charge their patients.”
The No-Fault law’s Medicare-based fee schedule will apply to the hourly rate for attendant care in Michigan provided after July 1, 2021. It applies to rates charged by agencies and the injured person’s family members. It will be a percentage of the Medicare reimbursement rate or the provider’s previous average rate charged. For services that are on the Medicare fee schedule, the provider will be paid between 200% and 190% of the Medicare reimbursement rate. (MCL 500.3157(2))
However, if the attendant services are not on the Medicare fee schedule, 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))
Some examples of services that will likely not be on the Medicare-based fee schedule: (1) 24/7 assistance provided in the home; (2) assistance provided by a friend or family member; and (3) personal help that involves helping a car accident victim with dressing, bathing, grooming, and using the toilet.
Typically, you or a lawyer hired on your behalf can negotiate with the car insurance company about what is a reasonable hourly rate for your attendant care benefits in Michigan. If the reasonable rate amount cannot be mutually agreed upon, your attorney may file a Michigan No-Fault insurance lawsuit to have the reasonableness of the payment determined in court.
As a negotiating tool with the auto insurance company, it is important to mention to the auto claims adjuster that if a reasonable rate for family-provided attendant care for in-home assistance cannot be agreed upon, then a commercial agency could likely be hired to provide attendant care. Commercial agency provided nursing assistance is considerably more expensive to the auto insurance company.
Services compensation to a caregiver, nurse, or family member who provides a car accident victim for assistance given for “activities of daily living.” Activities of daily living can include such things as providing assistance with supervision, bathing, dressing, eating, medication management and even with using the toilet. These are all activities of our daily life that someone who is seriously injured in an auto accident may not be able to perform independently because of his or her accident-related injuries or limitations. These services can also include monitoring and supervision when someone has a serious brain injury or psychiatric disorder that makes such supervision necessary to protect the safety of an accident victim.
These services involve providing a car accident victim with assistance with the activities such as: (1) administering and/or giving medication; (2) walking; (3) moving about both inside and outside a victim’s home; (4) carrying and lifting items for the victim; (5) wound care; and (6) helping a victim get in and out of bed. There are many other examples of the kinds of services allowed for personal home care. It is always fact specific for the individual claimant, his or her medical needs and the level of skill the assistant providing the services has.
In many cases involving catastrophic injury after an auto accident, assistance is provided on a 24/7 basis.
Michigan has a “priority” law that determine the proper payer of No-Fault benefits. Usually, your own auto insurance company or another insurer will pay your No-Fault benefits. Generally, it will be your own insurer or that of your spouse or a resident relative who lives in your household. If no household auto insurance exists, it could be the Michigan Assigned Claims Plan.
Generally, attendant care benefits are paid to the people who provide the assistance to seriously injured car accident victims. The providers could be nurses or home-health aides. Also, the providers can be any family member, close friend and/or legal guardian of the car crash victim.
Payment for family and friends provided in-home personal attendant care will now be limited to providing a maximum of 56 hours per week for direct care provided to the car crash victim. If the victim is catastrophically injured and needs round-the-clock care, they may have to contract with a private agency, a home health aide company, or other commercial type care providers.
For people if you were injured before the new law took effect on July 1, 2021, you will likely have to fight your round-the-clock attendant care services claim in court. The new law is poorly written, meaning that there is no clear direction for whether victims are “grandfathered” in under the old no fault laws.
Some insurance companies have already started to play games when it comes to paying compensation for in-home attendant care. Now personal attendant care providers must carefully document their hours and details of services and justify the hourly compensation rate, especially if $20-40 per hour. The Joseph Dedvukaj Firm auto accident lawyers help ensure that the insurance companies adequately compensate doctor ordered in-home attendant care services.
If you have been injured in a car crash and would like to speak with an experienced car accident attorney, call toll free anytime 24/7 at 866-HIRE-JOE for a free consultation with one of our No-Fault attorneys. You can also get help from an experienced accident attorney by emailing us.