When a person is seriously injured in a car accident, sometimes they need ongoing supervision and care. But a recent case urges caution in choosing an attendant care facility to provide that aid.
After a serious auto accident, family members, case managers, and even attorneys sometimes have to help the injured person find the care they need. But an unpublished opinion by the Michigan Court of Appeals, Riverview Macomb Home and Attendant Care, LLC v State Farm Mut Auto Ins Co, warns that a careless choice of facility could cut off no-fault benefits.
Dan Richardson needed help even before his pedestrian accident. He was renting a room in his uncle’s basement. But then he was struck by a vehicle and suffered serious injuries including a traumatic brain injury. After the crash, Richardson was bedbound, “non-ambulatory” and unable to climb stairs. He also had hearing and visual problems. All these injuries meant that he could no longer live in his basement room.
To keep Richardson from becoming homeless, a case manager with Ava Care and Case Management, operated by Riverview Macomb Home and Attendant Care, arranged for housing at Group 1 Home, Inc. The facility provided Richardson a residence and access to the 24-hour attendant care services prescribed by his doctors.
But when Group 1 Home filed a claim for no-fault benefits through the Michigan Assigned Claims Facility, State Farm denied the claim. The auto insurance company said that Group 1 was not a licensed adult foster care facility, so it wasn’t legally allowed to provide the services Richardson required.
Attendant Care & Foster Care Facilities
The Michigan No-Fault Act allows PIP benefits for allowable expenses, including “reasonably necessary products, services and accommodations for an injured person’s care, recovery, or rehabilitation.” MCL 500.3107(1)(a). When it comes to medical providers, MCL 500.3157 provides:
“A physician, hospital, clinic or other person or institution lawfully rendering treatment to an injured person for an accidental bodily injury covered by personal protection insurance, and a person or institution providing rehabilitative occupational training following the injury, may charge a reasonable amount for the products, services and accommodations rendered. The charge shall not exceed the amount the person or institution customarily charges for like products, services and accommodations in cases not involving insurance.”
Group 1 Home said that their attendant care services are not “treatment” so Section 3157 shouldn’t apply. The Michigan Court of Appeals disagreed, saying:
“Here, when the two statutory provisions are read together as a whole, it is clear that the Legislature intended for ‘treatment’ to include all ‘reasonably necessary products, services, and accommodations for an insured person’s care, recovery, or rehabilitation.’ Thus, read together, it is clear that ‘care’ and ‘treatment’ are not mutually exclusive alternatives Instead, ‘care, recovery, and rehabilitation’ are alternative forms of treatment.”
The question, then was whether Group 1 was lawfully rendering adult foster care services to Richardson. An “adult foster care facility” provides “supervision, personal care, and protection in addition to room and board” for adults who, because of age, illness, or disability, “require supervision on an ongoing basis but who do not require continuous nursing care.” MCL 400.703(4)(h) and 704(7). Personal care, in turn, includes providing assistance with dressing, personal hygiene, grooming, medication, or the development of personal and social skills. If what a facility does for its residence amounts to adult foster care, Michigan law requires the facility to obtain a license.
Group 1 Home, as an assisted listing facility, did not hold an adult foster care license. However, it provided 24 hour attendant care including assistance with showering, personal hygiene, dressing, medication, and transportation.
In deciding whether the care required a license, the court focused on the injured person’s needs, rather than the nature of services. Because Richardson fell into the class of person requiring adult foster care services, particularly continuous supervision, the court held that this care was adult foster care.
Representing Clients Needing Adult Foster Care
Auto accident attorneys regularly assist seriously injured clients to find service providers that can help them with everyday attendant care needs. While relatives are sometimes able to provide attendant care, and be compensated for it, more severely disabled clients will often require adult foster care.
Riverview Macomb Home and Attendant Care LLC v State Farm warns that attorneys, case workers, and other professionals need to thoroughly vet the facilities they choose to provide these services. If a facility doesn’t do what it takes to maintain the proper license, it could leave your client with attendant care bills the no-fault provider isn’t willing or required to pay.
David Christensen is a brain injury attorney at Christensen Law in Southfield, Michigan. He has extensive experience in helping clients get their attendant care costs covered. If your client has suffered a brain injury accident, contact Christensen Law today for a referral.