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Lawyers’ Corner: Provider Claims in Chiropractors Rehab Group v State Farm

Medical provider claims are derived from an injured party’s claim. But can an injured party destroy a medical provider’s claim just by failing to show up? The Michigan Court of Appeals says not necessarily.

Attorneys who bring medical provider claims under the Michigan No-Fault Act are constantly facing arguments that their lawsuits are no good through no fault of their own when an injured party is uncooperative.

A new published Michigan Court of Appeals decision in Chiropractors Rehabilitation Group, P.C. v. State Farm Mutual Automobile Insurance Company, makes clear that a medical provider’s claim for no-fault payment of medical billing doesn’t automatically fail because the patient’s lack of cooperation, including failure to show up for medical examinations or examinations under oath.

Medical Providers Can File Claims Directly

The court reaffirmed medical providers’ right to seek payment for their medical services directly from no-fault insurance providers. Their independent right to recover payment for expenses incurred for the benefit of patients injured in an auto accident gave medical provider plaintiffs standing to sue.

Medical Provider Claims Need Eligible Patients

Before the insurance company is required to pay, the plaintiffs will have to show that their patients were eligible to receive no-fault benefits. State Farm claimed that the patients in these cases were ineligible for benefits because they had failed to appear for medical examinations or examinations under oath.

Michigan no-fault law requires injured parties to attend “independent medical examinations.” However, failure to appear doesn’t make a patient permanently ineligible for benefits. The court said:

 State  Farm  may  reasonably  suspend  claims  by  the  injured parties  due  to  a  failure  to  submit  to  MEs,  and  a suspension  of benefits  is  not  an  “irrevocable denial” of benefits; the eligibility for PIP benefits is simply suspended until compliance with the ME.

If an auto insurer were allowed automatically terminate benefits for failure to attend a medical examination, it would take power away from the court to compel attendance and preserve a party’s claim.

Therefore, we conclude that the injured parties’ failure to submit to the MEs and EUOs requested by State Farm did not demonstrate that there is no genuine issue of material fact as to  whether plaintiffs, as the injured parties’ healthcare providers,  were entitled to no-fault benefits as a matter of law, because the injured parties’ failure to comply does not conclusively establish the ineligibility of the injured parties and plaintiffs’ related inability to recover payment for PIP benefits from State Farm.

Instead, medical providers may be able to establish an injured party’s eligibility prior to or at trial, thus preserving their claim. Medical provider attorneys need to work closely with personal injury lawyers to make sure their clients cooperate. But the insurance companies can’t avoid trial just because of a missed medical exam.

David Christensen is a medical provider attorney at Christensen Law in Southfield, Michigan. He has represented doctors and hospitals for over 20 years. If your clients need help recovering their medical billing, contact Christensen Law for a referral today.