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No Fault Explained: Reasonable Medical Charges

After a serious auto accident, medical expenses can quickly mount into tens of thousands of dollars. The Michigan No-Fault Act ensures that your auto insurance will cover those reasonable medical charges as long as they are both reasonable and necessary.

MCL 500.3157 says:

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.

This comprehensive statute ensures that injured motorists can collect benefits from everything from surgery to occupational therapy to prosthetic devices. However, the amount of those benefits are often the heart of intense legal debate.

Necessary Medical Treatment

Unfortunately, auto insurance providers often believe themselves better qualified to plan claimants’ medical treatment than the doctors overseeing their care. Insurance adjusters will often claim that a particular treatment is “unnecessary” or that a patient has already received all the benefit a particular treatment can give. Defense counsel will provide reports by “independent” medical experts to support this position. However, this often ignores the need for ongoing maintenance treatment to prevent atrophy or further disability.

To combat this, your auto accident attorneys will need to work with your doctors and treating professionals. As a team, they will present a complete story of your recovery and explain just what will happen if you stop receivig care.

Reasonable Medical Charges

When a medical practitioner brings a lawsuit against an insurance company, settlement often hinges on how much the doctor or hospital charges. The treating physician may join your lawsuit as an “intervening party” or files a separate lawsuit to collect benefits. Either way, you can expect the defendants to claim the doctor was overcharging for his or her services.

The insurance company doesn’t get to directly set the cost of medical care. However, it can compare what other hospitals charge for similar treatments to decide what is reasonable. If your doctor’s bill is higher, they may only offer to settle based on an average charge.

It’s important for the attorneys representing doctors and patients to work together throughout the negotiation process. Otherwise, one party could accept a settlement that shorts the other party. If your medical provider settles for less than they are owed, they could come after you for the difference, unless the settlement says otherwise. If the patient settles for too little, the medical provider may be forced to settle for pennies on the dollar because it is all the patient has to give them.

The attorneys at Christensen Law will help you fight back against insurance companies trying to short change your no-fault benefits. You don’t have to accept a small settlement. Your attorneys can establish reasonable medical care and get all your medical expenses covered.