PIP benefits under the No-Fault Act (NFA); Claim for PIP benefits that exceeded the fee schedule provisions in MCL 500.3157; Andary v USAA Cas Ins Co; MCL 500.2111f

In this “claim for PIP benefits that exceeded the fee schedule provisions delineated in MCL 500.3157,” the court concluded “that the trial court erred in denying [defendant-insurer’s] motion for partial summary disposition because all relevant events, comprised of policy renewal, accident, injury, and treatment, occurred after the statutory enactment of the amendments to the” NFA. Following an auto accident, plaintiffs-guardian and conservator for protected individual RD contended the fee schedules in MCL 500.3157 did not apply to services provided to RD after 7/1/21. “The plain language of MCL 500.3157 provides that the fee schedules apply to treatment or training rendered after” 7/1/21. To avoid application of the 7/1/21 fee schedule caps, plaintiffs contended Andary found the “caps in MCL 500.3157 were inapplicable.” Contrary to their claim, “the Andary Court concluded that the amendments to the [NFA] applied at the earliest ‘to those individuals who were injured while covered by an insurance policy issued on or after [6/11/19],’ and at the latest, applied ‘to those individuals who were injured by an insurance policy issued after [7/1/20], that incorporated the requirements of the 2019 amendments.’” The Andary Court did not determine, as plaintiffs alleged, “that it could not apply to their policy that was issued on [10/1/19] because the amendments . . . were only applied to policies issued after [7/1/20]. Our review of MCL 500.2111f reveals that it required an automobile insurer in Michigan to file premium rates for PIP coverage to the insurance director before [7/1/20].” The court found that its “disposition of this matter is not solely contingent upon MCL 500.3157 or MCL 500.2111f. Rather, because PIP benefits required by the [NFA] arise from both statutory and contract law, we must examine whether the injured person is covered under the terms of a no fault policy and the applicable PIP benefits.” The accident occurred on 10/25/19, “24 days after the policy was in effect. The amendments to the [NFA] took effect on [6/11/19]. Therefore, at the time of the accident, the amended [NFA] applied. The scope of available PIP benefits vested when the accident occurred on [10/25/19].” The court noted that under “Michigan insurance law, the rights and obligations of the parties vest at the time of the accident. But, a PIP benefits claim for a specific amount of money to pay for medical services does not accrue until the expense is actually incurred.” The court found that “although the amendments to the [NFA] took effect on [6/11/19], MCL 500.3157(2) set forth a reduction in the amount of the benefit covered contingent on the date the service was performed for treatment rendered after [7/1/21] and before [7/2/22], MCL 500.3157(2)(a) covered 200% of the Medicare rate. Defendant presented documentary evidence addressing the date of the service provided, the bills reflecting the fee charged, the Medicare fee scheduling price, and the computed benefit amount premised on the Medicare schedule. Plaintiffs did not challenge defendant’s calculation of the covered benefit amount under the amended” NFA. Reversed and remanded for entry of an order granting defendant’s motion for partial summary disposition.