Reasonable and Necessary Medical Expenses

Reasonable and Necessary Medical Expenses

The Michigan No-Fault Act requires your auto insurance company to pay for all reasonable and necessary medical expenses resulting from a motor vehicle accident. This may sound straightforward, but those 5 words can cause a big fight between medical providers, auto insurance adjusters, and your auto accident attorneys.

Reasonable Medical Expenses

Under MCL 500.3157, part of the Michigan No Fault Act, a medical provider, including a doctor or hospital, is entitled to charge a reasonable amount for services rendered. This can include prosthetic equipment, surgical services, housing in hospitals, and therapeutic treatments.

Unfortunately, auto insurance companies like to put their two cents in when it comes to what that reasonable amount is for medical expenses. And their estimates are almost always low. The law says:

The charge shall not exceed the amount the person or institution customarily charges for like products, services and accommodations in cases not involving insurance.

In other words, your doctor is allowed to charge your insurance company the same amount it would charge an uninsured patient.

But over the years, insurance defense attorneys have tried to tie medical provider benefits to everything from Medicaid and Medicare to Workers’ Compensation schedules. Since the courts have overturned these calculations, they will often measure your medical bills against the benefits paid by other insurance companies. But that’s not the right standard either.

When you file a First Party claim for no-fault benefits, your auto accident attorneys will need to be prepared to demonstrate that the costs of your medical treatment is reasonable compared to ordinary market rates. Often, this requires full disclosure of all medical records, as well as taking your doctor’s deposition.

Necessary Medical Expenses

Auto insurance companies will also try to limit benefits by claiming medical treatment is “unnecessary.” The industry hires “independent” medical experts (IME) to review your file and decide how much care you “really” need. In most cases, the IME report will say the medical treatments you went through were not necessary or that no further treatment is necessary because you have already achieved full recovery.

You and your doctor should be the one deciding your medical treatment plan, not some insurance adjuster. During your doctor’s deposition, and again at trial if necessary, your car crash attorneys will prove that your doctor’s plan was based on medical knowledge and experience. That way, the judge and jury will be able to see they are reasonable and necessary medical expenses.

You shouldn’t have to worry about medical expenses after a serious car crash. Trust the auto accident attorneys at Christensen Law in Southfield, Michigan. They’ll work with you and your doctors to get the benefits you need to pay your bills.