Michigan No Fault System

The Michigan No Fault system must be investigated.  Charges have been made that insurance companies, in essence, treat their insureds as adversaries.  It wasn't supposed to be that way.

The Michigan No Fault was passed in the early 1970s.  At that time, insurance companies employed adjusters in local areas.  Adjusters were people who went to the accident scene, met with injured people and got their medical bills, wage loss, replacement service and rehabilitation bills paid.  Adjusters knew the geography and the kinds of people making the claim.  They often helped people with their claims.  They put injured people they insured in their "good hands" or act as "good neighbors."

The No Fault system was thought to be automatic.  Hurt in a motor vehicle accident?  The No Fault insurer paid.  There was an ethical question about whether an attorney could charge a contingent - a percentage - fee for helping a person with the person's No Fault claim.

Insurance companies stopped using local adjusters and began centralizing adjusting service.  Adjusters sit in a centralized office or at home and process files.  No longer do adjusters visit people.  It is a bureaucratic paper process requiring paperwork filed precisely in accordance with company requirements.  A slip up and payments are cut off.

A recent article in the Michigan Association of Justice magazine assails State Farm for using a policy that does not work to make sure State Farm's insured drivers are paid benefits they are entitled to but, instead, to make State Farm money.  The policy, if accurately described in the article, delays payments, for example, to pressure lower settlements.

Insurance companies use a couple of agencies to provide doctors, to examine injured people, and give opinions that claim there is no physical problem.  Anecdotal evidence indicates that insurance company doctors make findings against the injured person at least 90% of the time.

It is time that adjusting practices by insurance companies be vigorously investigated.  Do they treat insureds as "good neighbors" and keep them in "good hands" or do they treat insureds as adversaries?  Until the practices of No Fault companies are exposed to sunlight by investigation, people will need to seek lawyers for advice in a system originally thought to be automatic.

Richard Clark

Local Representation is Best - Here's Why!!

Very often we will receive phone calls from people that have hired attorneys that are not from the Upper Peninsula or even from Michigan.  Usually, these people have had very little contact with their attorney and often are unhappy with the current representation that they are receiving from these attorneys.  What they want is advice from us telling them to fire their attorney and assuring the caller that we will represent him or her.  Unfortunately, we can’t do that.  

According to the Michigan Rules of Professional Conduct, a lawyer shall not communicate with a person the lawyer knows to be represented in the matter by another lawyer.  (MRPC 4.2)

We represent many people with pending Social Security disability cases.  These people are waiting for a hearing and often the wait can be 12 to 18 months.  As you may see on TV, there are many law firms that advertise nationally for Social Security disability cases.  Because it is federal law, a lawyer does not have to be licensed in the state in which they represent someone for a social security disability case.  Therefore, they will advertise nationally, take just about every single case that comes in through their phone line and then once the hook is in to the client, won’t do a very good job of representing the client.  

Just recently, I had a woman call me who was waiting for a decision on her Social Security disability case.  She hired a national firm out of Texas.   When it was time for her hearing, the Texas firm did nothing for her.  She had to track down all of her medical records and submit those.  Then, no one met with her to prepare her for the hearing.  Instead, the Texas firm, hired a Marquette lawyer to go to the Social Security office and sit next to the woman during her hearing.  This lawyer had never met her and had never reviewed her file.  Then, she called us worried that her case was screwed up and wanting help.  Unfortunately, I couldn’t give her advice because she was already represented and I couldn’t tell her I would represent her should she fire her Texas attorney.  It was too late for me to jump into the case, as well, when I didn’t get a chance to look at her file, prepare the medical, and of course, meet a few times and prepare the client for the hearing.  

The short version of this is to warn people to be very careful before hiring a lawyer. While it may seem appealing to hire a big national or state wide law firm, it is often not the best avenue.  Lawyers that practice in the Upper Peninsula have a unique knowledge of the area, the people here, the judges and courtrooms and the procedures.  In addition, most local lawyers care about the people in their own community and want to do what is best for them.  Whether you want to hire Upper Michigan Law or not, please think twice before you hire a firm out of the area.  

Jessica Bray

Michigan Workers’ Compensation Update

Effective December 26, 2014, the new Health Care Service Rules will make it much easier for workers’ compensation insurance carriers to deny reimbursement to physicians who prescribe opioids to injured workers.

Rule 418.101008 will require the physician to submit a written report to the insurance carrier no later than 90 days after the initial opioid prescription fill, and every 90 days thereafter.  In addition, the physician will have to include a treatment plan, which includes periodic urine drug screens.

The new regulation is touted as part of the Workers’ Compensation Agency’s efforts to contain costs for job providers.  (See the Associated Press article on Michigan Radio).

Clearly, this regulation will benefit workers’ compensation insurance carriers; it is another step towards evidence-based medicine.  How it effects physicians, injured workers, and employers remains to be seen.  Can physicians provide the office time to meet with injured workers every 90 days?  Will it be feasible for physicians to meet these reporting requirements?  Will injured workers receive less than optimal treatment for their work injuries, which in turn may prevent them from being able to return to work?  Will insurance premiums be reduced for employers?

Sam Larrabee

Estate Planning

Life has a 100 % risk of death: Plan for it!

It is difficult for us to spend money on problems that haven’t happened yet.  We buy car and home owner’s insurance because we are required to by law. Other types of insurance are personal decisions: Do I buy life insurance and how much? Do I buy a short term or long term disability plan  in case of injury or illness? All of these insurance coverages have something in common: we are making payments now to avoid financial difficulties or even ruin for ourselves and our families in the future.

When it comes to making a will, we are not required by law to do so.  And, since most of us would like to avoid the unpleasant thoughts of incapacity, possible nursing home care and death, we put off doing so. Yet, if we are honest with ourselves, one out of those three events will most certainly happen. We may never be injured in a car accident or fall seriously ill but, one day, all of us will pass.  How well have we have prepared for it?

The uncertainty that we face when making a will is this: Will the Court honor my wishes and my intentions? Do my heirs and family clearly understand what I intended in order to manage my will?

Given the importance of “getting it right”, this is not the time to do-it-yourself by using an internet document.   A good wills and trust attorney will provide you clarity and certainty as you develop and record your wishes and intentions. Some people hesitate to consult an attorney, concerned they will be charged an exorbitant fee and required to take services they do not want. A good estate planning attorney will let you know up front the anticipated cost of drafting a simple will or a more involved trust. The attorney will allow you to choose which plan you are comfortable with and discuss with you goals, pricing and the consequences of particular plans. 

Be cautious if the attorney you have consulted tries to “upsell” you a plan you do not need.  For instance, an individual with limited assets does not need a trust and should not be talked into one. If you are not comfortable with what your potential attorney is telling you, seek other counsel.  A key ingredient to making a satisfactory will or estate plan is that your attorney listens carefully to you. This ensures that your wishes are communicated clearly in the written document. Don’t stay with an attorney who passes you on to support staff after a quick, “cookie-cutter” interview.

Don’t gamble with putting your wishes and intentions in a document you pulled off the internet or got from a  friend.  A good wills and trusts attorney is like an insurance plan.You want to make sure that the document that records your wishes holds up in court when you’re not there to explain what you meant.

Katie Clark

Michigan No-Fault Law

Most people know that Michigan Automobile Insurance Law is called No-Fault or PIP which stands for Personal Injury Protection.  Essentially, what that means is that if you are involved in an automobile accident, no matter who caused the accident, you look to your own insurance for medical coverage, wage loss benefits and household services, among other benefits.  Of course, there are a myriad of factors that go into the analysis of which insurance company covers the claimant and whether or not the claimant is actually entitled to those no-fault benefits.  

In general, no-fault coverage for those above mentioned benefits is payable to people who suffer injuries “arising out of the ownership, operation, maintenance or use of a motor vehicle.”  MCLA 500.3105.  This will include not only those in a motor vehicle but also pedestrians struck by a motor vehicle or a bicyclist.  Excluded from coverage will be a thief or an uninsured person and even perhaps an out-of-state motorist in an out-of-State vehicle not insured by a Michigan compliant insurance company.  However, most Michigan residents with insurance will be covered under the Michigan No-Fault statute.  

The reason this is important, is that our legislators are constantly trying to take away the benefits that the No-Fault Statute affords us.  House Bills (HB) are continuously being brought to the floor and offered to amend those No-Fault protections that we have as Michigan residents.  For example, just in February, HB 4612 (H-3) was offered on the floor of the Michigan House to substitute for H-1 which had been stalled in the House for almost a year.  H-3 imposes unprecedented limitations of medical benefits and treatment and services allowed to those involved in a motor vehicle accident.  More specifically, H-3 seeks to limit benefits for those catastrophically injured in accident by capping lifetime medical for residents and non residents alike.  

Fortunately, we have the Coalition Protecting Auto No-Fault (CPAN) looking out for Michigan residents and monitoring the bills that come before our legislators.  However, if you have concerns about auto No-Fault and your benefits, it is important that you contact your local legislators to voice those concerns.  At this time of year, it is more important than ever.  Many legislators try to push bills though because it will be a “lame duck” session soon.  Watch for this and contact your local representatives.  Already, there is yet another proposal with further attempts to limit your No-Fault benefits call HB 5854.  While plaintiff lawyers and organizations like Michigan Association of Justice and CPAN will do their best to block these bills, it would be helpful if you too spoke up and demanded the No-Fault protections you are entitled too instead of cut or reduced versions of it.  You pay your premiums and someday, you may need the coverage.  

Jessica Bray

What you need to know about Workers' Compensation

Most people don’t know what Workers’ Compensation is until they or a loved one get hurt at work, and if they live or work in Michigan, they soon realize that their ability to feed their family is in jeopardy.

When you get hurt at work, many folks think that they can sue their employer for negligence, but when Michigan enacted its workers’ compensation law, it took away an employee’s Constitutional right to sue their employer for negligence. In return, workers don’t have to prove that their employer was at fault in causing their injury. Companies no longer have to worry about paying out a million dollar judgement to an injured employee. At one time it was a win-win situation for the worker and the employer. 

Not long ago, a worker only needed to prove that they got hurt at work, and if their doctor told them not to go back to work, then they had a right to wage loss benefits and their medical expenses would be covered. Over the last few years, the rights afforded to Michigan workers have been gutted so much, that the recourse for an injured worker is to go back to work or starve.

In 2011, Governor Rick Snyder passed amendments to the Workers’ Compensation law, which served only to gut workers rights and to help the insurance companies deny claims. One of the most atrocious amendments was to sever your relationship with your doctor after you are injured. 

One of the Snyder amendments keeps you from seeing your doctor for 28 days after you are hurt at work. When you get hurt, the insurance company gets to dictate which (if any) doctors you see and what treatment you receive. If you want to see your own doctor, the claim is denied. THIS IS HAPPENING!

Provided Governor Snyder is re-elected, he will pass more laws to prevent you from getting the treatment your doctor recommends. The administration refers to it as “Evidence Based Medicine”, which basically means that a doctor can only provide you with treatment as outlined in the new law. 

If your doctor wants to perform a surgery which isn’t listed in the law or deviates from the sequence of treatment, then you go untreated. Evidence Based Medicine is code for “you only get the treatment Governor Snyder says you get” or “the politicians know what’s best for you—not your doctor.” 

The Snyder amendments have boosted insurance company rights to the drastic detriment of workers and their families, so choose your politicians wisely in November.

Gabe Cameron