 Miller & Tischler, P.C.
26711 Northwestern Hwy. Ste. 200
Southfield, MI 48033
(248) 945-1040 |
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M&T
No-Fault News
Spring 2012
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26711 Northwestern Hwy. Ste. 200 Southfield, MI 48033 248-945-1040 |
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Dear Friends,
Greetings and welcome to the Spring 2012 edition of our M&T E-Newsletter!
Just as our weather has been unseasonably warm, so is the political environment heating up in this election year. And, as always, our No-Fault issues remain hot!
Sincerely,
Wayne, Ronni, Maureen and Mark |
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Firm News
M & T ABOUT TOWN
M&T has been named in the 2011-2012 US News Best Lawyers
"Best Law Firms" rankings.
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Legal Decisions and Verdicts
NO-FAULT COURT OF APPEALS DECISION ON REASONABLE CHARGE LAW: MARK UPS ON SURGICAL IMPLANTS ARE DISCOVERABLE!
We expect some very significant holdings from our Supreme Court over the next few months. In the interim, we have already seen at least one "game changer" from the Court of Appeals. This is the case of BRONSON METHODIST HOSPITAL V. AUTO-OWNERS INSURANCE. This case involved two different patients who treated at Bronson Hospital after automobile accidents. Both patients had surgery that included surgical implant products, including plates and screws. The insurance company demanded that Bronson Hospital provide the wholesale cost of the surgical implant products and refused to pay unless they received this information. Bronson argued that such a discovery request was improper and that it should not be required to provide this information. The trial court agreed and granted summary disposition in favor of Bronson Hospital. The insurer appealed the decision to the Michigan Court of Appeals.
On appeal, the Court reversed the trial court and held that the No-Fault act permits insurance companies to discover the wholesale costs to the hospital of the surgical implant products for which the patient is being charged. The Court went on to say that the hospital's actual cost for the surgical implants is not dispositive on the issue of whether the hospital's charges were reasonable, the actual cost is certainly a piece of the overall "collage of factors affecting the reasonable rate" of the hospital's charges."
Fortunately, the Court limited application to this decision to surgical implant products. However, a future Court could extend this reasoning to other aspects of treatment and open a huge can of worms - forcing hospitals and medical practices to disclose all kinds of "costs of doing business."
We believe this case is a "game changer" because "reasonable charges" under the no-fault law had always been determined by review of the relevant market place. I.e., charges were reasonable or unreasonable in comparison to the charges of other service providers. Now it appears that the Court of Appeals is willing to have courts and juries entertain the excruciating process of analyzing component costs (so far, limited just to surgical implants) and reaching determinations on case-by-case bases as to whether the profit margin on that cost is reasonable. If this decision stands, we can expect insurance fishing expeditions into other component costs, and arguments about whether profit margins are reasonable. This obviously will tend to penalize well managed companies, i.e., companies who are able to keep their costs down and therefore have a higher profit margin. This author would much prefer the market mechanism be used to determine whether charges are reasonable.
ATTORNEY FEES FROM SERVICE PROVIDERS
In our last edition, we reported on the Supreme Court decision in Miller v. Citizens. This case seemed to lay to rest the efforts of plaintiff attorneys to take fees from service providers who didn't hire them or want their services. The case clearly held that the service provider "...is not liable for plaintiff's attorney's fees under the no-fault act...[T]he no-fault act generally requires each party to pay its own attorney fees." This holding is nothing but common sense. After all, when service providers render services to their patients, the patients are their debtors; service providers are their creditors. It makes no sense to have the debtor hire attorneys to collect their debts at the expense of the creditor!
Just when we thought this area of law was settled after years of conflict, the Court of Appeals issued an opinion in Nicholson v. Citizens, allowing the plaintiff's attorney to take a fee from plaintiff's service provider. This is an unpublished decision, so it does not have precedential force. Moreover, we believe this opinion is completely inconsistent with what the Supreme Court held in Miller, so we will be appealing this decision.
AUTO NEGLIGENCE CASES/SETTLEMENTS
Wayne Miller achieved two excellent settlements in automobile negligence cases in the first quarter of 2012. One case involved a woman who suffered a fractured ankle when another car turned left in front of her and collided. We settled this case for $95,000.
The second case involved another woman who was injured when the defendant driver also turned left in front of her, resulting in several serious fractures and extended medical care. This case was challenging because the driver contested his negligence (claimed our client had run a red light), and because our client had extensive pre-existing and disabling conditions. Careful deposition of the defendant driver resulted in admissions that he did not see our client before the collision. This resulted in a settlement of $300,000.
Ronni Tischler also recently settled an auto negligence/wrongful death lawsuit filed in Macomb County Circuit Court. A negligent driver ran a red light and struck our 87- year-old client's vehicle. Her acute injuries included a fractured scapula, pleural effusion, and significant bruising. Though she had some health challenges before the accident, she remained a dynamic and energetic woman, who took care of her home, garden and husband (who was in the beginning stages of Alzheimer's) without outside assistance. Her health continued to deteriorate following the accident, and she eventually developed an infection and died several months later. Given our client's numerous pre-existing conditions, the case involved many complex medical issues. In her handling of the case, Ronni effectively demonstrated how the significant trauma to our client's frail body aggravated and accelerated the progression of her pre-existing health conditions. The case settled for $99,000 early in the litigation due to all of the investigatory work done to prepare the case before suit was even filed.
NO-FAULT LEGISLATION
We all know how frenzied were the efforts last fall to fight insurance efforts to change our No-Fault law. Though this fight seems to have moved off of the front burner and off the front pages, be assured that the insurance industry continues to seek changes in the No-Fault law. These include efforts to provides "caps" that are dramatically lower than our current unlimited system; fee schedules for service providers; and so on. Just recently, the MCCA announced that it would raise premiums by $30, to the highest levels in the history of No-Fault. Consumer groups fear that this is a political move, designed to scare the public into demanding the reforms sought by the insurers. We remain concerned that the MCCA's rate making machinery is not transparent. A lawsuit is pending to demand information about how MCCA determines its rates. So be aware that the battle to change No-Fault is not over, and it will continue over the coming months. Please continue to be alert and assertive in protecting our No-Fault system. Stay tuned! |
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What if my home is not handicap
accessible?
Few homes are originally built barrier-free or handicap accessible. Thus, most homes require modification to meet your needs if you are catastrophically injured. Ramps, lifts, emergency exits, bathroom facilities, accessible kitchens and much more may be needed. Should your injuries require special accommodation, your No-Fault insurer is obligated to pay for all reasonably necessary modifications. To read the actual statute identifying home modifications as a compensable benefit click here.
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Testimonials
"Ronni: I hope all is well with you. I'm sorry it's taken me so long to get back with you, but I wanted to wait til "mission accomplished." It was on Friday -11/11/11! My beautiful, very high tech van made its way here, and is now in my garage. I have to wait til tomorrow to really drive it, as I have to make it legal. It has ALOT of bells and whistles, and is a little overwhelming. Especially for someone like me, whose last vehicle was an '82 Chevy S10. I was lucky to have a steering wheel! I just want to take very good care of it, so it will last a long time.
There is a "check in the mail" for you, and I want to thank you for how reasonable your bill was. I think you cut me a break, and I am very appreciative. I think you're great, and so does Michelle.
I sent a letter to my state Rep re: the proposed changes to our MI No-Fault laws. I really can't see even this Republican controlled state govt. changing the law that few Michiganders really want changed. Alot of jobs are at stake, as well as the fact that without our no fault coverage, many of us will end up on Medicaid. I don't see the state wanting that burden.
Anyway...I've got my wheels, and your assistance made it possible."
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About Our Law Firm
Miller & Tischler, P.C., represents survivors of catastrophic brain and spinal injuries, their families and their professional service providers who are having difficulty pursuing their entitlement to receive No-Fault benefits for injuries sustained in motor vehicle accidents. We help our clients understand how their No-Fault insurance may coordinate with other kinds of insurances they have whether it be private health insurance, Medicaid, Medicare, Workers' Compensation, or Veterans benefits. We also assist our clients in learning about and obtaining all of the benefits to which they are entitled, whether they be individuals or service providers.
Let Us Help You.
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