Favot v MemberSelect Insurance: What This Ruling Means for Your No-Fault Claim
The Michigan Supreme Court's decision in Favot v MemberSelect Insurance Company addressed a critical question under the reformed no-fault system: how fee schedule caps apply to medical providers treating auto accident victims. This ruling has direct implications for every Michigan car accident victim's access to medical care and the cost of that care under their PIP coverage.
Background: The 2019 No-Fault Reform and Fee Schedules
Michigan's 2019 no-fault reform didn't just create PIP coverage tiers — it also imposed fee schedules that cap what medical providers can charge for treating auto accident patients. Under MCL § 500.3157, providers are limited to charging a percentage of what Medicare would pay for the same service. This was intended to reduce insurance costs, but it created a tension: many providers found the capped rates insufficient to cover their costs and began refusing to treat no-fault patients.
What the Court Decided
The Favot decision clarified how these fee caps apply in practice, particularly regarding the calculation methodology and which services are subject to the caps. The ruling affects how insurers process PIP claims for medical expenses and how providers bill for auto accident-related treatment. For injured patients, the practical impact is significant — it determines whether your medical providers will accept your no-fault insurance and at what rates.
Impact on Your Personal Injury Claim
If you've been in a car accident in Michigan, this ruling affects you in several ways. First, it may influence which medical providers are willing to treat you under no-fault coverage. Second, it affects how your PIP benefits are calculated and how quickly they may be exhausted — particularly if you chose a coverage tier below unlimited. Third, any gap between your PIP coverage and your actual medical costs becomes part of your third-party claim against the at-fault driver. Koussan Law stays current on all no-fault developments to maximize recovery for clients dealing with fractures, spinal injuries, and other serious accident injuries.
Questions about your no-fault coverage? Call Koussan Law at (313) 800-0000 or use our case calculator.
