Detroit, Michigan No-Fault Insurance Issues – Case Management and the Law

Though Michigan's No-Fault law is not a managed care system, insurance companies frequently hire case managers to assist in processing benefits claims.  The case managers' role is to act as liaison between the patient and the insurance company.  However, the No-Fault statute does not specifically require a patient to work with their insurance company's case manager.  Unfortunately, some insurance companies lead patients to believe that they must cooperate with the case managers assigned to them or risk jeopardizing their benefits claims.  At Sinas, Dramis, Brake, Boughton & McIntyre, P.C., serving Detroit and communities throughout Michigan, our No-Fault insurance attorneys work with auto accident victims to ensure that they receive the full benefits they are entitled to by law.

The Role of Case Managers

In Michigan's No-Fault insurance system, the patient holds the power.  Though more and more insurance companies are using case managers to assist in processing benefits claims, there is no language included in Michigan's No-Fault law that requires victims to work with case managers. 

Where appropriate, however, a case manager can be very helpful in coordinating medical care, assisting the injured person in accessing community resources, and making arrangements regarding issues of daily living.  A case manager can also be a valuable intermediary between the patient and the insurance company.  The involvement of a case manager can help to keep communication lines free and open and to facilitate the prompt payment of benefits.

At all times, the case manager must act as an advocate for the best interests of the patient.

Case Managers and Michigan's No-Fault Law

Michigan's No-Fault law is silent regarding the involvement of case managers in the handling of benefit claims.  Whether a case manager is needed to assist you in your claim depends on the specific facts of your case.  You should know, however, that if insurance companies use case managers as a gatekeeper to obtain preauthorization before you are provided medical treatment, that type of conduct is not allowed under Michigan law.  In short, insurance companies cannot:

• Obligate a No-Fault claimant to work with a case manager as a pre-condition to receiving No-Fault benefits.
• Require medical providers to deal with case managers as a pre-condition to receiving payment for medical services rendered.

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Contact Our Attorneys who handle No-Fault Insurance Cases throughout Michigan

Case managers can be valuable assets to auto accident victims during the benefits claims process.  When they exceed their authority, however, victims need assertive representation to ensure that they receive the compensation to which the law entitles them.  If you or a loved one has been injured in a car accident, contact Sinas, Dramis, Brake, Boughton & McIntyre, P.C., serving Detroit and all of Michigan. Our No-Fault insurance attorneys will protect your rights.