Michigan No-Fault Reform: What Accident Victims Get Under the PIP Tier System
Michigan’s 2019 no-fault legislation, including Public Act 21 arising from HB 4397, replaced mandatory unlimited personal-protection-insurance medical benefits with a choice system. Policies may provide unlimited coverage or limits commonly including $500,000, $250,000, and $50,000 for qualifying Medicaid enrollees. Certain Medicare beneficiaries may opt out, and qualified health-coverage rules can support other exclusions. Eligibility requirements must be checked carefully.
The coverage choice affects every serious claim. A lower tier can reduce premiums but leave catastrophic-care expenses beyond the selected PIP medical limit. Claimants and attorneys must identify the policy, household members, priority rules, exclusions, health coverage, and available limits immediately. Wage loss, replacement services, survivor benefits, and medical benefits also have distinct rules and documentation requirements.
The reform imposed medical-provider fee schedules tied to Medicare or other statutory benchmarks. The often-described 45% reduction refers to reimbursement limits affecting some services and providers, not a universal reduction of every bill. Providers serving catastrophically injured patients have argued that reduced reimbursement threatens long-term care availability, while application of the schedules to older accidents has generated significant litigation.
Family-provided attendant care paid by an insurer is generally limited to 56 hours per week, although an insurer may agree to more and professional agencies are treated differently under the statute. Detailed records should identify the task, time, caregiver, medical necessity, and prescribing professional. Families should not assume that around-the-clock need automatically produces reimbursement for every hour.
A person seeking noneconomic tort damages must satisfy Michigan’s threshold, which includes death, serious impairment of body function, or permanent serious disfigurement. Serious impairment analysis focuses on an objectively manifested impairment of an important body function that affects the person’s general ability to lead a normal life. Michigan also permits a limited mini-tort recovery for uninsured vehicle damage, subject to the current statutory cap and comparative-fault rules.
Trial preparation should translate medical findings into concrete changes in the claimant’s life. Before-and-after witnesses, work records, photographs, calendars, treating-provider testimony, and evidence of lost household, recreational, and family functions can make the threshold understandable. Counsel must separate admissible threshold evidence from sympathy alone and should verify current PIP limits, fee-schedule decisions, and mini-tort amounts because the reform remains heavily litigated.