Bill Text: MI HB5106 | 2017-2018 | 99th Legislature | Introduced

---

Bill Title: Insurance; no-fault; personal protection insurance; make miscellaneous changes to payment of allowable expenses, and revise effect of fraud on certain claims for benefits. Amends sec. 3107 of 1956 PA 218 (MCL 500.3107) & adds secs. 3113a & 3113b.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2017-10-17 - Bill Electronically Reproduced 10/12/2017 [HB5106 Detail]

Download: Michigan-2017-HB5106-Introduced.html

---

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HOUSE BILL No. 5106

 

 

October 12, 2017, Introduced by Reps. Roberts, Wittenberg, Chirkun, Frederick, LaGrand, Moss, Brinks, Camilleri, Chang, Ellison, Green, Sabo, Liberati, Webber, Sowerby, Sneller, Pagan, Howrylak, Lasinski, Faris, Love, Byrd, Hammoud, Scott, Geiss, Greimel, Hertel, Gay-Dagnogo, Jones, Rabhi, Robinson and Zemke and referred to the Committee on Insurance.

 

     A bill to amend 1956 PA 218, entitled

 

"The insurance code of 1956,"

 

by amending section 3107 (MCL 500.3107), as amended by 2012 PA 542,

 

and by adding sections 3113a and 3113b.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 3107. (1) Except as provided in subsection (2), personal

 

protection insurance benefits are payable for the following:

 

     (a) Allowable expenses consisting of all reasonable charges

 

incurred for reasonably necessary products, services, and

 

accommodations for an injured person's care, recovery, or

 

rehabilitation. Allowable expenses within personal protection

 

insurance coverage shall do not include either of the following:

 

     (i) Charges for a hospital room in excess of a reasonable and

customary charge for semiprivate accommodations except if the

 

injured person requires special or intensive care.

 

     (ii) Funeral and burial expenses in excess of the amount set

 

forth in the policy, which shall must not be less than $1,750.00 or

 

more than $5,000.00.

 

     (b) Work loss consisting of loss of income from work an

 

injured person would have performed during the first 3 years after

 

the date of the accident if he or she had not been injured. Work

 

loss does not include any loss after the date on which the injured

 

person dies. Because the benefits received from personal protection

 

insurance for loss of income are not taxable income, the benefits

 

payable for such loss of income shall must be reduced 15% unless

 

the claimant presents to the insurer in support of his or her claim

 

reasonable proof of a lower value of the income tax advantage in

 

his or her case, in which case the lower value shall apply.

 

applies. For the period beginning October 1, 2012 through September

 

30, 2013, the benefits payable for work loss sustained in a single

 

30-day period and the income earned by an injured person for work

 

during the same period together shall must not exceed $5,189.00,

 

which maximum shall apply must be applied pro rata to any lesser

 

period of work loss. Beginning October 1, 2013, the maximum shall

 

must be adjusted annually to reflect changes in the cost of living

 

under rules prescribed by the commissioner director, but any change

 

in the maximum shall apply applies only to benefits arising out of

 

accidents occurring subsequent to that occur after the date of

 

change in the maximum.

 

     (c) Expenses not exceeding $20.00 per day, reasonably incurred

in obtaining ordinary and necessary services in lieu instead of

 

those that, if he or she had not been injured, an injured person

 

would have performed during the first 3 years after the date of the

 

accident, not for income but for the benefit of himself or herself

 

or of his or her dependent.

 

     (2) Both of the following apply to personal protection

 

insurance benefits payable under subsection (1):

 

     (a) A person who is 60 years of age or older and in the event

 

of an accidental bodily injury would not be eligible to receive

 

work loss benefits under subsection (1)(b) may waive coverage for

 

work loss benefits by signing a waiver on a form provided by the

 

insurer. An insurer shall offer a reduced premium rate to a person

 

who waives coverage under this subsection for work loss benefits.

 

Waiver of coverage for work loss benefits applies only to work loss

 

benefits payable to the person or persons who have signed the

 

waiver form.

 

     (b) An insurer shall is not be required to provide coverage

 

for the medical use of marihuana or for expenses related to the

 

medical use of marihuana.

 

     (3) All of the following apply to a claim for allowable

 

 expenses under subsection (1)(a):

 

     (a) The required causal connection between an accidental

 

bodily injury and the claim is considered to be established if both

 

of the following apply:

 

     (i) The accidental bodily injury, or its consequences, is 1 of

 

the causes, direct or indirect, of the injured person's need for

 

the claimed allowable expense, even though there may be other

causes, conditions, or reasons contributing to that need.

 

     (ii) The claimed causal connection is not so incidental or

 

attenuated as to be considered de minimis.

 

     (b) Subject to subdivision (a), an insurer shall not deny

 

payment of a claim, or a portion of a claim, for a product,

 

service, or accommodation on the grounds that it is an everyday

 

ordinary expense that the injured person would have incurred for

 

similar products, services, or accommodations had the accidental

 

bodily injury not occurred, if it is shown that the injured

 

person's need for the clamed product, service, or accommodation has

 

been affected or altered by the accidental bodily injury that gives

 

rise to the claim. If such a showing is made, the claim may not be

 

reduced or diminished by any amount that allegedly represents

 

expenses that the injured person would have incurred for similar

 

products, services, or accommodations had the accidental bodily

 

injury not occurred.

 

     (c) A charge for a product, service, or accommodation is

 

deemed to have been incurred by the injured person if any of the

 

following have been demonstrated:

 

     (i) The injured person or his or her estate has paid all or

 

part of the charge or has become liable, unconditionally or

 

conditionally, to pay all or part of the charge.

 

     (ii) The injured person or his or her estate has provided

 

written documentation to the insurer that reasonably establishes

 

that the charge is for a product, service, or accommodation that is

 

reasonably necessary for the injured person's care, recovery, or

 

rehabilitation.

     (iii) The product, service, or accommodation has actually been

 

provided to the injured person.

 

     (d) If the injured person, or someone acting on his or her

 

behalf, submits reasonable proof that a particular product,

 

service, or accommodation is reasonably necessary for the injured

 

person's care, recovery, or rehabilitation and the injured person

 

desires to be provided with that product, service, or

 

accommodation, the expense for the product, service, or

 

accommodation is deemed to have been incurred and the insurer

 

responsible to pay the claim shall issue written prior approval to

 

the injured person or someone acting on the injured person's behalf

 

and to the provider of the product, service, or accommodation that

 

the insurer will make payment when the product, service, or

 

accommodation has been provided to the injured person. Failure to

 

issue written prior approval under this subdivision within 30 days

 

after receiving reasonable proof as provided in this subsection is

 

deemed to be a denial of the claim and creates a presumption that

 

the denial was unreasonable under section 3148(1). To overcome a

 

presumption that arises under this subdivision, the insurer must

 

present clear and convincing evidence to the contrary.

 

     (4) A claim for personal protection insurance benefits may be

 

made and enforced by a civil action filed by the injured person, by

 

the injured person's representative or fiduciary, or by a person

 

that has delivered, rendered, or provided a product, service, or

 

accommodation for the injured person's care, recovery, or

 

rehabilitation.

 

     Sec. 3113a. The right of a person to claim personal protection

insurance benefits under an automobile insurance policy is not

 

affected by a determination that the policy is void because it was

 

fraudulently procured if the claimant was not a participant in the

 

fraudulent procurement.

 

     Sec. 3113b. The submission of a claim for personal protection

 

insurance benefits that was in some respect fraudulent does not

 

void the insurance policy or the statutory entitlement under which

 

the claim was payable and does not disqualify the claimant from any

 

other past, present, or future personal protection insurance

 

benefits.