The Michigan Court of Appeals recently published the case, Life Skills Village, PLLC v Nationwide Mutual Fire Insurance Company. This case focused on a dispute for unpaid bills between a medical provider, LSR and an auto insurer, Nationwide.
Here, Nationwide denied bills for reasonably necessary products, services and accommodations for an injured person's care, recovery, or rehabilitation. LSR provided services to Mr. Donald Oliver, who was “severely injured in December 2014 when a car struck him as he was walking across a street. He sustained a closed head injury, a spinal cord injury, and multiple broken bones.” LSR is “a semi-independent residential program that's built on helping assist people transition back to independent living.” “LSR staff would prompt residents such as Oliver in important activities of daily living, such as eating, bathing, taking medication if needed, and seeing doctors when needed.”
And, Nationwide decided not to pay for these services (after paying the first two months). LSR filed suit against Nationwide in the Oakland County Circuit Court. The trial court granted Nationwide’s motion for summary disposition “because LSR was not licensed as an adult foster care facility,” and Nationwide claimed LSR required a license to lawfully provide its services to Mr. Oliver and other auto accident victims under the No-Fault Act.
The Michigan Court of Appeals decided that because LSR didn’t perform the specifically listed services within the definition of MCL 400.704(7), which governs personal assistance under the Adult Foster Care Facility Licensing Act (AFCFLA), it was not required to have a license under the AFCFLA. Moreover the Court of Appeals determined that the trial court erred in its analysis that LSR required a license under the AFCLA because it provided supervision rather than personal care. A license under the AFCLA may have been required if personal care was performed, but ultimately “[t]he lack of personal care means that LSR was not providing adult foster care and did not need to be licensed as an adult foster care facility. Accordingly, the services were not unlawfully rendered.”
The Court of Appeals highlights a very important issue, that the decision of whether a license is needed to provide services to a car accident victim and whether those services should be paid by the No-Fault insurer is “dependent on the facts of each case.” The Court makes a point of not generalizing the activities of a provider, but zeroing in on the fact that Michigan courts must uphold their obligation to allow for the development of facts in each case with a licensing or No-Fault compensability issue and rule based on a review and analysis of those facts specific to “each case.”
A copy of the Life Skills Village opinion can be found here: Life Skills Vill, PLLC v Nationwide Mut Fire Ins Co, __ Mich App ; __ NW2d __ (January 30, 2020)(Docket No. 345237).
The Michigan Law Firm, PC has experienced medical provider attorneys ready to assist with denied bills, auto-insurance short pay scenarios, billing disputes, and unreasonable denials of medical bills. Our office offers free consultations. Contact our office at 844.464.3476 to speak to a Michigan medical provider lawyer today.