‘We should be grandfathered'

A Gaines woman would like to make people aware of what Michigan's no-fault law reform, which went into effect July, could mean for injured victims of automobile crashes that occurred before the new law was passed in 2019.

Gov. Gretchen Whitmer signed the bipartisan no-fault auto insurance reform legislation (Public Acts 21 and 22 of 2019) May 30, 2019 to provide insurance coverage options, lower rates for Michigan drivers while maintaining the highest benefits in the country, and strengthen consumer protections.

Jody Nagy's husband, William, was critically injured in 2017 while riding his trike motorcycle in North Carolina. Jody is 65 and William is 70.

William is currently in an electric wheelchair and requires 24-hour care due to his catastrophic injuries (spinal cord, brain injury, right leg amputation, right brachial plexus injury).

"I gave up a job that I was at for 25 years. I was forced to quit to take care of him," she said. "My income went from $24/hour plus benefits to $12hour."

The Nagys traveled to the capitol in Lansing on Tuesday, Sept. 28 to protest the outcome of the no-fault law that went into effect on July 1.

"This law has set my husband back by months. The insurance adjuster thinks he is God. In fact, he is a bully. In just a few months, they have taken away physical therapy, occupational therapy, massage therapy, care services, and reimbursement of essential medical prescriptions just to name a few," Jody said. "All of these services have been ordered by his doctors and all have letters of necessity. They also show how beneficial these services are and how they impact his everyday life."

While at the capitol, she said she was upset because they were unable to speak with State Sen. Ken Horn, who was notified that they were there. They also were unable to speak with State. Sen. Mike Shirkey. She did send a letter expressing her concerns to the senators.

"These lawmakers must live in a box because they don't understand the anxiety, depression and uncertainty that they have created for all the people affected by this law," she said. "I agree that there needs to be a level of reform in the laws, but this is going too far. It is ridiculous. Shame on all the lawmakers that decided that this was going to fix a problem. They just caused many more."

There is no Michigan no-fault law grandfather clause for the new law. Auto insurers could take advantage of the lack of a clause by using the reform's coverage restrictions and its arbitrary medical fee schedule.

Jody said she was discouraged when conversations with legislators about the new law did not happen as she had hoped for. She admits that she and William will be okay with the reform, but she expressed concern and sadness for others who might not be as fortunate due to their pre-existing medical condition due to a previous auto accident.

She said at the time of her husband's crash, their insurance company told them that if they did not sue the other party, her husband would have medical care for life.

"We should be grandfathered," she said. "I'm sure a lot of people are up against this too."

The Nagys have been back and forth with insurance companies and medical care providers. She said medication reimbursement has been denied. "They don't care," she said.

New Michigan no-fault law, effective July 1, 2021

The following hypothetical situations illustrate how devastating the lack of a Michigan No-Fault law grandfather clause can be for victims, according to the legal experts at michiganautolaw.com.

Prior to the reform law that was passed in 2019, suppose that a catastrophically injured car accident victim was receiving doctor-prescribed 24/7 attendant care (168 hours per week), provided in-home by her husband. He was paid $12.25 per hour (only slightly more than the Bureau of Labor statistics rate) which came out to $294 per day.

Under the reform law, the fee schedule that took effect July 1, 2021, will slash the husband's attendant care hourly rates by 45% to $6.74 per hour.

On top of that, the victim's husband would only be entitled to compensation for 8 hours per day because under the reform law, auto insurance companies are only required to pay for 56 hours per week of in-home, family provided attendant care. That comes out to just $53.92 per day - down $240.08 per day from pre-No-Fault reform.

The resulting scenarios include one or more of the following with the lack of a Michigan No-Fault Law grandfather clause:

The victim and her husband suffer financial ruin because he no longer works outside the home and because insurance will no longer pay him adequately or fully for the attendant care he provides to his wife.

A commercial nursing agency may be needed to provide the remaining 111 hours per week of doctor-prescribed attendant care. The feasibility of this option is uncertain considering that once the fee schedule took effect July 1 many home health care agencies would no longer be providing in-home, attendant care. Additionally, given how low the reimbursement rates are being driven down under the fee schedule, it is likely that the quality of whatever attendant care is available will be lower than what is necessary - and what was available before the reform fee schedule.

The victim may be forced to leave her home and enter a residential care facility (if any continue to operate once the fee schedule took effect July 1, 2021) if arrangements cannot be made to ensure that she is able to receive in her home the 24/7 attendant care that was prescribed by her doctor.