Judge: Auto Insurer Must Keep Paying For Victim’s Medical Care

Berrien County Circuit Court Judge Donna Howard Monday ordered Auto-Owners Insurance Co. to pay Private Duty Home Healthcare of St. Joseph the same rate it was paying before the state's no-fault insurance act cut payments almost in half last summer. The higher rate, which starts today, is $30 an hour for high-tech home health aide care, $51 an hour for a licensed practical nurse and $65 an hour for a registered nurse.

The guardian for Kiera Ogburn, 27, and Private Duty officials filed a lawsuit against Auto-Owners in December, claiming the insurance company is violating the state's no-fault insurance act by cutting how much it is paying to care for Ogburn. Ogburn's guardian is her grandmother, Josephine Wooden.

Monday's ruling was based on an emergency motion for a preliminary injunction concerning the case, which Howard heard last month.

Private Duty officials said they can't continue to care for Ogburn at the reduced rate because it doesn't even cover the wages for the healthcare workers.

Howard stated in her order that it would cause Ogburn "serious and potentially life-threatening harm" if she didn't receive the necessary skilled care while the case is litigated, which could take months.

Howard further ordered Wooden and Private Duty officials to make efforts to find alternative care options for Ogburn or enter into an agreement for Wooden to cover the unreimbursed portion of Private Duty's services under the reduced fee schedule.

Howard denied the part of the preliminary injunction asking that Private Duty be reimbursed at the higher rate for care given to Ogburn since last summer.

She said there is no evidence that Ogburn will suffer irreparable harm if full payment for services already given to Ogburn is delayed.

Ogburn was 17 when she was hit by multiple cars and suffered a traumatic brain injury, leaving her paralyzed and only able to communicate through blinking, according to Wooden. Ogburn and Wooden currently live across the street from one another.

Michigan legislators in 2019 approved changes in the no-fault insurance act that were meant to give drivers more choice and to reduce auto insurance rates.

One of the changes that went into effect July 2 of last year was that auto insurance companies only had to reimburse providers at 55 percent of what they were paying in 2019 for services not covered by Medicare, which includes most home health care. That rate drops to 54 percent this July and to 52.5 percent after July 1, 2023.

No future court dates have been set, yet. Wooden and Private Duty officials have asked for a jury trial.