No fault, no fixes: Insurers ‘still try to pay nothing’

Michigan's elected leaders have long acknowledged problems in the state's 2019 reforms, and Ruckle-Mahon said she'd grown weary of waiting for the Legislature to address them.

At least, she said, it looked like the court was doing something.

"We thought it was a victory," Ruckle-Mahon said. "And it has improved a few things, but insurance companies still look for loopholes. They still try to pay nothing."

Ellen Andary, 67, of East Lansing, was lead plaintiff in a case the court decided in July, with judges ruling 5-2 that no-fault reforms passed in 2019 could not be applied retroactively.

Andary suffered a brain injury while riding in a vehicle struck by a drunken driver, and her attorneys successfully argued that her round-the-clock care was interrupted when legislators failed to "grandfather in" survivors injured before reforms were passed.

In 2007, when she was 9, Ruckle-Mahon's daughter, Brittney Ruckle, also suffered a brain injury in a car crash, and is among the estimated 18,000 survivors whose care was negatively impacted when reforms were signed into law.

Passage with problems

"They knew there were problems, but they passed it anyway," Ruckle-Mahon said. "This is not a Democrat or Republican issue — both parties are to blame."

Before the reforms, Michigan was the only state where drivers were required to pay for personal injury insurance with unlimited medical benefits for catastrophically injured survivors.

Reforms made this coverage optional as of June 2019, which supporters said would save people money on their premiums — that were then among the highest in the nation, according to a trade group, Insurance Alliance of Michigan.

Reforms also mandated a 45-percent rate reduction in charges insurers would pay to those providers of care for car crash survivors — a provision which didn't take effect until July 2021 and was designed to further reduce premiums.

Supporters say insurance customers in Michigan are still saving money and, with lowered prices, more uninsured drivers in the state have purchased policies.

"Reforming the state's broken auto no-fault system has saved Michigan drivers more than $5 billion in reduced insurance costs and allowed more than 200,000 previously uninsured drivers to purchase auto insurance," said Erin McDonough of the IAM.

A consequence of the rate-reduction provision, however, is that some providers discharged their auto insurance patients and clients, stopped accepting others, have gone out of business — or all three, according to the Michigan HomeCare & Hospice Association.

"How many wheelchairs do we need to bring to Lansing? How many companies need to close?" a Mount Clemens home care provider, Bob Mlynarek, asked members of a Senate committee in October.

"It's been four years," Mlynarek said. "Enough is enough."

State senate bills

Days after Mlynarek's testimony, the Senate passed reform repair bills that Ruckle-Mahon still calls "tiny fixes" (SB 530, SB531 and SB575).

Sen. John Damoose, R-Harbor Springs, who voted for the fixes, mentioned the Ruckle-Mahon family in a floor speech.

Damoose said some car crash survivors were twice devastated — first by the car crash and then when they "lost the insurance coverage they had bought and paid for."

These were unintended consequences, Damoose said, of an otherwise well-intentioned law.

"When auto no-fault reform was passed, almost everybody said it would need to be tweaked along the way," Damoose said. "We tried to change it last year, but we were told we needed to give it more time to see how the reforms would work."

In January, Gov. Gretchen Whitmer told Off the Record anchor Tim Skubick, 2019 no-fault reforms gave consumers more choice, while she also acknowledged concerns about people injured prior to the law change.

"I think, with the Supreme Court ruling, it now gives us the ability to ascertain where can we make some additional improvements," Whitmer said. "I think this has got to come from the Legislature," adding, "We'll get it right."

Leaders of the Michigan Brain Injury Provider Council said they were dismayed the issue was not mentioned in Whitmer's Jan. 24 State of the State address.

And as of Friday, the Senate-passed bills have been parked in the House Insurance and Financial Services Committee with no hearing scheduled.

Committee Chair Brenda Carter, D-Pontiac, did not return requests for comment.

Carter in December told Bridge Michigan the proposed Senate legislation "would turn the clock back on reform and raise costs."

"We must be cautious with drafting legislation for such a complicated system," she said, adding a "narrow fix" was needed that would not raise rates for those who could least afford it.

Therapy on Tuesday

Back at the Ruckle-Mahon home, it's a typical Tuesday afternoon.

Todd Nienhouse, owner of Agevix, a Traverse City-based physical therapy practice, was there for a regular appointment with Brittney Ruckle.

Ruckle, now an outgoing, optimistic 26-year-old, greeted Nienhouse with a smile and then, with her mom's help, the trio got to work.

"It's exercise therapy, but it's way more than that, it's getting her moving, it's gross motor skills, we've seen the best gains and she really works at it," Ruckle-Mahon said. "It's really important for her spinal cord injury."

Nienhouse echoed difficulties experienced by other providers, despite the state Supreme Court's ruling.

"What happens with the big insurance companies now is they have medical review teams and third-party payment providers that slow things down," Nienhouse said. "We send in our documentation and our invoices and wait."

Medical reviewers have the power to deny coverage, he said, and he's lost several clients this way. Medical reviewers now do what insurance adjusters used to do and information on what is approved and when payment will be provided is hard to come by.

"You have to be a pretty savvy biller to follow all these requirements," Nienhouse said. "And to talk to someone? Forget about it — on hold for hours and nobody calls back."

Earlier that day, Ruckle-Mahon had taken Brittney Ruckle to the orthodontist to see about braces.

That had been the plan in the months before the 2007 car crash, Ruckle-Mahon said, and they were just now, 16 years later, getting back to it.

"She smiles so much, she's such a joy, that's why we wanted to pursue it again," Ruckle-Mahon said.

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