John Doe v. A Michigan No-Fault Insurer
Sep 08, 2008OUTCOME: Client's in home nursing care was paid and penalty attorney fees awarded.
This courageous client was rendered quadriplegic in a catastrophic auto accident. A dispute arose with his First Party No-Fault Insurer (“PIP carrier). The Insurer tendered a woefully inadequate all- ... encompassing daily rate for physician prescribed “one on one” 24 hour daily nursing care. When pressed for an explanation of why the rate tendered was so low, the insurance company said it was based on the cost of housing at an Adult Foster Care Facility (AFC Home) where a few “med-techs” would attend multiple patients requiring substantial care. Quite understandably, my client did not want to be institutionalized with impersonal care. He wanted to be in his home with his family and have nursing care provided within his household. Attorney Day sought an injunction which was granted by the Court ordering a reasonable rate that would cover in-home nursing care as the physicians had prescribed. This injunctive relief temporarily allowed my client to stay in his home while the lawsuit pended. The insurance company continued to fight the rate issue in litigation, but finally agreed to pay a reasonable rate for around-the-clock nursing care. The in-home nursing care won for this client amounts to millions of dollars, but more importantly, this legal battle gave a very brave man what he was entitled to under the Michigan No-Fault Act. It allowed him to stay in his home with his loving family. Substantial penalty attorney fees and interest were awarded by the Court against this insurer for its unreasonable denial of benefits.
