October 12, 2017, Introduced by Reps. Canfield, Frederick, Bizon, Sabo, Liberati, Faris, Sneller, Byrd, Yaroch and Scott and referred to the Committee on Insurance.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
by amending sections 3142 and 3157 (MCL 500.3142 and 500.3157) and
by adding section 3149.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3142. (1) Personal protection insurance benefits are
payable as loss accrues.
(2) Personal protection insurance benefits are overdue if not
paid within 30 days after an insurer receives reasonable proof of
the fact and of the amount of loss sustained. If reasonable proof
is not supplied as to the entire claim, the amount supported by
reasonable proof is overdue if not paid within 30 days after the
proof is received by the insurer. Any part of the remainder of the
claim that is later supported by reasonable proof is overdue if not
paid within 30 days after the proof is received by the insurer. For
the purpose of calculating the extent to which benefits are
overdue,
payment shall must be treated as made on the date a draft
or other valid instrument was placed in the United States mail in a
properly addressed, postpaid envelope, or, if not so posted, on the
date of delivery.
(3) An overdue payment bears simple interest at the rate of
12% per annum.
(4) For a claim under a policy that provides personal
protection insurance benefits that are coordinated with, or that
has deductibles or exclusions reasonably related to, other health
and accident coverage on the injured person under section 3109a,
the insurer shall not demand the production of any 1 particular
type of documentation to prove whether any health and accident
coverage is applicable to the claim. The insurer shall accept any
of the following types of documentation reasonably demonstrating
that no other health and accident coverage is applicable to the
claim, or covers the specific claimed benefit at issue:
(a) A copy of the health insurance plan or policy; a summary
plan description; or some other health plan documentation
containing actual plan language, or a summary of the plan language,
showing that the claimed benefit is either not a benefit or not
payable under the plan.
(b) An explanation of benefit or explanation of review form
showing that the claimed benefit is either not a benefit or not
payable under the plan.
(c) Any other documentation or information, including
correspondence or other communication from an authorized
representative of the other health and accident coverage plan,
showing that the claimed benefit is either not a benefit or not
payable under the plan.
(5) By January 1, 2018, an automobile insurer or the
association created under section 3104 shall accept electronic
documentation of proof of a personal protection insurance claim and
the amount of the loss sustained.
Sec. 3149. (1) An insurer that is obligated to pay claims for
personal protection insurance benefits under this chapter has a
duty to deal fairly and in good faith with a person claiming
benefits and the person's service providers.
(2) An insurer that breaches the duty imposed under this
section is liable for compensatory, consequential, economic,
noneconomic, and exemplary damages proximately caused by the breach
and actual attorney fees and the related costs of litigation.
(3) Conduct that constitutes a breach of the duty imposed
under this section includes, by way of example and not by way of
limitation, any of the following:
(a) Making a statement or representation regarding the legal
rights of the claimant or a service provider or the legal duties
and obligations of the insurer that is materially false or
deceptive, if the falsity or deceptiveness of the statement or
misrepresentation was known, or should have been known, by the
insurer or its agents or representatives when the statement or
misrepresentation was made.
(b) Making a threat or an act of intimidation or retaliation
against the claimant or a service provider regarding the
submission, adjustment, or payment of a claim for benefits under
this act.
(c) Failing to pay the claim or a portion of the claim if it
reasonably appears that the insurer owes the claim or portion of
the claim.
(d) Demanding that the claimant submit to a mental or physical
examination under section 3151 performed by an examiner to whom 1
or more of the following apply:
(i) The examiner is routinely hired by insurers to conduct
examinations and has demonstrated himself or herself to be biased
in favor of insurers or is otherwise not fair and impartial with
respect to claimants seeking benefits under this chapter.
(ii) The examiner does not practice in the same specialty as
the health care professional who is treating the claimant.
(iii) The examiner devotes less than a majority of his or her
professional time to active clinical practice or instruction of
students in an accredited health professional school or accredited
residency or clinical research program.
(e) Failing to make reasonable efforts to reconcile
conflicting medical opinions and documentation if it reasonably
appears that a conflict exists, particularly if there is a conflict
between the medical opinions of the claimant's treating medical
providers and the opinions of an examiner hired by the insurer.
(f) Demanding that the claimant or a service provider submit
unnecessary and excessive documentation in support of the claim if
it appears that the claimant or provider has submitted reasonable
proof in connection with the claim.
(g) Any other conduct that demonstrates the insurer has not
dealt fairly and in good faith with the claimant or a service
provider in connection with the claim.
Sec.
3157. (1) A physician, hospital, clinic, or
other person
or
medical institution or
other person that lawfully rendering
renders treatment to an injured person for an accidental bodily
injury
covered by personal protection insurance, and a person or
institution
including, but not limited
to, providing rehabilitative
occupational training following the injury, may charge a reasonable
amount
for the products, services, and or
accommodations rendered.
The
charge shall must not exceed the amount the person or
institution
customarily charges for like
products, services, and or
accommodations
in cases that do not involving involve insurance.
(2) After June 30, 2018, except as otherwise provided in
subsection (5), a person, including a hospital, clinic, or other
medical institution, that lawfully renders products, services, or
accommodations to an injured person for an accidental bodily injury
covered by personal protection insurance is entitled to be paid for
the services at 185% of the maximum amount payable under schedules
of fees for worker's compensation contained in R 418.10101 to R
418.101503 of the Michigan Administrative Code that are in effect
on the effective date of the amendatory act that added this
subsection.
(3) By October 1 of each year after 2017, the director shall
adjust the payment amounts under subsection (2) for the following
calendar year to the greater of the following:
(a) One hundred eighty-five percent of the maximum amount
payable for products, services, or accommodations under schedules
of fees for worker's compensation contained in R 418.10101 to R
418.101503 of the Michigan Administrative Code that are in effect
on the effective date of the amendatory act that added this
subsection.
(b) One hundred eighty-five percent of the maximum amount
payable for products, services, or accommodations under schedules
of fees for worker's compensation contained in R 418.10101 to R
418.101503 of the Michigan Administrative Code that are in effect
on the date of the adjustment.
(c) The amount payable for products, services, or
accommodations under subsection (2) as previously adjusted, if
applicable, under this subsection, adjusted to reflect the
percentage change in the medical care component of the United
States Consumer Price Index for the most recent 12-month period for
which data are available.
(4) An adjustment to fees under subsection (3) applies to
charges for products, services, or accommodations rendered on or
after the date of the adjustment.
(5) Notwithstanding subsections (2) to (4), a person that
renders products, services, or accommodations may, at its sole
discretion, charge and accept payment in an amount that is less
than the amount provided under subsections (2) to (4).
(6) Subsections (2) to (4) only limit the dollar amount
payable for products, services, or accommodations, and do not limit
the scope or duration of products, services, or accommodations that
are allowable expenses payable as personal protection benefits
under section 3107(1)(a).
(7) Subsections (2) to (6) apply to motor vehicle accidents
that occur after June 30, 2018.
(8) Subsections (2) to (7) and (9) do not apply to either of
the following:
(a) Products, services, or accommodations at a hospital
designated as a level I or II trauma center by the American College
of Surgeons Committee on Trauma.
(b) Attendant care, home health aide care, or home nursing
care, regardless of the level of skill or training involved in the
care.
(9) As used in this section, "products, services, or
accommodations" means those products, services, or accommodations
under section 3107(1)(a) that are specifically described and
monetarily quantified to be greater than zero under schedules of
fees for worker's compensation contained in R 418.10101 to R
418.101503 of the Michigan Administrative Code that are in effect
on the effective date of the amendatory act that added this
subsection. A product, service, or accommodation not specifically
described or monetarily quantified to be greater than zero under
schedules of fees for worker's compensation contained in R
418.10101 to R 418.101503 of the Michigan Administrative Code that
are in effect on the effective date of the amendatory act that
added this subsection are subject to the requirements of section
3107(1)(a).
Enacting section 1. This amendatory act does not take effect
unless Senate Bill No.____ or House Bill No.____ (request no.
04183'17) of the 99th Legislature is enacted into law.