Since the 2019 amendments, the fight in Michigan no-fault is less often about whether treatment happened and more often about what an insurer is required to pay for it. Fee schedule calculations, utilization review, coding disputes, and the one-year-back rule now decide most provider claims.
For medical providers
The firm represents clinics, physical therapy practices, imaging and laboratory providers, transportation companies, attendant care providers, and durable medical equipment suppliers pursuing payment from no-fault insurers.
- Suits on assignments of benefits for denied and underpaid claims
- Fee schedule disputes under the amended act, including the Medicare-based calculations and the treatment of services with no Medicare analog
- Utilization review determinations and appeals
- Coding, bundling, and medical necessity denials
- The one-year-back rule and the tolling that an assignment does and does not provide
- Explanation-of-review and payment-log reconciliation across long claim histories
- Penalty interest and attorney fees on overdue benefits
- Coordination of benefits and priority disputes between carriers
For injured claimants
- Denied, terminated, or cut-off PIP benefits
- Wage loss, replacement services, and attendant care claims
- Independent medical examination disputes and benefit terminations based on them
- Assigned Claims Plan and priority questions when no policy applies
- Fraud and rescission defenses raised by carriers
The one-year-back rule is the claim killer. Michigan generally limits recovery to expenses incurred in the year before suit is filed. Every month a provider waits on an aging receivable is a month of billing that stops being recoverable. Aged AR should be reviewed on a schedule, not when someone notices.
How provider matters are handled
Most provider files start with a reconciliation: what was billed, what was paid, what was denied, and on what stated basis. That analysis frequently shows that a portion of the balance is recoverable and a portion is not — which is the difference between a demand that gets paid and one that gets ignored. The firm will explain the fee arrangement after reviewing a sample of the file.
Common questions
Can a medical provider sue a no-fault insurer directly in Michigan?
A provider that holds a valid assignment of benefits from the patient can bring its own action against the insurer. The assignment's wording, its timing, and any anti-assignment language in the policy all matter, so the assignment is the first document to review.
What is the one-year-back rule?
Michigan's no-fault act generally limits recovery to expenses incurred within one year before the action is filed. It is not the same thing as a statute of limitations, and it quietly erases old billing even where the claim itself is timely.
Why did the insurer pay only part of our bill?
Most commonly the carrier applied the statutory fee schedule, reduced the charge through utilization review, recoded the service, or asserted that the treatment was not reasonably necessary. Each has a different response, and the explanation of review usually says which one is being used.
How are provider reimbursement matters billed?
It depends on the size and age of the receivable. The firm will review a sample of the file and explain the fee arrangement that fits before any work begins.
Speak with the firm about this
Describe the situation and any deadline. The firm responds to time-sensitive matters the same business day.