MICHIGAN ASSIGNED CLAIMS PLAN Holli La Joice Michigan

MICHIGAN ASSIGNED CLAIMS PLAN Holli La. Joice, Michigan Assigned Claims Plan Manager

Why the transition? § In 1997 the Assigned Claims Assessment was $37. 7 million. § By 2011 the Assigned Claims Assessment was $172. 7 million. § That is a total increase of 358% over a 14 year period. This was not ignored. § According Dr. Gary Wolfram, the director of economics at Hillsdale College, in October of 2010 it was determined that the Assigned Claims Assessment was 2. 4 times that of the consumer purchased policy’s PIP payments. Year Over Year Assessment 2015 $238, 737, 085 4. 82% 2014 $227, 748, 456 . 44% 2013 $226, 759, 696 10. 94% 2012 $204, 401, 454 18. 33% 2011 $172, 733, 186 7. 94% 2010 $160, 023, 835 7. 79% 2009 $148, 455, 608 4. 97% 2008 $141, 423, 725 9. 66% 2007 $128, 962, 504 7. 72% 2006 $119, 721, 603 17. 11% 2005 $102, 232, 840 23. 24% 2004 $82, 955, 356 16. 56%

The Transition § On June 26, 2012 Governor Rick Snyder signed into law House Bill Number 4455. § On December 17, 2012 the operations of the Assigned Claims Plan was transferred to the Michigan Automobile Insurance Placement Facility (MAIPF).

Assigned Claims Plan Michigan No Fault Statutes § § The statutes that apply to specifically to the MACP are MCL 500. 3171 -3178. www. legislature. mi. gov (enter the statute number on the “MCL Section. ” Pertinent statutes to medical providers: § MCL 500. 3172 (1)-A person entitled to claim because of accidental bodily injury arising out of the § ownership, operation, maintenance, or use of a motor vehicle as a motor vehicle in this state may obtain personal protection insurance benefits through the assigned claims plan if no personal protection insurance is applicable to the injury, no personal protection insurance applicable to the injury can be identified, the personal protection insurance applicable to the injury cannot be ascertained because of a dispute between 2 or more automobile insurers concerning their obligation to provide coverage or the equitable distribution of the loss, or the only identifiable personal protection insurance applicable to the injury is, because of financial inability of 1 or more insurers to fulfill their obligations, inadequate to provide benefits up to the maximum prescribed. MCL 500. 3172 (2)-Except as otherwise provided in this subsection, personal protection insurance benefits, including benefits arising from accidents occurring before March 29, 1985, payable through the assigned claims plan shall be reduced to the extent that benefits covering the same loss are available from other sources, regardless of the nature or number of benefit sources available and regardless of the nature or form of the benefits, to a person claiming personal protection insurance benefits through the assigned claims plan…. "sources" and "benefit sources" do not include the program for medical assistance for the medically indigent under the social welfare act, 1939 PA 280, MCL 400. 1 to 400. 119 b, or insurance under the health insurance for the aged act, title XVIII of the social security act, 42 USC 1395 to 1395 kkk-1.

Michigan No Fault Statutes Continued… § MCL 500. 3173 - A person who because of a limitation or exclusion in sections 3105 to 3116 is disqualified from receiving personal protection insurance benefits under a policy otherwise applying to his accidental bodily injury is also disqualified from receiving benefits under the assigned claims plan. § MCL 500. 3173 a(1)-The Michigan automobile insurance placement facility shall make an initial determination of a claimant's eligibility for benefits under the assigned claims plan and shall deny an obviously ineligible claim. The claimant shall be notified promptly in writing of the denial and the reasons for the denial. § MCL 500. 3173 a(2)-A person who presents or causes to be presented an oral or written statement, including computer-generated information, as part of or in support of a claim to the Michigan automobile insurance placement facility for payment or another benefit knowing that the statement contains false information concerning a fact or thing material to the claim commits a fraudulent insurance act under section 4503 that is subject to the penalties imposed under section 4511. A claim that contains or is supported by a fraudulent insurance act as described in this subsection is ineligible for payment or benefits under the assigned claims plan. § MCL 500. 3174 - One year notice provision

The Structure of the MACP § Directed by a Board of Governors: § 2 Public Representatives(appointed by the insurance commissioner) § 2 Insurance Agent Representatives (appointed by the insurance commissioner) § 7 Representatives from Michigan Insurance Companies § Additionally, there is one Department of Insurance Representative in attendance at all meetings § The administration of the MACP is assessed to all Michigan participating insurance companies once per year, who then pass on the costs to auto insurance customers. Large MACP assessment = larger insurance premiums for customers. § Subsequently, it is vital that the MACP takes a stance against insurance fraud!

What Changed? § A new Application for Personal Injury Protection Benefits was created. § A new process for requesting the claimant or medical provider proactively determine the MACP is the proper place for coverage instead of the MACP being the first stop for coverage (MCL 500. 3114). § Online claim submissions § Information available on the MACP website, www. michacp. org

The MACP Application and what is needed for possible assignment of the claim. § A complete application for benefits along with proof of the loss are necessary for claim assignment. § The MACP Application for benefits: § Proof of Loss: § While there is no black and white definition of proof of loss, some examples are: § A Police Report taken at the scene of the accident § An EMS report from the scene of the accident

Most Common PIP Disqualifications § § § § Owner/Registrant of the involved uninsured motor vehicle A motor vehicle was not involved An injury did not arise out of a motor vehicle accident The involved vehicle was taken by the injured party without permission Out of state resident in an out of state vehicle that did not carry Michigan certified insurance Written notice was not provided within one year from the date of the accident For the MACP-Accident did not occur in Michigan For the MACP-There is higher identifiable coverage

Questions? ? Visit our website anytime at: www. michacp. org