The Andary case in Michigan is the July 2023 Michigan Supreme Court decision holding that the state’s 2019 No-Fault auto insurance reforms cannot be applied to people injured in accidents before June 11, 2019. For those earlier claimants, the new caps on family-provided attendant care hours and the Medicare-based fee schedule for medical providers do not apply, and the pre-reform Personal Protection Insurance (PIP) benefits remain in force.1Justia. Andary v. USAA Cas. Ins. Co.2Michigan Department of Insurance and Financial Services. No-Fault Insurance Reform FAQ – Section: Fee Schedule
What the Court Decided
The court’s reasoning turned on vested rights. Once a covered accident happens, the policyholder has a contractual right to the benefits promised under the policy in effect at that moment, and the legislature cannot reduce those benefits after the fact without saying so clearly. The court found no such clear legislative intent behind the 2019 cost-control measures as applied to people already in the system.1Justia. Andary v. USAA Cas. Ins. Co.
Who the Ruling Protects
The cutoff is the date of the accident, not the date of the policy or the date care began. If your automobile accident occurred before June 11, 2019, the pre-reform PIP rules continue to govern your benefits. Insurance carriers cannot lower the standard of care for these long-term claimants, even where treatment is ongoing years later, because the entitlement was fixed when the accident happened.2Michigan Department of Insurance and Financial Services. No-Fault Insurance Reform FAQ – Section: Fee Schedule1Justia. Andary v. USAA Cas. Ins. Co.
Which Benefits Are Restored
Two specific restrictions were struck down for pre-reform claimants. The first was the hourly cap on in-home attendant care provided by family members. The 2019 law had limited the number of hours an insurer was required to pay for that care, and the court held that cap cannot be applied to earlier-injury claims.1Justia. Andary v. USAA Cas. Ins. Co.3Michigan Legislature. MCL § 500.3157
The second was the fee schedule that limited medical provider reimbursements to set percentages of Medicare rates, with tiered figures running from 190% to 230% depending on the facility and the date of service.3Michigan Legislature. MCL § 500.3157 With those ceilings removed for pre-reform claimants, insurers must again pay reasonable charges for reasonably necessary treatment. For people living with traumatic brain or spinal cord injuries, that restores the broader coverage standard that existed before the cost-containment measures.1Justia. Andary v. USAA Cas. Ins. Co.
If You Were Underpaid Between 2019 and 2023
Claimants whose benefits were cut during the years the reforms were being enforced should pull their Explanation of Benefits statements and compare the amounts paid against the original care rates and billed charges. Those statements show where hour caps or Medicare-based reductions were applied, and they are the starting point for any request to the insurer for a catch-up payment.
Act quickly. Michigan’s one-year-back rule generally bars recovery of any loss that occurred more than one year before a lawsuit is filed, so delay directly shrinks what can be recovered.4Michigan Legislature. MCL § 500.3145 If the carrier refuses to adjust its payments to reflect the reasonable charges the court restored, legal counsel can help preserve the right to the withheld funds.