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Michigan’s No-Fault insurance system promises coverage for medical care, wage loss, and essential services after a motor vehicle accident. In theory, Personal Injury Protection (PIP) benefits should be paid promptly, without regard to fault. In practice, however, many injured individuals quickly encounter delays, disputes, and outright denials from insurance companies.
For families already dealing with serious injuries—whether it’s a traumatic brain injury, spinal damage, or ongoing rehabilitation—the stress of a Michigan PIP denial can feel overwhelming. Bills pile up, treatment is interrupted, and uncertainty takes hold at a time when stability matters most. Insurance carriers often rely on technical rules and internal reviews to limit or terminate benefits.
At Liss, Shapero & Mitnick, we see firsthand how these denials affect real people across Berkley and Metro Detroit. Our team-based approach ensures that every client receives the full support of our firm—not just a single attorney—because navigating No-Fault disputes requires attention, strategy, and persistence.
Independent Medical Exams (IMEs) and Benefit Cutoffs
What an IME Is and How Insurers Use It
An Independent Medical Exam (IME) is a medical evaluation requested by the insurance company to assess an injured person’s condition and ongoing need for treatment or benefits. While it is presented as “independent,” the exam is typically arranged and paid for by the insurer.
Insurance companies use IMEs as a tool to:
- Evaluate whether treatment is still necessary
- Determine if injuries are related to the accident
- Justify reducing or terminating benefits
The Problem with So-Called “Independent” Exams
Despite the name, IMEs are often anything but neutral. The physicians conducting these exams are frequently selected by insurance companies and may perform large volumes of evaluations for insurers.
This creates a system where:
- The examiner may have a financial incentive to produce findings favorable to the insurer
- The evaluation may not reflect the full scope of the patient’s condition
- Treating physicians’ opinions are minimized or disregarded
Red Flags in IME Reports
Not all IME reports are created equally. Certain warning signs may indicate that the evaluation was not thorough or objective:
- Brief evaluations
Exams that last only a short time may fail to capture the full extent of injuries. - Pre-determined conclusions
Reports that appear formulaic or dismissive of symptoms can suggest bias. - Ignoring treating physician opinions
A failure to meaningfully address the findings of long-term treating doctors is a significant concern.
How to Challenge an IME-Based Denial
An IME does not have to be the final word. There are effective ways to challenge a denial based on these exams:
- Obtain rebuttal reports
Treating physicians can provide detailed opinions that counter the IME findings. - Document ongoing treatment needs
Consistent medical records, therapy notes, and progress reports can demonstrate continued necessity. - Legal strategies to reinstate benefits
Filing a claim and presenting evidence in court can compel insurers to resume payment and may expose weaknesses in the IME.
Attendant Care Disputes
What Attendant Care Includes
Attendant care is one of the most important—and most contested—PIP benefits. It is designed to support individuals who need assistance with daily activities due to their injuries.
This type of care may include:
- In-home nursing
Professional medical or non-medical care provided in the home. - Family-provided care
Assistance from spouses, parents, or other loved ones. - Supervision for cognitive injuries
Monitoring individuals with traumatic brain injuries or similar conditions to ensure safety.
Common Attendant Care Dispute Issues
Disputes over attendant care are common and can significantly impact a family’s financial and emotional well-being. Insurance companies may attempt to limit their exposure by:
- Imposing hourly limits
Arbitrary caps on the number of care hours approved per day. - Refusing to pay family caregivers
Challenging the legitimacy or value of care provided by relatives. - Claiming care is “not medically necessary”
Arguing that the injured person no longer requires assistance.
Documentation That Strengthens Your Claim
Strong documentation is key to overcoming an attendant care dispute. The more detailed and consistent the records, the stronger the claim:
- Physician prescriptions
Clear medical recommendations outlining the need for attendant care. - Daily care logs
Detailed records of services provided, including dates, times, and tasks performed. - Testimony from caregivers
Statements explaining the level of care required and its impact on daily life.
Legal Remedies When Benefits Are Reduced or Denied
When attendant care benefits are reduced or denied, legal action may be necessary to protect your rights. Potential remedies include:
- Filing a lawsuit to recover unpaid benefits
- Seeking payment for previously denied care
- Challenging insurer-imposed limitations
The One-Year-Back Rule Explained
The one-year-back rule is a critical legal limitation in Michigan No-Fault claims. It restricts how far back an injured person can recover unpaid PIP benefits.
In general, an individual may only recover benefits for losses incurred within one year prior to filing a lawsuit.
How It Limits Recovery of Unpaid Benefits
Even if an insurance company has wrongfully denied benefits for an extended period, the one-year-back rule can significantly limit recovery.
For example:
- If benefits were denied two years ago, but no lawsuit was filed, those earlier losses may no longer be recoverable
- Only the most recent year of unpaid benefits may be claimed
How to Protect Your Claim
The best way to protect your rights under the one-year-back rule is to act promptly:
- Acting quickly after denial
Early action preserves your ability to recover the full value of your claim. - Don’t assume negotiations pause the deadline
Ongoing discussions with an insurance company do not stop the clock. - Seeking legal guidance
Understanding deadlines and requirements can prevent costly mistakes.
“Reasonable and Necessary” Disputes
Insurers Challenging Treatment Necessity
One of the most frequent reasons for a Michigan PIP denial is a dispute over whether medical care is “reasonable and necessary.” While this standard is meant to ensure appropriate treatment, insurance companies often use it as a basis to limit or deny benefits.
Rather than focusing on recovery, insurers may question:
- Whether treatment is still needed
- Whether progress is being made
- Whether alternative (and often less costly) care should be used
Commonly Disputed Treatments
Certain types of care are more likely to be scrutinized or denied, especially when treatment extends over time. Common examples include:
- Physical therapy
Insurers may argue that therapy should end after a certain number of sessions, regardless of ongoing need. - Chiropractic care
Frequently challenged as excessive or unnecessary, even when providing relief and functional improvement. - Long-term rehabilitation
Extended care for serious injuries—such as brain trauma or spinal damage—is often disputed due to cost.
How Doctors’ Opinions Are Undervalued
A troubling aspect of these disputes is how often treating physicians’ opinions are discounted. Doctors who have seen a patient over months—or even years—may provide detailed recommendations, only to have them overridden by:
- Brief reviews conducted by insurance company doctors
- Paper-only evaluations with no in-person examination
- Opinions that prioritize cost containment over patient care
Building Strong Medical Evidence
To overcome these challenges, strong and consistent medical evidence is essential. Supporting a claim may involve:
- Detailed physician reports explaining the necessity of treatment
- Consistent treatment records showing ongoing symptoms and progress
- Specialist evaluations that reinforce the seriousness of the injury
Overdue Benefits and Penalty Interest
When Benefits Become Overdue
Under Michigan law, PIP benefits must be paid within a reasonable time after an insurer receives proof of loss. When payments are delayed without proper justification, they are considered overdue.
This can occur when:
- Bills are submitted but not processed
- Payments are delayed pending unnecessary review
- Insurers fail to respond within a reasonable timeframe
Insurance Company Obligations Under Michigan Law
Insurance companies are legally required to:
- Promptly review and process claims
- Pay benefits once reasonable proof is provided
- Avoid unnecessary delays or denials
12% Penalty Interest for Unpaid Benefits
When benefits become overdue, Michigan law allows for 12% penalty interest on unpaid amounts. This interest is designed to:
- Compensate claimants for delays
- Encourage timely payment by insurers
- Discourage improper claim handling practices
Why Insurers Delay Despite Penalties
Despite the existence of penalty interest and potential attorney fees, delays still happen. Common reasons include:
- Financial incentives to postpone payment
- Internal review processes designed to limit payouts
- The assumption that some claimants will not challenge the delay
Protecting Your Rights After a PIP Denial
A Michigan PIP denial is not the end of your claim—it is often the beginning of a process that requires persistence, documentation, and legal advocacy. Whether benefits are cut off after an IME, reduced in an attendant care dispute, or limited by the one-year-back rule, each denial presents an opportunity to take action and pursue the benefits you are rightfully owed.
At Liss, Shapero & Mitnick, we believe that every client deserves more than just legal representation—they deserve a team that listens, communicates clearly, and fights tirelessly on their behalf. Our firm is built on integrity, transparency, and a commitment to treating every client like family.
If your benefits have been denied, reduced, or delayed, the most important step you can take is to act. The sooner you move forward, the more options you have to recover the full compensation available under Michigan law.
Speak With Our Team Today
Liss, Shapero & Mitnick
2695 Coolidge Highway
Berkley, MI 48072
📞 Phone: 248-584-1300
📞 Toll Free: 1-855-LISS-LAW (1-855-547-7529)
📠 Fax: 248-584-1323