Appellate Court Rules Insured Entitled to Unlimited Attendant Care Benefits

The Michigan Court of Appeals recently held in a published decision that the terms of an insurance policy providing for unlimited medical benefits entitled the insured to unlimited attendant care benefits.

The appellate court ruled that when an insured renewed his insurance policy and selected “unlimited” medical benefits, that selection entitled him to unlimited attendant care benefits, rather than the statutory 56 hours per week of attendant care provided by the No Fault Act.

The case is Smejkal v. Beck, Case No. 363394, 2024 WL 1684864 (Mich App, April 18, 2024).  The litigation arose out of a December 2020 accident, after the 2019 amendments to the No Fault Act had been enacted. As to entitlement to attendant care, those amendments stated that attendant care a friend or family member provides in an injured person’s home is capped at 56 hours per week. 

In Smejkal, the defendant insurance carrier argued that under the terms of the No fault Act, it was obligated to provide only 56 hours per week of attendant care. However, the insured argued that because the No Fault Act contains a provision allowing an insurer to contract to pay benefits for attendant care for more than 56 hours a week and because he selected “unlimited” medical expenses in the category of personal protection insurance (PIP) benefits when he renewed his policy, he was entitled to unlimited attendant care benefits.

The appellate court agreed with the insured and held that because the insured selected “unlimited” medical expenses, and because it was undisputed that attendant care is considered “medical expenses,” the insured was allowed to recover unlimited attendant care benefits, rather than the statutory default of 56 hours per week.  The appellate court noted that the insurer’s policy provided that allowable expenses were subject to limitations in the No Fault Act, but it rejected the insurer’s argument that this provision meant that attendant care was limited to 56 hours per week. Rather, the appellate court held that this provision did not explicitly invoke the default hourly cap within the No Fault Act.  

The appellate court explained that insurers who wish to avoid the result in Smejkal could either allow its insureds to select unlimited PIP benefits in terms of the dollar amount, but still restrict attendant care hours to 56 per week. Alternatively, the appellate court stated that insurers could include a provision in their policies explicitly providing that “unlimited coverage” does not include attendant care hours.

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