Recoverable expenses and services where catastrophically injured no fault victim lives at home

In Hoover v. Michigan Mutual, the Court of Appeals recently addressed the complicated issue of caring for a catastrophically injured accident victim.  Under Michigan's no fault act, the insurance company obligated to provide Personal Injury Protection [PIP] benefits to the victim (usually the insured's own company) is required to pay all of the expenses reasonable and necessary for the victim's "care, recovery or rehabilitation".  Michael Hoover was struck by a drunk driver, as a child, and has been cared for at home by his parents for more than 20 years.  The defendant in this case was the insurer of the drunk and responsible for Michael's PIP benefits because there was no auto insurance in his household.  Michigan Mutual had discontinued paying certain of Michael's parents' expenses and the lower court had awarded family these expenses, plus fees and costs.

Michigan Mutual appealed the trial court's decision, claiming that under the Engler majority's recent revision of the Supreme Court's interpretation of no fault law, it was not responsible for many of the expenses associated with Michael's care. It argued that under the Griffith decision it was not required to pay for Michael's special dietary or housing needs, for example.  The Court of Appeals rejected Michigan Mutual's appeal, noting that even under the Griffith decision, the PIP insurer was obligated to pay for dietary or housing expenses that were "causally related" to the motor vehicle injuries. 

By way of examples, the Court noted that the electrical power necessary to operate Michael's ventilator was an expense that would not have been incurred if Michael had benefited from an "accident-free" life:  therefore that expenses was an expense necessary for Michael's care.  Similarly, his special diet and feeding tube were unusual, they cost more than "normal" sustenance costs, and were caused directly by his injuries.

The Appellate Court also affirmed the award of attorneys fees and costs related to the denial of expenses such as the back-up generator, elevator and medical monitoring systems which were necessary to Michael's care.  The court noted that there was no reasonable dispute with regard to the Defendant's obligation to pay these costs.  Parenthetically, it should be noted that a family's decision to care for a catastrophically injured member at home usually saves the PIP insurer an enormous sum when compared with the cost of institutional care:  these victims typically survive much longer and are healthier than similarly injured patients who are institutionalized, as well.  Home care is generally better for everyone concerned and should not be a "windfall" for the insurer.  In any event, these families should not be penalized for their heroic decision to care for a loved one at home.