Court of Appeals Finds That PIP Providers “May” Invoke Utilization Review Appeals

As part of the 2019 amendments to the No-Fault Act, the Legislature enacted a utilization review (“UR”) process at MCL 500.3157a.

Providers who are unhappy with an insurer’s UR decision have the ability to file an administrative appeal with the Department of Insurance and Financial Services (“DIFS”). MCL 500.3157a(3)(b)(iii) and (5). Per regulations enacted by DIFS, a dissatisfied party may appeal a DIFS decision to Circuit Court, Rule 500.65(7).

In True Care Physical Therapy, PLLC v Auto Club Group Ins Co, ___ Mich App ___; ___ NW2d ___ (2023), the Court of Appeals held that § 3157a does not require providers to file an administrative appeal. Rather, the process is optional, and providers may instead bring a “direct independent cause of action [as] provided in MCL 500.3112.” True Care, ___ Mich App at ___; slip op at 3.

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