Action Reports
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COA: Insurance Code Does Not Require Administrative Appeal as a Precondition to Sue Insurance Company Over Utilization Reviews
On May 25, 2023, the Michigan Court of Appeals issued a decision in True Care Physical Therapy v. Auto Club Group Insurance Company (COA Docket No. 362094), an auto no-fault case that involved a health care provider who filed suit against an auto insurance company rather than first appeal the insurer’s utilization review determination to the Michigan Department of Insurance and Financial Services (DIFS). According to the COA, Michigan’s revised auto no-fault insurance statute does not require a medical provider to administratively appeal an insurance company’s utilization review. Rather, the administrative appeal process is optional, and providers may instead file suit without an appeal to DIFS.