Pay the Provider: Medical Expense “Incurred” When Payment is Expected From the No-Fault Carrier Instead of the Claimant

Peters v Auto Club Insurance Association and Halleck is an unpublished opinion, and therefore is not binding authority. Unpublished decisions may be used as persuasive authority in the lower courts.

The Court of Appeals affirmed that an expense is incurred by a claimant under the No-Fault Act when the claimant accepts treatment from a medical provider. This is true even if the medical provider expects payment from the insurer rather than the claimant. Thus, a no-fault insurer cannot dodge its obligation of payment when the provider does not bill the claimant directly.

A medical expense “incurred” under the No-Fault Act is limited to the reduced amount accepted by the provider as payment of full. For example, the claimant would not incur a balance when the provider accepts a reduced payment from the claimant’s health insurer as full payment. However, an invoice showing health insurance payments does not sufficiently demonstrate that the provider accepted the amount paid as payment in full.

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