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Plaintiff Seeks ‘Double Dip’ From His Insurer (continued)

Attendant care, housing, work loss sought when lower rates paid
$2,707,430

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Plaintiff, a 27 year old man, sought a readjustment of benefits from defendant Auto-Owners Insurance Co. The dispute related to the payment of work loss benefits, attendant care benefits, housing and a “double dip” in allowable expense benefits.

Plaintiff was injured in a truck-motorcycle accident in October 2009. His injuries — including respiratory failure, blunt trauma to the head and a T4 fracture — led to a complete spinal cord lesion, paraplegia, blindness, cognitive disorder, and depressive disorder.

Although Auto Owners was paying for attendant care, plaintiff said it was being paid at a rate that was lower than the rate its own adjuster had determined to be the reasonable value of the care. In addition, it was argued that Auto Owners also paid work loss benefits, but the adjuster was using her own method to calculate the benefits rather than that method provided for by the No-Fault Act.

Plaintiffs said the adjuster also ignored his legal entitlement to “double dip” allowable expense benefits. It is known as a double dip because, Plaintiff’s counsel explained, in normal circumstances, a no-fault carrier would pay the medical provider’s bill. However, in this instance, because it was a non-coordinated policy, Auto-Owners was required to pay Plaintiff the amount that Blue Cross Blue Shield, Plaintiff’s health insurer, paid for medical expenses.

Plaintiff was able to obtain partial summary disposition in his favor on the double dip benefits issue.

The matter settled for $2,707,430. The total value of the settlement of the attendant care issues includes the amount paid by Auto Owners for the previous years’ deficiencies in attendant care payments and the value of the claim during the pendency of the agreement between the parties. Auto Owners agreed to pay $768 per day for attendant care through 2017.

The settlement value also includes resolution of work loss benefits, home modifications and double dip allowable expense benefits.

Type of action: First-party no-fault benefits
Types of injuries: Paraplegia, blindness, cognitive disorder, depressive disorder
Court/Case no. Oakland County Circuit Court; 10-113223-NF
Name of judge: Shalina Kumar
Settlement amount: $2,707,430
Insurance carrier: Auto-Owners