Andary v. USAA explained

What the 2019 law changed

The 2019 no-fault reform (Public Acts 21 and 22 of 2019) added two limits that hit catastrophically injured people hardest. MCL 500.3157(7) capped what providers could charge for care that Medicare does not price, such as most residential brain injury programs and agency attendant care, at a percentage of what they charged on January 1, 2019. That percentage started at 55% and has been 52.5% for treatment after July 1, 2023. MCL 500.3157(10) limited in-home attendant care from family, household members and friends to 56 hours per week. Both limits took effect for treatment after July 1, 2021.

Insurers applied the limits to everyone, including people injured decades earlier.

The case

Ellen Andary was injured in a 2014 crash and Phillip Krueger in a 1990 crash. Both suffered brain injuries that left them permanently disabled. They sued their insurers together with the Eisenhower Center, an Ann Arbor brain injury rehabilitation facility. The Court of Appeals ruled in their favor on retroactivity, and the insurers appealed.

The holding

Justice Elizabeth Welch wrote for the majority, joined by Chief Justice Elizabeth Clement and Justices Richard Bernstein, Megan Cavanagh and Kyra Harris Bolden. The Court held:

• The scope of PIP benefits under an insurance policy vests at the time of injury. The insured’s rights are contractual as well as statutory.
• The 2019 amendments to MCL 500.3157(7) and (10) do not clearly show that the Legislature intended them to apply retroactively.
• So the amendments cannot be applied to reduce the benefits of people injured while covered by a policy issued before June 11, 2019. Those people keep benefits at the pre-amendment level, for care given before and after July 1, 2021.

Justice David Viviano, joined by Justice Brian Zahra, dissented in part. He would have held that the amendments apply to all care provided after their effective date, whatever the injury date.

What the Court did not decide

• The 2019 to 2020 window. The Court said the amendments apply, at the earliest, to people injured under a policy issued on or after June 11, 2019, and at the latest to people injured under a policy issued after July 1, 2020. It expressly declined to resolve the tension between those dates, because both plaintiffs were injured under pre-June 11, 2019 policies.
• The Contracts Clause. The Court of Appeals had also held that retroactive application would violate the Michigan Constitution’s Contracts Clause. The Supreme Court vacated that part without deciding it, resting the result on statutory interpretation alone.

What the Court rejected

The plaintiffs also challenged the fee schedule for people injured after the reform, on due process and equal protection grounds. The Court reinstated the trial court’s dismissal of those claims. It held that Andary and Krueger lacked standing to press them once their own claims were resolved, that the Eisenhower Center had not pleaded a challenge to the attendant care limit on its own behalf, and that the fee schedule is rationally related to the legitimate goals of curbing PIP costs and lowering premiums. For people injured under post-reform policies, the limits stand.

After Andary

In Fremont Insurance Co. v. Lighthouse Outpatient Center (published, April 11, 2025), the Court of Appeals held that Andary’s reasoning also applies to the Medicare-based fee schedule in MCL 500.3157(2) and related subsections, so a provider treating a pre-reform patient is paid under the pre-amendment reasonable-charge standard. For agencies serving post-reform patients, DIFS Bulletin 2026-15-INS addresses which fee-schedule formula applies to home care; see Bulletin 2026-15 for home care.

What to do if you or a family member is protected

1. Find the date of the crash and the policy that paid the claim, and confirm the policy was issued before June 11, 2019.
2. Compare what the insurer has paid since July 2021 for attendant care hours and provider rates with what it paid before.
3. Ask the insurer in writing to restore pre-amendment rates and hours. A specific claim for payment starts tolling of the one-year-back period until the insurer formally denies it.
4. If it refuses, file suit. The one-year-back rule limits recovery to losses incurred within a year before filing, subject to tolling.

Providers owed the difference for protected patients should read home care and attendant care agencies and the fee schedule. Families can start with attendant care, or contact us for a review of the payment history.

Sources: Andary v. USAA Casualty Ins. Co., Michigan Supreme Court No. 164772 (July 31, 2023); Fremont Ins. Co. v. Lighthouse Outpatient Center, Court of Appeals No. 370500 (April 11, 2025); MCL 500.3157(2), (7), (10); MCL 500.3145; 2019 PA 21 and 22; DIFS Bulletin 2026-15-INS.