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Nos. 126530-126531
| Michigan Chiropractic Council, |
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Kevin J. Moody |
Michigan Chiropractic Society, |
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Petitioners-Appellees, |
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vs (Appeal from Ct of Appeals) |
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(Ingham - Brown, T.) |
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Commissioner of the Office of |
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Financial and Insurance Service, |
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Respondent, |
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| Farmers Insurance Exchange and |
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Joseph A. Kuiper |
Mid-Century Insurance Company, |
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Intervenors-Respondents-Appellants. |
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| ______________________________________ |
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Click to view briefs in Adobe format:
Petitioners-Appellees' Brief on Appeal>>
Intervenors-Respondents-Appellants' Brief on Appeal>>
Intervenors-Respondents-Appellants' Reply Brief>>
Coalition Protecting Auto No-Fault's Amicus Curiae Brief>>
Insurance Institute of Michigan's Amicus Curiae Brief>>
Michigan State Medical Society's Amicus Curiae Brief>>
PPOM, L.L.C.'s Amicus Curiae Brief>>
Background
The petitioners are two groups of chiropractors who practice in Michigan. Farmers Insurance Exchange and Mid-Century Insurance Company, the appellants, are insurance companies that sell no-fault automobile policies in Michigan. They offer their no-fault policy holders a managed care option that requires the policyholders to seek medical care from members of a PPO network and pay extra (a $500 deductible and the balance above network rates) for out-of-network care. In exchange, policyholders receive a 40 percent premium discount. The petitioners filed an administrative action to challenge the validity of the managed care option, asking the Commissioner of the Office of Financial and Insurance Service to find that the option violated Michigan 's No-Fault Act. The Commissioner did not schedule a hearing, ruling that the petitioners failed to established that their claims had any merit. The petitioners appealed to the Ingham County Circuit Court, which ruled in their favor. The circuit court concluded that the managed care option violated the No-Fault Act by requiring the health care providers to be part of the PPO network, and by forcing participating health care providers to accept a fee that is less than the customary and reasonable fee required by the Act. The Court of Appeals affirmed this ruling in a published decision. It agreed with the circuit court that the managed care option was not authorized by law, and stated that the adoption of such a program was a matter for the Legislature. The Court of Appeals also stated that policyholders who elected the managed care option were potentially misled or deceived about the way in which their election affected the overall cost of their medical care. The no-fault insurance companies appeal.
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