A serious car accident can leave an injured person needing help long after leaving the hospital. Under Michigan’s No-Fault insurance system, medically necessary attendant care may be covered as part of an injured person’s Personal Injury Protection (PIP) medical benefits. Some people need assistance getting dressed, bathing, taking medications, moving safely around the house, attending medical appointments, or simply remaining safe because of a brain injury or other serious condition.
Under Michigan’s No-Fault insurance system, medically necessary attendant care may be covered as part of an injured person’s Personal Injury Protection (PIP) medical benefits.
Attendant care can be particularly important for people who suffer traumatic brain injuries, spinal cord injuries, orthopedic injuries, neurological conditions, or other serious injuries that prevent them from safely caring for themselves.
Family members may also be compensated for providing qualifying attendant care. However, Michigan law contains important rules governing family-provided care, including a 56-hour-per-week provision that is frequently misunderstood.
At Khamo Law Accident & Injury Lawyers, we help people injured in Michigan motor vehicle accidents pursue the No-Fault benefits available to them and challenge insurance companies when necessary medical care is delayed, reduced, or denied.
Call Khamo Law at 248-466-0606 to discuss a Michigan No-Fault claim.
Legally reviewed by Attorney Koro E. Khamo
Founder & Managing Attorney at Khamo Law, PLLC
Michigan Bar No. P80994
What Is Attendant Care Under Michigan No-Fault?
Attendant care generally refers to services reasonably necessary for an injured person’s care, recovery, or rehabilitation because of injuries suffered in a motor vehicle accident.
Depending on the person’s injuries and medical needs, attendant care may include assistance with:
- Bathing and personal hygiene
- Dressing and grooming
- Toileting
- Eating and meal-related personal assistance
- Transferring between a bed, wheelchair, chair, or other location
- Mobility and fall prevention
- Medication management
- Monitoring symptoms or medical conditions
- Supervision required because of cognitive or behavioral problems
- Assistance related to medical equipment
- Transportation or assistance associated with medical treatment
- Safety monitoring
- Other medically necessary personal care
The appropriate amount and type of care depends on the individual. Someone recovering from an orthopedic injury may need temporary assistance, while a person with a severe traumatic brain injury or spinal cord injury may require extensive or long-term assistance.
Attendant care is part of the broader system of Michigan No-Fault benefits available after qualifying motor vehicle accidents.
Attendant Care vs. Replacement Services in Michigan
One of the most common sources of confusion in Michigan No-Fault claims is the difference between attendant care and replacement services.
They are not the same benefit.
Attendant care focuses on services provided for the injured person’s care, recovery, or rehabilitation.
Replacement services generally involve ordinary household tasks the injured person would have performed but can no longer perform because of accident-related injuries.
For example:
Attendant care may include:
- Helping an injured person bathe
- Assisting with medication
- Helping the person transfer from a wheelchair
- Monitoring a person with a brain injury for safety
- Providing medically necessary supervision
Replacement services may include:
- Housecleaning
- Laundry
- Yard work
- Grocery shopping
- Routine household chores the injured person previously performed
The Michigan Supreme Court addressed this distinction in Douglas v. Allstate Insurance Company. The Court explained that ordinary household activities such as preparing family meals, maintaining the house or yard, and performing household chores can constitute replacement services rather than attendant care. At the same time, services directed toward the injured person’s actual care—such as medication management and certain assistance involving medical treatment—may qualify as attendant care.
Correctly identifying and documenting the services being provided can therefore make a significant difference in a No-Fault claim.
Can Family Members Be Paid for Attendant Care in Michigan?
Yes.
Michigan No-Fault law allows qualifying attendant-care services to be provided by family members and other people close to an injured person.
A spouse, parent, adult child, sibling, or another qualifying individual may provide necessary care in the home rather than requiring every hour of assistance to come from a professional home-care agency.
The fact that someone is a family member does not automatically make the services unpaid.
The key questions generally include whether the care was actually provided, whether it was reasonably necessary because of the motor vehicle accident, whether a charge was incurred for the service, and whether the amount sought is reasonable and payable under the applicable No-Fault rules.
This becomes particularly important when a seriously injured person requires daily supervision or assistance for months or years.
Michigan’s 56-Hour Attendant Care Rule
Michigan’s 2019 No-Fault reforms created an important rule affecting certain in-home attendant care.
Under MCL 500.3157(10), an insurer generally is only required to pay for up to 56 hours per week of in-home attendant care when that care is provided by:
- A person related to the injured person;
- Someone domiciled in the injured person’s household; or
- Someone who had a business or social relationship with the injured person before the injury.
This provision is often referred to as the 56-hour family-provided attendant-care rule.
But calling it a 56-hour “cap” on all attendant care can be misleading.
Does Michigan Limit All Attendant Care to 56 Hours Per Week?
No.
The 56-hour provision does not necessarily mean that a catastrophically injured person who medically requires around-the-clock care can receive only 56 hours of care per week.
Michigan’s Department of Insurance and Financial Services has specifically explained that an injured person remains entitled to medically necessary attendant care subject to the applicable PIP medical coverage.
The restriction concerns certain categories of people providing the in-home care—not necessarily the injured person’s total medical need.
For example, suppose a person suffers a catastrophic brain injury and doctors determine that the person requires 24-hour supervision.
Twenty-four-hour care equals:
24 hours × 7 days = 168 hours per week.
A 56-hour restriction on certain family-provided care does not automatically reduce a medically necessary 168-hour care plan to 56 hours.
Depending on the circumstances, additional medically necessary hours may be provided by professional caregivers or other providers who are not within the statutory category. Michigan law also permits insurers to contract for additional attendant-care hours from people who otherwise fall within the 56-hour provision.
The details matter, especially when an insurer attempts to treat the 56-hour provision as though it automatically determines the patient’s total medical need.
Can an Insurance Company Approve More Than 56 Hours of Family-Provided Care?
Potentially, yes.
Michigan law allows an insurer to contract for additional attendant-care hours beyond the 56-hour threshold.
The Michigan Department of Insurance and Financial Services has also advised consumers who require more than 56 hours of attendant care and want those hours provided by family or other covered individuals to contact their insurer about contracting for additional hours.
Families dealing with catastrophic injuries should therefore not assume that 56 hours represents the maximum amount of care available under every circumstance.
Why a Doctor’s Attendant-Care Prescription Matters
Medical documentation can be critical in an attendant-care claim.
An insurer may question why care is needed, what services are medically necessary, how many hours should be provided, and whether those needs are actually related to the motor vehicle accident.
A treating physician’s written recommendation or prescription can help establish the medical basis for the care.
Depending on the circumstances, a prescription or supporting medical documentation may identify:
- The patient’s accident-related injuries
- Why attendant care is medically necessary
- The type of assistance required
- The number of hours of care required each day
- Whether overnight supervision is necessary
- Whether the patient requires continuous supervision
- How long the care is expected to continue
- Specific restrictions or safety concerns
The prescription should accurately reflect the injured person’s actual medical needs.
A vague statement that a patient “needs help” may create unnecessary disputes over what care was actually ordered.
What Should an Attendant-Care Log Include?
Families providing attendant care should keep detailed, consistent records.
The Michigan Supreme Court has recognized that itemized statements, bills, contracts, or logs identifying the nature of services provided can help establish that compensable services were actually rendered.
An attendant-care log should generally document information such as:
Date of care
Record the specific date on which services were provided.
Caregiver
Identify the person who provided the care.
Start and end times
Document when the attendant-care period began and ended.
Total hours
Keep an accurate calculation of the hours provided.
Services performed
Describe what the caregiver actually did.
Instead of writing only:
“Helped patient.”
A useful record might identify services such as:
“Assisted with showering, dressing, medication management, transfers, mobility, and safety supervision.”
Records should accurately reflect what actually occurred. They should not simply repeat generic descriptions every day when the services were different.
Consistent documentation can become particularly important if an insurer later disputes whether the services were performed or whether they qualify as attendant care.
Why Insurance Companies Challenge Attendant-Care Claims
Attendant care can become a significant expense in catastrophic-injury cases, particularly when someone requires years of daily assistance.
Insurance companies may investigate whether the claimed care remains medically necessary, whether the hours are reasonable, whether the services actually occurred, and whether the requested rate is appropriate.
Common disputes include the following.
The Insurer Says the Care Is No Longer Medically Necessary
An insurance company may argue that the injured person’s condition has improved or that fewer hours are now required.
This may occur even when treating physicians continue to recommend substantial assistance.
The Insurer Calls the Services “Ordinary Household Help”
Insurers may argue that activities being claimed as attendant care are actually replacement services or ordinary household tasks.
That distinction matters because Michigan No-Fault law treats the benefits differently.
Detailed medical documentation and accurate care logs can help establish whether a service is being performed for the injured person’s care rather than simply for maintenance of the household.
The Insurer Disputes the Hourly Rate
Even when the need for attendant care is accepted, an insurer may challenge the amount charged.
A dispute may arise over what constitutes a reasonable charge for the particular services being performed, the caregiver’s qualifications, the level of care required, or applicable reimbursement provisions under Michigan law.
The Insurance Company Orders an Insurance Medical Examination
An insurer may require an injured person to attend an examination with a physician or other professional as permitted by Michigan law.
The insurer may use the examination when evaluating whether continued attendant care is medically necessary or whether the amount of care should change.
If an insurer relies on an examination to reduce or terminate benefits despite contrary evidence from treating providers, the medical opinions and records may become central to the dispute.
Surveillance
Insurance companies may conduct surveillance in significant injury claims.
An investigator may observe or record an injured person outside the home in an effort to compare the person’s activities with the limitations described in the claim.
A short video showing someone walking, shopping, driving, attending an event, or performing another activity does not by itself establish the full extent of that person’s medical needs. However, insurers may use surveillance evidence to question reported limitations or challenge the amount of attendant care requested.
Claimants should always provide truthful and accurate information about their abilities and limitations.
What Happens If an Insurance Company Stops Paying Attendant Care?
A sudden reduction or termination of attendant-care benefits can create an immediate problem for an injured person and the family members responsible for that person’s safety.
If benefits are reduced or stopped, determine why the insurer made the decision.
Important documents may include:
- The insurer’s denial or reduction letter
- Attendant-care prescriptions
- Recent medical records
- Caregiver logs
- Bills and invoices
- Prior payment records
- Insurance medical examination reports
- Correspondence with the adjuster
- Any requests for additional documentation
Do not stop keeping attendant-care records simply because an insurer has stopped paying.
If medically necessary care continues to be provided, accurate records of those services may become important in a later dispute.
Michigan DIFS also accepts consumer complaints concerning access to attendant care. However, a regulatory complaint and a legal claim are not necessarily the same thing, and people facing substantial unpaid benefits should consider obtaining legal advice regarding their specific circumstances.
What If the Insurer Says There Isn’t Enough Documentation?
Documentation problems should be addressed quickly.
An insurer may claim that it cannot determine:
- Who provided the care
- When the care occurred
- What services were performed
- Why those services were medically necessary
- How many hours were actually provided
- Whether the caregiver expected to be compensated
Michigan courts have emphasized the importance of proving that services were actually rendered.
For families handling a catastrophic-injury claim, creating a consistent documentation system early can prevent months of records from having to be reconstructed later.
Attendant Care After a Traumatic Brain Injury
Attendant care can be especially important after a traumatic brain injury.
A person with a brain injury may look physically capable of performing everyday activities while still experiencing serious problems with:
- Memory
- Judgment
- Impulse control
- Medication management
- Orientation
- Behavioral regulation
- Fall risk
- Cooking safety
- Wandering
- Driving safety
- Recognizing emergencies
For some brain-injury survivors, the primary attendant-care need is supervision, not physical assistance.
That distinction can be important when an insurer argues that someone who can walk, dress, or eat independently no longer requires significant care.
Attendant Care After a Spinal Cord Injury
People suffering a spinal cord injury may require extensive assistance with activities of daily living.
Depending on the level and severity of the injury, care may involve:
- Transfers
- Positioning
- Bathing
- Dressing
- Toileting
- Mobility
- Skin monitoring
- Assistance with medical equipment
- Medication
- Transportation
- Overnight assistance
Some spinal-cord injury survivors may require multiple caregivers or a combination of family-provided and professional care.
Attendant Care Is Part of Michigan No-Fault Benefits
Attendant care should not be viewed in isolation.
A seriously injured accident victim may have several different claims or benefits arising from the same crash.
Depending on eligibility and the circumstances of the accident, Michigan No-Fault benefits may include medical treatment and rehabilitation, attendant care, certain replacement services, wage-loss benefits, mileage or transportation expenses associated with medical care, and other allowable expenses.
Learn more about the broader system in our guide to Michigan No-Fault benefits.
An injured person may also have a separate claim against an at-fault driver for damages that are not paid through PIP benefits. Learn more about these issues from our Michigan car accident lawyers.
Michigan Attendant Care FAQ
Can my spouse get paid to take care of me after a Michigan car accident?
Potentially. Michigan No-Fault benefits can cover qualifying attendant-care services provided by family members when the applicable legal requirements are satisfied. The 56-hour rule may affect the number of in-home hours an insurer is required to pay when care is provided by certain family members or other people described by the statute.
Is attendant care limited to 56 hours per week in Michigan?
Not necessarily. The 56-hour provision applies to certain people providing in-home attendant care. It does not automatically mean that an injured person who medically requires more than 56 hours of care can receive only 56 hours total.
Can someone receive 24-hour attendant care?
A person may require around-the-clock care depending on the nature and severity of the injuries. Whether particular hours are payable and who can provide them depends on the medical need, applicable PIP coverage, Michigan law, and the circumstances of the claim.
Do I need a professional nurse to receive attendant-care benefits?
Not necessarily. Qualifying attendant care can be provided by family members and other caregivers. The type of caregiver required depends on the nature of the services and the injured person’s medical needs.
What is the difference between attendant care and replacement services?
Attendant care involves services for the injured person’s care, recovery, or rehabilitation. Replacement services generally involve ordinary household tasks that the injured person would have performed but cannot perform because of the accident.
What should I do if my attendant-care benefits were terminated?
Obtain the insurer’s explanation for the termination, continue accurately documenting medically necessary care that is actually being provided, preserve medical records and prescriptions, and consider having the claim reviewed by a Michigan No-Fault attorney.
Talk to Khamo Law About a Michigan Attendant-Care Claim
When someone suffers a serious injury, attendant care may determine whether that person can safely remain at home and receive the assistance recommended by medical providers.
Disputes over attendant care can involve medical necessity, caregiver hours, documentation, reimbursement rates, insurance examinations, surveillance, the 56-hour rule, and disagreements over whether particular services constitute attendant care or replacement services.
Khamo Law Accident & Injury Lawyers represents people injured in Michigan motor vehicle accidents and helps clients pursue the No-Fault benefits available to them.
If an insurance company has denied, reduced, delayed, or terminated attendant-care benefits—or you need help understanding what benefits may be available—contact Khamo Law.
Khamo Law Accident & Injury Lawyers
1120 E. Long Lake Rd., Ste. 250
Troy, MI 48085
248-466-0606
KHAMOLAW.COM