Bill Text: MI HB5604 | 2015-2016 | 98th Legislature | Introduced
Bill Title: Insurance; no-fault; processing of claims for benefits under the assigned claims plan; enact procedures. Amends sec. 3173a of 1956 PA 218 (MCL 500.3173a).
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2016-04-28 - Bill Electronically Reproduced 04/27/2016 [HB5604 Detail]
Download: Michigan-2015-HB5604-Introduced.html
HOUSE BILL No. 5604
April 27, 2016, Introduced by Rep. Theis and referred to the Committee on Insurance.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
by amending section 3173a (MCL 500.3173a), as amended by 2012 PA
204.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3173a. (1) The Michigan automobile insurance placement
facility
shall make an initial determination of a claimant's the
eligibility for benefits under the assigned claims plan for a
claimant or a person making a claim through or on behalf of a
claimant
and shall deny an obviously
ineligible a claim . The that
is determined to be ineligible under this chapter or the assigned
claims plan. A claimant or person making a claim through or on
behalf of a claimant that fails to cooperate is ineligible for
benefits under the assigned claims plan. The Michigan automobile
insurance
placement facility shall notify the claimant
shall be
notified
promptly in writing of the a denial
and the reasons for
the denial.
(2) A claimant or a person making a claim through or on behalf
of a claimant shall cooperate in the investigation of eligibility
and the settlement or defense of any claim or suit, including, but
not limited to, submitting to examinations under oath and to
sections 3151 to 3153.
(3) A person who has reason to believe that the Michigan
automobile insurance placement facility has improperly determined
that an application for benefits is ineligible is entitled to a
private, informal, managerial-level conference with the Michigan
automobile insurance placement facility.
(4) The Michigan automobile insurance placement facility shall
establish reasonable internal procedures to provide a person with a
private, informal, managerial-level conference described in
subsection (3). The procedures must include all of the following:
(a) A method of providing the person, on written request and
payment of a reasonable copying charge, with information pertinent
to the decision.
(b) A method for resolving the dispute promptly and
informally, while protecting the interests of both the person and
the Michigan automobile insurance placement facility.
(5) If the Michigan automobile insurance placement facility
fails to provide a conference under subsection (3) and a proposed
resolution of the dispute within 30 days after a request by a
person, or if the person disagrees with the proposed resolution of
the Michigan automobile insurance placement facility after
completion of the conference, the person is entitled to a
determination of the matter by the director. The director shall by
rule establish a procedure for determinations under this
subsection, which must be reasonably calculated to resolve these
matters informally and promptly, while protecting the interests of
both the person and the Michigan automobile insurance placement
facility.
(6) The Michigan automobile insurance placement facility shall
close the claim file of a person who fails to appear for a
conference under subsection (3) or for a scheduled review by the
director.
(7) (2)
A person who presents or causes to
be presented an
oral or written statement, including computer-generated
information, as part of or in support of a claim to the Michigan
automobile insurance placement facility, or to an insurer to which
the claim is assigned under the assigned claims plan, for payment
or another benefit knowing that the statement contains false
information concerning a fact or thing material to the claim
commits a fraudulent insurance act under section 4503 that is
subject to the penalties imposed under section 4511. A claim that
contains or is supported by a fraudulent insurance act as described
in
this subsection is ineligible for payment or of personal
protection insurance benefits under the assigned claims plan.
Enacting section 1. This amendatory act takes effect 90 days
after the date it is enacted into law.