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MadScience:HowTheMichigan SupremeCourtUnreasonablyEliminated CoverageofExperimentalProcedures UndertheStatesNoFaultAct

* ERINHYSELL

ABSTRACT
The State of Michigans NoFault Automobile Insurance Act is designedtoprovideadequateandpromptcompensationforautoaccident victimswithoutregardtofault.TheprovisionoftheActgoverningmedical expensesisleftuncapped,providingbroadcoveragetoinjuredpartiesfor the expenses they incur as a result of their accidents. However, the Michigan Supreme Court in Krohn v. HomeOwners Insurance Company arbitrarily limits the expenses that may be covered under the Act by effectivelyremovingexperimentalproceduresoutright. TheMichiganSupremeCourtincorrectlydecidedthecaseofKrohnv. HomeOwners Insurance Company and, in doing so, circumvented the policies of the states NoFault Auto Insurance Act. The court held that coverage of an experimental procedure under the Act is subject to a thresholdstandardandaproceduremaybedeterminedunreasonableand unnecessary as a matter of law. This holding ignores binding precedent interpreting the Acts reasonable necessity standard and disregards the languageoftheAct.Inaddition,thestandardthecourtcreatesisrendered unworkable because the court immediately contradicts itself in its application to the facts of Krohn. Ultimately, the courts decision runs countertothegoalsoftheActmeanttobenefitautoaccidentvictimsand does so at the expense of the motorists most in need of the Acts protections.

Candidate forJurisDoctor, New England Law | Boston (2013). B.A., Marketing, Michigan State University (2010). I would like to thank my family and friends for their support throughoutthewritingprocess,andIwouldalsoliketothanktheLawReviewstafffortheir assistanceineditingthisComment.
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INTRODUCTION
nDecember11,2001,KevinKrohnwashitheadonbyavanwhile riding his motorcycle; he suffered a severe spinal cord injury and wasparalyzedfromthewaistdown.1Emergencysurgeriesproved futile,andnoamountofphysicaltherapycouldreturnfeelingtohislower body, leaving Kevin in need of assistance for what had once been simple tasks.2WhenKevinwastoldaboutasurgerythatcouldhelphim,hishope returned.3Hemetwithadoctorwhoexplainedabreakthroughstemcell procedure being performed at a government hospital in Portugal.4 After submittingtoextensivetesting,KevintraveledtoPortugaltoundergothe surgeryandreturnedhomewithimmediateimprovements.5 Before leaving for the surgery, Kevin notified his automobile insurance provider, HomeOwners Insurance Company (Home Owners),thathewouldbeundergoingtheprocedure.6UnderMichigans NoFault Automobile Insurance Act7 an auto insurance provider must compensate an injured party for any reasonable expenses incurred from injuriesinanautoaccidentwithoutregardtofault.8Despitethisprovision oftheAct,Kevinsproviderdeniedhisclaim.9 After returning from Portugal, Kevin sued HomeOwners to recover hissurgicalexpenses,andajuryagreedthattheprocedurewasreasonable and necessary under the NoFault Auto Insurance Act.10 Oddly, the same doctorwhotoldKevinaboutthesurgeryspotentialandscreenedhimfor the procedure served as a defense expert.11 When the case reached the SupremeCourtofMichigan,thecourtusedthedoctorsstatementstohold that the procedure could not possibly provide a chance at improvement andignoredtheevidenceoftheproceduressuccess.12 Inreversingthetrialcourtsdecision,thecourtnotonlydeniedKevin hisbenefitsundertheNoFaultActbutalsocreatedaprecedentwhereno

1Krohnv.HomeOwnersIns.Co.,802N.W.2d281,285(Mich.2011). 2Id. 3BriefofPlaintiffAppellantat4,Krohn,802N.W.2d281(No.140945),2010WL6351954at*4. 4Id.at9. 5Krohn,802N.W.2dat286. 6Id. 7SeeMICH.COMP.LAWS500.3101.500.3179(2002). 8500.3105(1)(2),.3107(1)(a). 9Krohn,802N.W.2dat286. 10Id.at28687. 11Seeid.at29596. 12Seeid.at295.

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experimental surgeries or treatments will be covered in the future.13 Automobileaccidentvictimswiththemostsevereinjurieswhocannotpay for surgery outofpocket are being denied any chance at recovery.14 The State of Michigans status as a model for nofault automobile insurance systemsthe state with the most inclusive nofault coveragehas been compromisedattheexpenseofthepeoplewhoneeditmost.15 This Comment argues that Krohn v. HomeOwners Insurance Company16 was incorrectly decided, because the Supreme Court of Michigan inappropriately took the determination of reasonableness and necessity away from the jury by creating a vague threshold test for experimental procedures. This Comment asserts that the court ignored binding precedentandthelanguageofMichigansNoFaultAutoInsuranceActin applying an unreasonable standard to Kevin Krohns procedure. In addition, the decision fails to further the Acts goal of confronting the inequality and inconsistency of a tort liability system for automobile accidents. The decision arbitrarily limits automobile accident victims accesstobenefitsundertheActbycreatingamisguidedstandardthatno experimentalprocedurecanmeet. PartI.AofthisCommentprovidesbackgroundonnofaultautomobile insurance systems, and Part I.B explains the development of Michigans NoFault Automobile Insurance Act. Part II outlines the facts and the decision in Krohn. Part III.A discusses how the courts decision in Krohn departed from binding Michigan Supreme Court precedent. Part III.B explainsthatthecourtignoredthepreviouslyestablishedtestforremoving issues from the jury contained in a provision of the Act. Part IV.A shows that the Krohn decision effectively eliminates all experimental procedures fromcoverageundertheAct.Finally,PartIV.Bdiscusseshowthecourtin Krohn went against the Michigan legislatures purposes in implementing theNoFaultAct,becausethedecisionfostersinequalityandinconsistency attheexpenseofthemostseverelyinjuredautomobileaccidentvictims. I. Background A. LegislativeNoFaultAutomobileInsurance Thetermnofaultinthecontextofautomobileinsurancereferstoa legal system by which a person injured in an automobile accident has a righttorecovereconomiclossessuchasmedicalexpensesandlostwages,

13SeeinfraPart0,0. 14SeeinfraPart0. 15SeeinfraPart0. 16802N.W.2d281(Mich.2011).

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regardlessofwhetherheorshewasatfaultincausingtheaccident.17No faultautomobileinsurancerepresentsafirstpartysystemunderwhichthe insured18seekscompensationfromhisorherownproviderasopposedto thethirdpartysystemseenwithtraditionalinsurance.19Nofaultinsurance involveseitheralegislativelyauthorizedormandatedformofautomobile insurance intended to provide benefits while limiting or prohibiting the insureds ability to bring suits in tort.20 Legislative nofault automobile insurancesystemsaredesignedto:provideadequateandpromptbenefits toinjuredparties;reducethenumberofminortortclaimsrelatingtoauto accidents; and eliminate the inefficiencies and inequalities of the tort system.21 Today, twelve states have nofault automobile insurance law.22 Ten states utilize addon nofault insurance, through which an insured person may receive firstparty benefits but avoid the limitations on their righttosueintort.23 B. MichigansNoFaultAutomobileInsuranceAct Michigans nofault auto insurance plan is often recognized as one of the most comprehensive in the United States.24 The development of this systemwaslargelyinlinewiththegrowthoftheautoindustrythroughthe 1900s.25 As the number of vehicles on the states roadways increased, logicallysodidthenumberofautomobileaccidents.26Priortothepassage
17ROBERTH.JOOST,AUTOMOBILEINSURANCEANDNOFAULTLAW1:1(2ded.2002). 18Theinsuredreferstotheperson(s)coveredbyinsurance.BLACKS LAW DICTIONARY 870

(9thed.2009).
19THOMASF. BURKE, LAWYERS, LAWSUITS,AND LEGALRIGHTS: THE BATTLEOVER LITIGATIONIN

AMERICAN SOCIETY 103 (2002). Inathirdpartysystem,theinjuredpartyseekscompensation fromtheinsurerofthepersonwhocausedtheinjury.Id.


20JOOST,supranote17. 21SeeThomasC.Jones,NoFaultAutomobileInsuranceinMichigan:APreliminaryStudy,inNO

FAULT AUTOMOBILE INSURANCE IN ACTION: THE EXPERIENCES IN MASSACHUSETTS, FLORIDA, DELAWARE, AND MICHIGAN 379, 381 (Oceana Publications 1977) (examining the success of MichigansNoFaultActthreeyearsafteritsenactment).
22 CassandraR.Coleetal.,AReviewoftheCurrentandHistoricalNoFaultEnvironment,231J.

OF INS. REGULATION 3, 3 (2004). Florida,Michigan,NewJersey,NewYork,andPennsylvania

useverbalthresholdsforallowingtortliability.Id.Hawaii,Kansas,Kentucky,Massachusetts, Minnesota,NorthDakota,andUtahusemonetarythresholds.Id.
23Id.Arkansas,Delaware,Maryland,NewHampshire,Oregon,SouthDakota,Texas,Virginia, Washington,andWisconsinofferaddonnofault.Id. 24 See Jones, supra note 21, at 37982; see also BURKE, supra note 19, at 108 (explaining that

Michigans nofault system constitutes the most radical departure from traditional tort liability).
25

See James T. Mellon & David A. Kowalski, The Foundations and Enactment of Michigan AutomobileNoFaultInsurance,87U.DET.MERCYL.REV.653,656,673(2010).

26SeeMich.OfficeofHighwaySafetyPlanning,19402009MichiganCrashOverview,MICHIGAN

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of the NoFault Auto Insurance Act of 1972,27 automobile accidents were subject to the traditional tort system.28 This included the doctrine of contributorynegligence.29Drawnoutlitigationresultingfromestablishing fault not only served to back up the courts, but italso left injured parties without compensation while they waitedsometimes yearsfor their trials to commence.30 At trial, awards were often inadequate and inconsistent.31 The issue of uninsured and judgmentproof motorists also limited recovery for automobile accident victims.32 The Michigan legislature eventually adopted a plan to resolve some of the legal, economic,andpracticalissuesbeingcreatedbyautoaccidents.33 The NoFault Auto Insurance Act set up a mandatory insurance scheme, which provides compensation for injuries sustained from an automobile accident without regard to fault.34 The Act is codified in the MichiganCompiledLawsassections500.3101500.3179.35MichigansNo Fault Insurance Act makes three types of insurance mandatory: personal injury protection (PIP), property protection insurance (PPI), and residualliabilityinsurance.36 PIP benefits are payable for medical expenses, three years of lost wages, and up to twenty dollars per day for replacement service

TRAFFICCRASHFACTS,http://www.michigantrafficcrashfacts.org/doc/2009/4009_Overview .pdf(lastvisitedJuly7,2012).
27MICH.COMP.LAWS500.3101.3179(2002). 28Mellon&Kowalski,supranote25,at656. 29 8AM. JUR.2D AutomobilesandHighwayTraffic947(2007)([T]hedoctrineofcontributory negligenceprecludesrecoverybyoneinjuredin amotorvehicleaccidentinanactionbased upon the defendants negligence, where there is any fault on the part of the injured person, eventhoughsmallincomparisonwiththatofthedefendant,ifthenegligenceoftheinjured personcontributedproximatelytotheoccurrenceoftheaccident....);see,e.g.,Desmaraisv. Myefski,174N.W.2d174,179(Mich.Ct.App.1969). 30 See COMM. TO STUDY COMP. FOR AUTO. ACCIDENTS, REPORT BY THE COMMITTEE TO STUDY

COMPENSATION FOR AUTOMOBILE ACCIDENTS TO THE COLUMBIA UNIVERSITY COUNCIL FOR RESEARCH IN THE SOCIAL SCIENCES 36, 43 & n.24 (1932). At the time of the Columbia Study, automobileaccidenttrialsrepresented34%ofciviltrialsinDetroit.Id.at43n.24.
31See7AM. JUR.2DAutomobileInsurance 31(2007);seealsoH.LaurenceRoss,AReviewArticle

onBasicProtectionfortheTrafficVictim,34J.OFRISK&INS.647,648(1967).
32 ROBERT E. KEETON & JEFFREY OCONNELL, BASIC PROTECTION FOR THE TRAFFIC VICTIM: A

BLUEPRINTFORREFORMINGAUTOMOBILEINSURANCE1,28(1965).
33Mellon&Kowalski,supranote25,at65355. 34 See MICH. COMP. LAWS 500.3101.3179 (2002); Claudia Maria Darmofal, Comment, The

DismantlingofMichigansNoFaultAutoInsuranceLawbyHouseBill4156:ThePermanentScaling BackofAutoInsuranceCoverageinMichiganforthePromiseofaTemporaryRateReduction,71U. Det.MercyL.Rev.597,597&n.1,599(1994).


35500.3101(1). 36Id.500.3101(1).

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expenses.37 The medical expense allowance is uncapped and covers expenses consisting of all reasonable charges incurred for reasonably necessary products, services and accommodations for an injured persons care,recovery,orrehabilitation.38Inexchangeforthisbroadcoverage,the Actlimitstortliabilitybasedonaverbalthreshold;motoristsmayonlysue iftheaccidentresultedinseriousinjuryordeath.39 C. StatutoryInterpretationofthePIPBenefitsProvision 1. InterpretingReasonablyNecessary Despitebeingconsideredamodelfornofaultautoinsurance,theAct hasregularlybeenthesubjectoflitigationsinceitsenactment.40TheActs broad language charges courts with executing the legislatures goals.41 A wide range of expenses have spurred litigation under the PIP provision that governs what products, services, and accommodations may be considered reasonably necessary . . . for an injured persons care, recovery, or rehabilitation.42 The possible products, services, and accommodations are endless when one considers the scope of potential medicalneedsthatcanresultfromanautomobileaccident.43Whilehealth insurance plans generally contain explicit language on the coverage of experimental procedures, the NoFault Automobile Insurance Act does

37Id.500.3107(1)(a)(c). 38Id.500.3107(1)(a)(emphasisadded). 39Seeid.500.3135(1)(Apersonremainssubjecttotortliabilityfornoneconomicloss...only iftheinjuredpersonhassuffereddeath,seriousimpairmentofbodyfunction,orpermanent seriousdisfigurement.).Theissueofwhatconstitutesaseriousinjuryisoftenasubjectof litigation. See, e.g., McCormick v. Carrier, 795 N.W.2d 517, 537 (Mich. 2010) (explaining that the serious impairment analysis is inherently factspecific and must be conducted caseby case). 40 Claudia Maria Darmofal, Comment, The Dismantling of Michigans NoFault Auto Insurance LawbyHouseBill4156:ThePermanentScalingBackofAutoInsuranceCoverageinMichiganforthe Promise of a Temporary Rate Reduction, 71 U. DET. MERCY L. REV. 597, 608 (1994); James T. Mellon,InsuranceLaw,50WAYNEL.REV.671,67172(2004). 41Mellon,supranote40. 42SeeHamiltonv.AAAMichigan,639N.W.2d837,843&nn.23(Mich.Ct.App.2001)(listing

expenses the court has previously found to be reasonable or unreasonable to form a frameworkbywhichtoconsidertheexpenseatissue).
43 See, e.g., Hoover v. Mich. Mut. Ins. Co., 761 N.W.2d 801, 80405 (Mich. Ct. App. 2008)

(discussing whether elevator maintenance, a backup generator, a television monitoring system,adumpster,andatwentyyearhomecleaningallowancewerereasonablynecessary expenses); Hamilton, 639 N.W.2d at 839 (holding that an inpatient telephone and television accesschargemaybereasonablynecessaryexpenses);SpectImaging,Inc.v.AllstateIns.Co., 633 N.W.2d 461, 464 (Mich. Ct. App. 2001) (discussing whether a novel brain scan imaging procedureisareasonablynecessaryexpense).

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not.44Thus,experimentalsurgeriesandtreatmentsaresubjecttothesame scrutinyasanyotherexpensesundertheActsPIPprovision.45 Whether an expense is reasonably necessary, for purposes of the PIP provision, is generally considered a question of fact for the jury, and the insured has the burden of proof on the matter.46 The Michigan Supreme CourtinNasserv.AutoClubInsuranceAssociationheld:
While the question whether expenses are reasonable and reasonably necessary is generally one of fact for the jury . . . it mayinsomecasesbepossibleforthecourttodecidethequestion of the reasonableness or necessity of particular expenses as a matteroflaw....Thus,ifitcouldbesaidwithcertaintythatan expense was both reasonable and necessary, the court could makethedecisionasamatteroflaw.47

InNasser,theplaintiffspentatotaloffiftydayshospitalizedfollowing a minor auto accident in a parking lot.48 After applying for his nofault benefits,hisinsurersdoctordeterminedthatmuchofthehospitaltimeand testingwasunnecessary.49Whenhisnofaultcarriersubsequentlyrefused topayanybenefits,theplaintiffinitiatedabreachofcontractsuit.50 The Michigan Supreme Court held that summary judgment was inappropriate in the case.51 The court found that a factual dispute existed regarding whether many of the expenses were reasonable charges for reasonablynecessaryservices.52Thecourtfurthernotedthatthetrialcourt could have granted partial summary judgment for the plaintiff for those expensesnotinquestion,suchashisinitialhospitalvisitdirectlyafterthe accident.53Thus,theNasserdecisionlimitsdecisionsasamatteroflawon the question of reasonable necessity to cases where the plaintiff has positively proved that an expense was reasonable and necessary.54

44

Compare Jennifer Belk, Undefined Experimental Treatment Exclusions in Health Insurance Contracts:AProposalforJudicialResponse,66WASH. L. REV. 809,809(1991)(Healthinsurance contracts often exclude coverage for experimental treatments.), with MICH. COMP. LAWS 500.3107(1)(a)(2002)(containingnolanguageonthetopicofexperimentaltreatments).

45500.3107(1)(a). 46Nasserv. Auto ClubIns.Assn, 457N.W.2d637,645,647(Mich. 1990);Nelsonv.Detroit

Auto.InterIns.Exch.,359N.W.2d536,538(Mich.Ct.App.1984).
47Id.at647. 48Id.at640. 49Id. 50Id. 51Id.at646. 52Nasser,457N.W.2dat647. 53Id. 54 SeeHealingPlace,Ltd.v.FarmBureauMut.Ins.Co.ofMich.,No.272438,2007WL778504, at*4(Mich.Ct.App.Mar.15,2007).

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Michigan courts have since held that the jury almost always decides this question;onlywhenitisclearthananexpenseisreasonablynecessarymay the judge overtake the jurys role.55 However, the court in Krohnv. Home OwnersInsuranceCompanywentagainstthiswellestablishedprecedent.56 Michigans Legislature has answered the question on matteroflaw decisionsregardingadifferentprovisionoftheNoFaultAct.57PublicAct 222 of 1995 amended Section 3135(2)(a) to place limits on when a judge maydeterminethataninjuredpersonhassufferedseriousimpairmentof bodyfunctionasamatteroflaw.58Theamendedprovisionallowsajudge tomakesuchadeterminationonlyintwoenumeratedcircumstances:(1)if there is no factual dispute concerning the nature and extent of a persons injuries; or (2) if a dispute exists, it is not material to the determination.59 Eventhen,theLegislatureprovidedanexceptionforclosedheadinjuries, providingthatagenuinequestionoffactforthejurystillexistsifalicensed physicianwhoregularlytreatsclosedheadinjuriestestifiesthattheremay beaseriousneurologicalinjury.60ThePIPbenefitsprovisionhasnotbeen similarlyamended.61 2. InterpretingForanInjuredPersonsCare,Recovery,or Rehabilitation The Michigan Supreme Court has defined care, recovery, or rehabilitation under the PIP provision.62 Griffith addressed whether everyday food expenses were necessary for the plaintiffs care.63 The court answered by defining each of the three words used in the statute.64

55SeeWilcoxv.StateFarmMut.Auto.Ins.Co.,791N.W.2d723,723(Mich.2010)(citingNasser toexplainthataquestionofreasonablenecessityisgenerallyoneoffactforthejury);seealso HealingPlace,Ltd.,No.272438,2007WL778504,at*4(Itdoesnotfollowthatthetrialcourtis freetodecidetheissueasamatteroflawwhereaplaintiffhasfailedtoprovereasonableness, orwhereadefendanthascharacterizedanalternativeasreasonable.Wheresuchisthecase,a trier of fact must decide what is reasonable.); Spect Imaging, Inc. v. Allstate Ins. Co., 633 N.W.2d461,46667(Mich.Ct.App.2001)(holdingthatconflictingexperttestimonycreatedan issue of fact for the jury on whether a novel brain scan imaging procedure is reasonably necessary). 56SeeinfraPart0. 57SeeMICH.COMP.LAWS500.3135(2)(a)(2002). 58 See George T. Sinas & Robert M. Ransom, The 1995 NoFault Tort Threshold: A Statutory Hybrid,76MICH.B.J.76,80(1997). 59500.3135(2)(a)(i)(ii). 60Id.500.3135(2)(a)(ii). 61SeeMICH.COMP.LAWS500.3107(2002). 62Griffithv.StateFarmMut.Auto.Ins.Co.,697N.W.2d895,902(Mich.2005). 63Id. 64Id.at90203.

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Based on the courts decision, recovery includes expenses that are necessary to return a person to his postinjury health, and rehabilitation encompasses those expenses that are necessary to bring the person back to a condition of productive activity.65 Expenses are considerednecessaryforaninjuredpersonscarewhentheyareneeded asaresultoftheaccident,eventhoughsuchcarewillnotrestoreaperson tohispreinjurystate.66 II. Krohnv.HomeOwnersInsuranceCompany In Krohn v. HomeOwners Insurance Company, the Michigan Supreme Court addressed whether an experimental surgery could be considered reasonablynecessaryforaplaintiffscare,recovery,orrehabilitationunder the PIP provision of the NoFault Auto Insurance Act.67 The insurance carrier appealed after a jury returned a verdict in favor of the plaintiff, finding the procedure reasonably necessary.68 The court of appeals reversed, holding that the trial court ought to have granted a directed verdict in favor the insurance company.69 The Michigan Supreme Court affirmed the court of appeals decision.70 The Court decided that: (1) the initial determination of reasonable necessity was an objective question of law;(2)thatanexperimentalproceduremustbeshowntobeefficacious to be considered reasonably necessary; (3) and that the plaintiffs proceduredidnotmeetthisthresholdunderthePIPprovisionoftheAct.71 A. Facts In2001,KevinKrohnwasparalyzedafterbeinghitheadonbyavan while riding his motorcycle.72 Despite several surgeries immediately followingtheaccidentandintensivephysicaltherapy,hecouldnotregain anysensationinhislowerbody.73Krohnresearchedtreatmentoptionsand learned of a procedure performed in Lisbon, Portugal through a patient who had benefited from the surgery.74 A team of neurology specialists at

65Id.at903n.12. 66 Id. A prosthetic leg is an example of an expense that goes to an injured persons care,

since the use of the prosthetic device would be necessary after an accident but would not returnthepersontohispreinjurystate.Id.
67Krohnv.HomeOwnersIns.Co.,802N.W.2d281,28485(Mich.2011). 68Id.at287. 69Id.at28788. 70Id.at285&n.1. 71Id.at301. 72Id.at285. 73BriefofPlaintiffAppellant,supranote3,at4. 74 Krohnv.HomeOwnersIns.Co.,No.283862,2010WL293004,at*5(Mich.Ct.App.Jan.26,

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Lisbons Hospital Egas Moniz developed a technique that involved using thepatientsownstemcellstoregrowspinalcordnervesatthesiteofthe injury.75 The surgery was regulated and fully approved in Portugal and reviewed by the European equivalent of the FDA, the Geneva Protocol.76 Oneofthespecialistsinvolved,Dr.CarlLima,aneuropathologistlicensed in Portugal, testified at trial that the procedure had been performed 110 times on patients with chronic spinal chord injury since 2001 and the majorityofpatientsexhibitedimprovementfollowingsurgery.77 Krohnsubmittedanapplicationtobeconsideredfortheprocedureto the Spinal Cord Injury Recovery Center (SCIR) at the Rehabilitation InstituteofMichigan,whichservesasaliaison.78Dr.Hinderer,thedirector oftheSCIR,interviewedKrohnandexplainedthebenefitsanddrawbacks of the procedure, including the fact that the FDA had not reviewed the procedure.79 Dr. Hinderer was considered very knowledgeable about the surgery, having visited Lisbon and witnessed the procedure himself.80 Afterchoosingtoundergotheprocedure,Krohnhadseveraltestsdoneat theSCIRbeforetravelingtoPortugal.81 Prior to his trip, Krohn contacted his automobile insurance carrier, HomeOwners Insurance Company, requesting coverage for his surgical expenses.82HomeOwnersrefusedtocovertheprocedure,claimingthatit did not qualify under the NoFault Act.83 Krohn traveled to Portugal and underwentsurgeryin2005.84Hetestifiedattrialthathenoticedimmediate improvement following his surgery: he became able to move his legs, crawl, and control his bowel and bladder function.85 Having paid for the surgical and travel expenses outofpocket, Krohn sought reimbursement fromHomeOwners,whichrefused.86Thelawsuitatissuefollowed.87

2010)(FortHood,J.,dissenting).
75BriefofPlaintiffAppellant,supranote3,at4. 76Id.at67(internalcitationomitted). 77Krohn,802N.W.2dat302(Hathaway,J.,dissenting)(internalcitationomitted). 78Krohn,2010WL293004,at*6. 79Krohn,802N.W.2dat285. 80BriefofPlaintiffAppellant,supranote3,at6. 81Id.at9. 82Krohn,802N.W.2dat286. 83BriefofPlaintiffAppellant,supranote3,at10. 84Krohn,802N.W.2dat286. 85Id. 86BriefofPlaintiffAppellant,supranote3,at10. 87Id.

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1. LowerCourtDecisions Kevin Krohn sued HomeOwners Insurance Company for the $51,412.85inexpensesheincurredbytravelingtoPortugalandundergoing thesurgicalprocedure.88HissuitwaspremisedonthePIPprovisionofthe NoFault Auto Insurance Act, which allows reimbursement for expenses incurredforreasonablynecessaryproducts,servicesandaccommodations for an injured persons care, recovery, or rehabilitation[] following an automobileaccident.89BothDr.HindererandDr.Limatestifiedaboutthe procedure.90 HomeOwners moved for a directed verdict, arguing that experimentalsurgeriesarenotreasonablynecessaryasamatteroflaw.91 Thetrialcourtdeniedthemotion,holdingthattheissuewasaquestionof fact.92ThejuryreturnedaverdictinfavorofKrohn,awardinghimthecost ofhisexpenses,includinginterest.93 The court of appeals reversed and held that Krohn was required to showthattheprocedurehadgainedgeneralacceptancewithinthemedical community.94BecauseKrohnlackedthiskindofproof,thecourtofappeals foundthatadirectedverdictinfavorofHomeOwnersshouldhavebeen granted.95Thedissentarguedthatwhethertheprocedurewasreasonably necessarywasaquestionoffact,submittabletothejury.96 C. TheMichiganSupremeCourtsOpinion The Michigan Supreme Court affirmed the judgment of the court of appeals but cited different reasons for its decision.97 The court departed fromthecourtofappealssholding,requiringtheplaintifftoshowthatthe procedurehadgainedgeneralacceptancewithinthemedicalcommunity.98 Thecourtalsostatedthatitmustreviewthetrialcourtsdecisiondenovo, asissuesofstatutoryinterpretationarequestionsoflaw.99 Themajorityfirstconcludedthattheprovisionauthorizingbenefitsfor

88Id. 89MICH.COMP.LAWS500.3107(a)(2002);seeKrohn,802N.W.2dat284. 90Krohn,802N.W.2dat28687. 91Id.at287. 92Id. 93Id. 94Id.at28788. 95Id.at288. 96Krohn,802N.W.2dat288. 97Id.at285&n.1. 98Id.at294. 99Id.at288.

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reasonably necessary expenses for the injured party must be assessed using an objective standard.100 Having made this conclusion, the court went on to hold that an experimental surgery could not be considered reasonably necessary unless it was shown to be efficacious.101 It stated that this must be determined based on objective and verifiable medical evidencebutdeclinedtofurtherdefinethisrequirement.102Thisstandard, was termed a minimal threshold of efficacy, that must be met for the issue of reasonableness to be submitted to the jury.103 Accordingly, the court found that unless expert testimony is presented showing that an experimentalsurgeryhasareasonablechanceofbeingefficacious,itwill be summarily barred from coverage under the PIP provision of the No FaultAct.104 The court next utilized its newly instituted efficacy threshold to find thatKrohnsprocedurewasnotreasonablynecessaryforhiscare,recovery, or rehabilitation.105 In this phase of the analysis, the court relied on Dr. Hinderers statement that the procedure was not standard practice and disregarded Dr. Limas testimony that the procedure afforded Krohn the opportunity to recover function below his injury site.106 It classified Dr. Limas testimony as pure speculation or conjecture.107 Ultimatelyruling in favor of HomeOwners, the court held that Krohns surgery did not qualifyforpurposesofsurvivingsummaryjudgment.108 D. DissentingOpinion JusticeHathaway,joinedbytwootherjustices,citedthreemajorerrors by the majority in Krohn.109 First, the dissent stated that the majority inappropriatelyremovedthedeterminationofreasonablenecessityfrom thejury.110Second,thedissentchargedthemajoritydecisionwithchanging theActslanguagetoheightenthestandardabovewhatthePIPprovision

100Id.at29091. 101Id.at293. 102Krohn,802N.W.2dat294. 103Id.at293. 104Id.at29394. 105Id.at295. 106Id.at296. 107Id.(internalquotationsomitted)(internalcitationomitted) 108Krohn,802N.W.2dat301. 109 Id.at311(Hathaway,J.,dissenting).JusticeCavanaghconcurredinallbutfootnotetwenty

of the dissent, which suggested that the result of Krohn may affect the term reasonably necessaryasitpertainstoallMichiganstatutes.Id.at306n.20,311.
110Id.at301.

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oftheActrequired.111Finallythedissentstatedthatthemajoritysdecision nullified the will of Michigan voters who rejected an amendment to the NoFault Act that would have incorporated a medically necessary standard.112

ANALYSIS
I. TheMichiganSupremeCourtIncorrectlyTooktheDecisionof ReasonableNecessityUnderthePIPProvisionoftheNoFaultAct AwayfromtheJury. A. TheCourtIncorrectlyAppliedBindingPrecedentInterpretingthe ActtoHoldthattheQuestionofReasonableNecessityCouldBe MadeasaMatterofLaw. ThecourtmisconstruedbindingprecedentintheStateofMichiganin order to remove the determination of reasonable necessity from the jury.113Thecourtstatedthatitsdecisionwasconsistentwithitsholdingin Nasserv.AutoClubInsuranceAssociation;114however,Nasserinfactlendsno support to the Krohn decision.115 The Krohn majority relied on Nassers holding:
[I]t may in some cases be possible for the court to decide the questionofthereasonablenessornecessityofparticularexpenses as a matter of law . . . . Thus, if it could be said with certainty that an expense was both reasonable and necessary, the court couldmakethedecisionasamatteroflaw.116

The court in Krohn mischaracterized this holding by taking the matteroflaw language out of context and conveniently excluding the expenses to which Nasser was referring in its support for judicial determinationsthosethatwerecertainlyreasonable.117ThecourtinNasser didnotpremiseitsdecisionontheplaintiffssubjectivebeliefthatallofhis hospital expenses were reasonably incurred, as the Krohn court suggested;118 rather, Nasser recognized that blatantly reasonable expenses

111Id. 112Id.at308. 113 See Krohn, 802 N.W.2d at 28990; Nasser v. Auto Club Ins. Assn, 457 N.W.2d 637, 647

(Mich.1990).
114457N.W.2d637(Mich.1990). 115ContraKrohn,802N.W.2dat28990. 116Nasser,457N.W.2dat647. 117SeeKrohn,802N.W.2dat28990(limitingtheNasserquotationtotheportionstatingthatit

mayinsomecasesbepossibleforthecourttodecidethequestion...asamatteroflaw).
118Id.at290.

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(e.g., an immediate visit to a doctor following a car accident) should be separatedfromthoseexpensesstillsubjecttofactualdisputes.119 The majority in Krohn took the idea that reasonable necessity may in rare instances be decided as a matter of law as an opportunity to extend such decisions to the PIP provision of the Act outright.120 While expenses maybeallowedasamatteroflawwhenitcanbesaidwithcertaintythat they are reasonably necessary, it does not logically follow that expenses canbedeemednotreasonablynecessaryinthesameway.121 ThecourtinKrohnconflatedtheideathatreasonablenecessitycannot bebasedonaninjuredpersonsperceptionofhisneedswiththeideathat the court is responsible for determining what is reasonably necessary care despite the existence of a factual dispute.122 In doing so, the Krohn courtheldthatthejudge,ratherthanthejury,maymakethedetermination by factoring in a minimum.123 While, the court purported to make this findinginlinewithbindingprecedent,analysisoftheMichiganSupreme Courts own prior decision does not support the Krohn majoritys conclusion.124 Instead, the courts selective application of language containedinprecedentservedasathinlyveiledexcusetoinappropriately removefromthejurywhatwasclearlyafactualdispute.125 B. TheCourtsNewlyCreatedStandardIsInconsistentwiththe LanguageonMatterofLawDecisionsContainedinAnother ProvisionoftheNoFaultAutomobileInsuranceAct. Had the court looked elsewhere in the NoFault Act for guidance in determiningwhetheranissueisamatteroflaw,Dr.Limassupportofthe procedurewouldhavebyitselfraisedafactualquestionsubmittableto the jury.126 A judicially created threshold standard in the PIP provision is inappropriate, considering the fact that the Legislature explicitly limits such a standard in another provision.127 The absence of matteroflaw
119SeeNasser,457N.W.2dat647. 120SeeKrohn,802N.W.2dat290;Nasser,457N.W.2dat647. 121 HealingPlace,Ltd.v.FarmBureauMut.Ins.Co.ofMich.,No.272438,2007WL778504,at *4(Mich.Ct.App.Mar.15,2007)(Itdoesnotfollowthatthetrialcourtisfreetodecidethe issue as a matter of law where a plaintiff has failed to prove reasonableness, or where a defendanthascharacterizedanalternativeasreasonable.). 122SeeKrohn,802N.W.2dat29091. 123Id.at29394. 124SeesupraPart0. 125SeeKrohn,802N.W.2dat307(Hathaway,J.,dissenting). 126SeeMICH. COMP. LAWS500.3135(2)(a)(2002);FarmersIns.Exch.V.FarmBureauIns.Co.,

724 N.W.2d 485, 491 (Mich. Ct. App. 2006) (Terms contained in the nofault insurance act mustbereadinthecontextofthelegislativehistoryandoftheactasawhole.).
127 SeePeoplev.BorchardRuhland,597N.W.2d1,56(Mich.1999)(Wherethelanguageof

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language in the PIP provisionin light of the legislatures limitation on judicial determinations elsewhere in the statuteshould haveserved asa glaring disincentive for the court to favor matteroflaw decisions in No Faultlitigation.128 The Acts definition of serious impairment of bodily function, for purposes of meeting the tort threshold was amended in 1995 to explain when the court may decide the issue as a matter of law.129 Section 3135(2)(a) recognizes only two distinct situations under which the judge, rather than the jury, may deem an injury serious: (1) when no factual disputeexistsconcerningthepersonsinjuries;or(2)thefactualdisputeis not material in determining whether the person suffered a serious impairment of bodily function.130 By establishing only two circumstances under which the judge may deem an injury serious, the legislature demonstratesitssupportforthepositionrepeatedlytakenbytheMichigan courts:factualdisputeswarrantajurydecision.131 Furthering this standpoint, the matteroflaw test for serious impairment of bodily function within the Act contains an exception for situations involving closedhead injuries.132 If a licensed physician who regularly treats closedhead injuries testifies that there may be serious neurological injury, a question of fact remains.133 Analogizing this to the PIPprovision,itisclearthat,asanexpertinthefield,Dr.Limastestimony on the reasonableness and the necessity of the procedure was enough to overcomeanyargumentinfavorofdeterminationbythecourt.134

thestatuteisunambiguous,theplainmeaningreflectstheLegislaturesintentandthisCourt applies the statute as written. Judicial construction under such circumstances is not permitted.)(internalcitationomitted).
128 See 500.3135(2)(a)(i)(ii); Bronson Methodist Hosp. v. Allstate Ins. Co., 779 N.W.2d 304, 309(Mich.Ct.App.2009),(quotingCarsonCityHosp.v.DeptofCmty.Health,656N.W.2d 366(2002))(WhentheLegislatureenactslaws,itispresumedtoknowtherulesofstatutory construction and therefore its use or omission of language is generally presumed to be intentional.); Daniel R. Siefer & Mary T. Nemeth, Lets Get Serious: A View of the Serious ImpairmentThresholdfromaDefensePerspective,87U.DET.MERCYL.REV.683,69899(2010). 129500.3135(2)(a). 130500.3135(2). 131Id.;see,e.g.,Mossv.Pacquing,455N.W.2d339,34243(Mich.Ct.App.1990)(discussingthe

timehonoredpreceptsthatwhereafactualdisputeexists,the question mustbeanswered bythejury).


132500.3135(2)(a)(ii). 133Id. 134SeeKrohnv.HomeOwnersIns.Co.,802N.W.2d281,302(Mich.2011).

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C. AfterIntroducingItsNewStandard,theMichiganSupremeCourt ErroneouslyHeldthatKrohnsProcedureDidNotSurvivethe MinimalThresholdforPurposesofOvercomingSummaryJudgment inFavoroftheDefendant. Purporting to require a showing of a reasonable chance that [the surgery] will be efficacious in the injured persons care, recovery, or rehabilitation, the court sets a threshold that it immediately abrogates.135 Basedonthecourtsvaguedefinitionofefficacy,Krohnssurgeryshould havesurvivedtheminimumthreshold,andthejuryshouldhaveanswered thequestionofwhetherthesurgerywasreasonablynecessary.136Thecourt ignored Dr. Limas testimony on the procedures success and, more importantly, disregarded the fact that Krohn himself benefited from the procedure.137 In its repeated assertion that a showing of an experimental surgerys efficacy must take place, the court stated: [T]he insured must present evidencethatthesurgerymayresultincare,recovery,orrehabilitation.In other words, there must be evidence that the surgery is efficacious.138 Despite its claim that this is only a minimum threshold of efficacy the courtconcludedthatDr.Limastestimonyonthepositiveresultsexhibited by his patients in the past established only the mere possibility of efficacy.139Creatingfurtherconfusion,thecourtstatedthat[p]resentation by an expert witness of . . . objective and verifiable evidence, even if opposedbyseveralwitnessesclaimingtheproposedmedicaltreatmentis not efficacious, is sufficient to sustain plaintiffs burden.140 The court conveniently sidestepped defining objective and verifiable medical evidence that would support a showing of efficacy; thus, the courts finding that Dr. Limas testimony does not point to the surgerys success wassuperficial.141 Binding precedent dictates that, under the Acts PIP provision, an expenseappliestowardaninjuredpersonscareifitisneededastheresult of an automobile accident.142 Krohn underwent the surgery based on his

135Seeid.at293. 136

Cf. McCormick v. Carrier, 795 N.W.2d 517, 53738 (Mich. 2010) (explaining that the legislatures vague language generally warrants a factual finding by the jury under the No FaultAct).

137SeeKrohn,802N.W.2dat287,29697. 138Id.at293(emphasisadded). 139Id.at293,296. 140Id.at300. 141Seeid.at300,301. 142Griffithv.StateFarmMut.Auto.Ins.Co.,697N.W.2d895,903&n.12(Mich.2005).

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discussion with Dr. Hinderer and the evidence showing the surgerys ability to help patients with similar spinal cord injuries.143 Following the surgery, Krohn gained movement in his lower body and became able to controlhisbladderandbowelfunctions.144Dr.LimaandDr.Hinderer,who were both involved in the advancement of the procedure in the medical community,testifiedattrialregardingthesurgeryintheabstractandasit applied to Krohn.145 Despite Dr. Limas assertion that the procedure constituted Krohns only means of gaining mobility below his injury site, thecourtdeterminedthatitsstandardofefficacyhadnotbeenmet.146Itdid so even after acknowledging that Dr. Lima did indeed claim that the procedure was reasonably necessary if [the] plaintiff wanted the opportunitytorecoversomefunctionbelowtheinjurysite.147 The court relied on select statements of Dr. Hinderer in an effort to downplay his role in the surgery at issue.148 In fact, Dr. Hinderer held a significantpositionattheSCIRfacilitatingaccesstothePortugalprocedure for Americans with spinal cord injuries.149 Dr. Hinderer clearly found the procedure to be promising, but he was legally constrained in fully advocatingforitbecausetheprocedurehasnotbeensubmittedfortesting withintheUnitedStates.150Hisinvolvementinassistingspinalcordinjury patientsinundergoingthePortugalprocedureindicatesthathecouldnot have believed that the surgery provided no possibility for a beneficial result for these patients.151 As such, neither expert witness in the case advanced the position that the procedure was incapable of benefiting an injuredpersoninKrohnsposition.152
143Krohn,802N.W.2dat286. 144Krohnv.HomeOwnersIns.Co.,No.283862,2010WL293004,at*6(Mich.Ct.App.Jan.26,

2010)(FortHood,J.,dissenting).
145Krohn,802N.W.2dat302(Hathaway,J.,dissenting). 146Id.at29697(majorityopinion). 147Id.at296. 148Compareid.(quotingDr.Hindererassayingitscertainlynotstandardpracticegivenits

experimental nature and we dont know the outcomes yet because this is such a new procedure.) (internal quotations omitted), with id. at 304 (Hathaway, J., dissenting) (explainingDr.Hindererssignificantinvolvementwiththeprocedure).
149 See Carols Lima et al., Olfactory Mucosa Autografts in Human Spinal Cord Injury: A Pilot

Clinical Study, 29 J. SPINAL CORD MED. 191, 202 (2006), available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1864811/pdf/i10790268293191.pdf. The Acknowledgments section of Dr. Limas study begins: We thank Dr. Steve Hinderer for helpintheneurologicalevaluationofthepatients....Id.
150 SeeKrohn,802N.W.2dat304(Hathaway,J.,dissenting)(Morethanathirdofthepatients

in the worldwide program were patients of Dr. Hinderer, which . . . suggests that Dr. Hindererdoesnotdoubttheeffectivenessoftheprocedure.).
151Id. 152Seeid.at30405.

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IV. TheCourtsDecisionGoesAgainstthePurposeoftheNoFault AutomobileInsuranceActOverall,BecauseItCreatesInconsistency andInequality. A. TheMichiganSupremeCourtsHoldingCreatesaVagueRulethat EffectivelyEliminatesExperimentalProcedures,Treatments,and DevicesFromCoverageUndertheNoFaultAutomobileInsurance Act. Courtsarenotmeanttomakemedicaldeterminations,153yetthecourt in Krohn unnecessarily attempted to classify the medical treatments that may qualify for coverage under the NoFault Act.154 The court arbitrarily handpickedmethodsbywhichaproceduressuccessmaybeshownunder the guise of introducing examples.155 In doing so, the court severely hampered the ability for any cuttingedge medical technology to qualify under the PIP provision of the NoFault Act.156 Ignoring the fact that the technologyutilizedinthesurgeryhasreceivedsupportwithinthemedical communityandthatithasbeenapprovedbytheEuropeanversionofthe FDA,157 the courts requirement of objective and verifiable medical evidencesuchascontrolledstudiessubjectedtopeerreviewordebatein scholarly publicationseffectively implements FDA procedure.158 The courtscapriciousmethodsforestablishingefficacywilldenyopportunities toMichiganautomobileaccidentvictimswiththemostsevereinjuries.159 With Krohn serving as precedent, lower courts in Michigan will be forced to exclude experimental procedures under the Act.160 The courts
153

See Melissa Wong, Coverage for Kidneys: The Intersection of Insurance and Organ Transplantation, 16 CONN. INS. L.J. 535, 562 (2010) (Courts [e]xhibit [b]iases and [l]ack [s]cientific[e]xpertiseto[m]ake[m]edical[d]eterminations.).

154SeeKrohn,802N.W.2dat300. 155Seeid. 156

See id. at 307 (Hathaway, J., dissenting) ([T]he majority effectively asserts that it is unreasonable . . . to have pursued the only procedure that could possibly prevent [Krohn] frombeingaparaplegicfortherestofhislife.).

157SeesupraPart0;see,e.g.,JuanC.Bartolomei&CharlesA.Greer,OlfactoryEnsheathingCells:

Bridging the Gap in Spinal Cord Injury, 47 NEUROSURGERY 1057 (2000) (It seems certain that [ensheathingcells]willcontributetotheestablishmentofnewhorizonsinSCIresearch.).
158 Compare Krohn, 802 N.W.2d at 29697 (presenting examples of showing efficacy through

comparisontoFDAapprovalprocedures),withEarlP.Steinbergetal.,InsuranceCoveragefor Experimental Technologies, HEALTH AFF., Winter 1995, at 143, 145 (1995) available at http://content.healthaffiars.org/content/14/4/143(BecausetheFDAdoesnotregulatesurgical or medical procedures, and because many diagnostic tests may be performed by clinical laboratorieswithouteverhavingbeenreviewedbytheFDA,...insurersmustmakedecisions regardingcoverageofsometechnologiesintheabsenceofFDAapproval.).
159SeeKrohn,802N.W.2dat307(Hathaway,J.,dissenting). 160Seeid.at306;Mellon,supranote40,at672(discussingtheMichiganSupremeCourtsactive

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confused analysis cannot possibly serve as a guide for lower courts to follow considering its contradictory statements and hypocritical applicationofitsowntest.161Thecourtfoundthatnoevidenceshowedthat the procedure could be beneficial, despite expert testimony on the surgerys benefits.162 Michigan courts will be forced to read this to mean that expert testimony in support of a newly developed procedureeven supported by researchis patently excluded as a means of advancing a procedures efficacy.163 Attempts to show efficacy and determine what objective and verifiable medical evidence will suffice are rendered a productofguessworkonthepartofinjuredparties.164 B. TheCourtsDecisionDoesNotFurthertheGoalsoftheNoFault AutomobileInsuranceActBecauseItCreatesInconsistencyand InequityforMichigansInsured. The Michigan Supreme Court has long recognized the purpose of the NoFault Automobile Insurance Actto provide victims of automobile accidentswithassured,adequate,andpromptreparation.165Thecourts decisioninKrohntakesawaytheassurancethatMichigandrivershavein their nofault auto insurance system.166 The decision compromises injured persons security by jeopardizing compensation for postaccident reasonableandnecessaryexpenses. The Michigan legislature developed the NoFault Automobile InsuranceActwithanexplicitintentionofprovidingbroadPIPbenefits.167 The legislature recognized that not only are there many types of people whoareinjuredbecauseofautomobileaccidents,butthattherearemany types of injuries that occur, as well.168 Creating an exhaustive list of the possible injuries for which PIP benefits could apply would be nearly impossible.169Forthisreason,theActsPIPlanguageisleftopensothatit may reach as many of the potential expenses incurred by auto accident victims as possible.170 The Act encompasses all reasonable charges incurredforreasonablynecessaryproducts,servicesandaccommodations

roleinshapingthestatesinsurancelaw).
161SeesupraPart0. 162Krohn,802N.W.2dat296. 163Seeid.at307(Hathaway,J.,dissenting). 164Seeid.at30001(majorityopinion). 165Shaversv.Kelly,267N.W.2d72,77(Mich.1978). 166SeesupraPart0. 167Jones,supranote21,at37980. 168Seeid. 169SeeMcCormickv.Carrier,795N.W.2d517,538. 170Seeid.

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foraninjuredpersonscare,recovery,orrehabilitation.171Inpractice,the PIP provisions inclusive language has long served its intended purpose; theActhasprovidedtheflexibilitynecessaryforthecourtstospeaktothe individualized needs of auto accident victims when automobile insurers deny coverage.172 Because the Michigan legislature designed the Act to haveabroadscope,thecourtseffectiveeliminationofanentirecategoryof proceduresandtreatmentsisunjustifiable.173 Some motorists leave an automobile accident with a sore back, and someescapewithabrokenbone.174Theseinjuriesarereadilytakencareof under the PIP provision of the NoFault Act through reimbursements for physical therapy and hospital bills.175 The motorists who most need the protectionaffordedbytheNoFaultActarethosewithdebilitatinginjuries: brain trauma, loss of limbs, or paralysis.176 Experimental procedures represent the cuttingedge medical technologies that are working to improvethelivesofpeoplewithseriousinjuries.177Ifthecourtsagendais to control the amount of money involved in the NoFault system, as the appealscourthasalluded,thedecisionisneverthelessmisguidedbecause it serves no such purpose.178 Denying access to these technologies does nothingtoreducethepayoutofautomobileinsurers:thecostsincurredby severely injured parties will, instead, be reflected in their continued need formedicalproductsandthirdpartycare.179

171 500.3107(1)(a);see,e.g.,Heinzv.AutoClubIns.Assn,443N.W.2d4,5(Mich.App.1995)

([T]henofaultactisnotlimitedstrictlytothepaymentofmedicalexpenses.).
172 See, e.g., Hamilton v. AAA Mich., 639 N.W.2d 837, 843 & n.2 (Costs resulting from the

appointment of guardians or conservators to perform services for seriously injured persons, and room and board, attendant care, modifying vehicles for paralyzed individuals, rental expenses, and similar costs have been found by this Court to be reasonably necessary expensesundersubsection3107(1)(a).).
173SeeMcCormick,795N.W.2dat538(quotingKreinerv.Fischer,683N.W.2d611(Mich.2004)

(Cavanagh,J.,dissenting))([B]ecausetheLegislatureavoideddrawinglinesinthesand... somustwe.).
174In2009intheUnitedStates,overtwomillionpeoplewereinjuredinautomobileaccidents.

NATLHIGHWAYTRAFFICSAFETYADMIN.,TRAFFICSAFETYFACTS2009,at103(2009),availableat http://wwwnrd.nhtsa.dot.gov/Pubs/811402.pdf.
175 See MICH. COMP. LAWS 500.3107(a) (2002); see, e.g., Nasser v. Auto Club Ins. Assn, 457 N.W.2d637,647(Mich.1990). 176 SeeBurkev.Warren,307N.W.2d89,93(Mich.Ct.App.1981)([T]he[NoFaultAct]must

beliberallyconstruedinfavorofthoseitintendstobenefit:theaccidentvictims.).
177 SeeMarkHenderson,StemCell TherapyGivesHopetoAccident Victims,THE TIMES, Jan.23,

2009,http://www.timesonline.co.uk/tol/life_and_style/health/article5569623.ece.
178 ContraKrohnv.HomeOwnersIns.Co.,No.283862,2010WL293004,at*2(Mich.Ct.App.

Jan.26,2010).
179 See, e.g., Hoover v. Mich. Mut. Ins. Co., 761 N.W.2d 801, 80405 (Mich. Ct. App. 2008)

(holding that conservators of the estate for an adult with quadriplegia were entitled to PIP

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When a jury finds that an innovative procedure is reasonable and necessary for an auto accident victim, that procedure should qualify for coverageforthesamereasonanyotherexpenseunderPIPiscovered:the NoFaultActguaranteesit.180MichiganresidentsarerequiredtohavePIP insurance, and in exchange they are told that they will be reimbursed adequatelyandpromptlyforreasonableandnecessaryexpensesthatresult from auto accident injuries.181 Despite this promise, the Krohn decision deniesMichigansinsured,whowouldbeunabletopayoutofpocketfor experimentalprocedures,whatislikelytheironlychanceatrecoveryand leavestheseindividualssusceptibletobleakfutures.

CONCLUSION
The Michigan Supreme Court erred in its decision to exclude Kevin Krohns procedure under the NoFault Automobile Insurance Act as a matteroflaw.Thecourtignoredprecedentthatestablishedwhenmatter oflawdeterminationscouldbemadeforpurposesofdecidingreasonable necessityanddisregardedlanguagewithintheActthatindicatesadisfavor forsuchdeterminations.Further,thecourtupendedthelegislaturesgoals in enacting NoFault, eliminating an entire category of potential benefits for auto accident victimsin Michigan.The court strayedfrom established aspects of statutory interpretation, creating an unprecedented threshold test for experimental procedures under the NoFault Act. Further, the holding provides no guidance for future courts to apply the standard because the key wordsefficacious and objective and verifiable medical evidenceare left undefined. The Michigan Supreme Court shouldhaveupheldthetrialcourtsdecisiontoallowthejurytodetermine whetherKevinKrohnsprocedurewasreasonableandnecessaryunderthe NoFaultAct,astheMichiganlegislatureintended.

benefitsforahomesecuritysystem,utilitybills,elevatorinspectioncosts,dumpstercosts,and house cleaning and snow removal expenses because they were necessitated by the accident victimsinjuries).
180SeeMcCormickv.Carrier,795N.W.2d517,547(Mich.2010). 181Darmofal,supranote40,at60203;seeJones,supranote21.