Michigan Insurance Medical Exam and Benefit Cutoff Attorney

The letter arrives a few weeks after the appointment. Your treating physician still has you off work and in therapy, but the report from the doctor the insurer chose says you have reached maximum medical improvement, and benefits are terminated effective immediately.

The exam is called an independent medical examination, and the physician is selected and paid by the insurer. That report is the insurer’s evidence, not the last word on what your care requires. Vahdat Weisman Law auto accident attorneys challenge wrongful benefit cutoffs across Michigan. Call (734) 469-4994 for a free consultation. No attorney fee unless we recover for you.

The Doctor the Insurer Chose Has to Qualify

Michigan does not let an insurer send you to just any physician. The examiner must be “licensed as a physician in this state or another state” and must meet two criteria as applicable (MCL 500.3151(2)).

Same specialty. Where care is being provided by a specialist, the examining physician “must specialize in the same specialty as the physician providing the care,” and must be board certified in that specialty if the treating physician is.

Still practicing. During “the year immediately preceding the examination,” the examining physician must have devoted “a majority of his or her professional time” to the active clinical practice of medicine relevant to that specialty, to instructing students in an accredited medical school or accredited residency or clinical research program in that specialty, or to both.

So a physician who has largely stopped treating patients to perform insurance examinations full time has a problem under the second requirement. Section 3151 defines who may conduct the examination; it does not say what follows when its requirements are not met, so whether a noncompliant report is excluded, discounted, or admitted subject to cross-examination is litigated case by case.

What that examiner earns from insurers is discoverable. In Leaverson v State Farm Mutual Automobile Insurance Co, Dockets 370698 and 370699 (Mich Ct App, July 23, 2025, unpublished), the Court of Appeals allowed discovery of an examining physician’s income records as bearing on credibility and bias, but vacated an order requiring complete personal and business tax returns, limited discovery to W-2s and 1099s, and reduced the period from four years to two, reasoning from the one-year lookback in MCL 500.3151(2)(b). Leaverson is unpublished and does not bind other courts; the published Micheli v. Michigan Automobile Insurance Placement Facility, 340 Mich App 360 (2022), addresses the same question and is the authority to start from. [ATTORNEY REVIEW: confirm the precise scope of the Micheli holding before publication.]

Discoverable is not the same as admissible: whether income evidence reaches a jury is decided under the rules of evidence.

You Can Request the Examination Reports

You are entitled to a copy of every written report concerning the examination, and at least one of those reports must set out the examiner’s findings and conclusions in detail (MCL 500.3152). Nothing is delivered automatically. You have to ask for it.

Asking has consequences. The party that caused the examination becomes entitled to written reports of any examination of the same condition, previously or later made. And by requesting and obtaining the report, or by taking the examiner’s deposition, you waive privilege as to those examinations. That is why the request should go out with a lawyer involved.

“Maximum Medical Improvement” Is Not the Michigan Test

The cutoff letter probably says you have reached “maximum medical improvement.” That phrase appears nowhere in the Michigan no-fault act. The governing standard makes payable “reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person’s care, recovery, or rehabilitation” (MCL 500.3107(1)(a)). Care, recovery, and rehabilitation are three separate things, so treatment that maintains function, manages pain, or prevents deterioration can be reasonably necessary even where no further improvement is expected. Whether a charge is reasonable, and whether the service was reasonably necessary, are questions of fact, subject to the coverage level selected (MCL 500.3107c) and, for applicable claims, the reimbursement limits in MCL 500.3157. A report resting on maximum medical improvement has not addressed that standard.

Should You Go to the Examination?

Usually, yes. A court can make orders “as are just” regarding a refusal to comply with sections 3151 and 3152, with one express exception: no order may direct the arrest of a person for disobeying an order to submit to an examination (MCL 500.3153). Short of that, a court can take your condition to be established in accordance with the contention of the party obtaining the order, bar you from introducing evidence of your own condition, enter a default judgment as to the claim or part of it, and order reimbursement of reasonable attorney fees and expenses.

Subdivision (e) runs the other direction: a court may order delivery of the examination report, and may exclude a physician’s testimony if the physician fails or refuses to make it.

The conditions of the examination are governed by the no-fault act, not the general discovery rule. In a benefits dispute, a court may order a mental or physical examination and, on a showing of good cause, may enter protective orders against annoyance, embarrassment, or oppression, including an order that the examination be had only on specified terms and conditions (MCL 500.3159). That framework comes from MCL 500.3159 rather than MCR 2.311 (Muci v. State Farm Mutual Automobile Insurance Co., 478 Mich 178 (2007)).

That is a showing made to a court, not a freestanding right to bring an observer, to record the examination, or to have counsel in the room. Be accurate and complete in the examination itself.

When the Bills Simply Stop

Not every termination arrives as a letter. MCL 500.3157a was enacted by 2019 PA 21, effective June 11, 2019. Its utilization review provisions apply to treatment rendered after July 1, 2020, and the implementing rules, R 500.61 through R 500.69, took effect December 18, 2020. Where treatment is not usually associated with the diagnosis, exceeds typical duration or frequency, or extends beyond normal parameters, the insurer may demand written justification of medical necessity from the provider.

That process runs on a clock. The insurer must request the explanation within 30 days after receiving the bill, the provider responds within 30 days, and the insurer issues a written determination within 30 days, identifying the criteria relied on, the payment amount, and the determination date (R 500.63). A provider appeal to the Department of Insurance and Financial Services is due within 90 days. DIFS notices it within 14 days, the insurer replies within 21 days, and the director issues an order within 28 days, extendable by 28 days. R 500.65(6) provides interest under MCL 500.3142 where the provider prevails.

That appeal is not a precondition to suing. Providers may pursue claims in the trial court without exhausting the permissive utilization review appeal process, because MCL 500.3157a is a nonexclusive grant of jurisdiction to DIFS (True Care Physical Therapy, PLLC v Auto Club Group Insurance Co, 347 Mich App 168; 14 NW3d 456 (2023)); the Supreme Court denied leave on April 26, 2024. Whether that reasoning extends to your own claim has not been decided, so do not assume a provider’s appeal protects your deadlines.

How Long You Have to Act

The cutoff letter did not start a clock. Other clocks started at the crash, and they decide how much of your care can still be paid for. MCL 500.3145 has several parts, each running from something different.

Subsection (1): notice and commencement. An action for personal protection insurance benefits may not be commenced more than one year after the accident, unless written notice of injury reached the insurer within that year or the insurer already paid those benefits for the injury. This is the subsection that requires a writing.

Subsection (2): the one-year-back limitation. Subject to subsection (3), you may not recover benefits for any portion of the loss incurred more than one year before the action was commenced.

Subsection (3): tolling. It tolls both the period for commencing an action and the period for recovering benefits, running from a specific claim for payment until the insurer formally denies it. The statute says “specific claim for payment” and does not require that claim in writing, so a written claim is evidentiary practice rather than a statutory element. Tolling does not apply if you fail to pursue the claim with reasonable diligence.

Subsection (4): what the notice must contain. Your name and address and, in ordinary language, the name of the injured person and the time, place, and nature of the injury.

A complaint to the Department of Insurance and Financial Services is worth filing and sometimes resolves things, but it is not a specific claim for payment under MCL 500.3145(3) and does not toll these periods. Waiting on a complaint outcome while the one-year-back period runs is how recoverable losses are lost.

MCL 500.3145(3) does not apply retroactively to causes of action accruing before June 11, 2019, and for medical benefits a claim accrues when the service is rendered (Spine Specialists of Michigan, PC v MemberSelect Insurance Co, Docket 165445 (Mich, April 1, 2025)). On April 2, 2025, the Court vacated the 2022 Court of Appeals judgment in Encompass Healthcare, PLLC v Citizens Insurance Co and remanded in light of Spine Specialists, and the opinion published October 29, 2025 applied that framework; the vacated Encompass analysis of formal denial and explanation of review is not current law.

Interest on Late Payments, and Who Pays the Lawyer

Benefits are overdue if not paid within 30 days after the insurer receives reasonable proof of the fact and amount of the loss, and an overdue payment bears simple interest at 12 percent per year (MCL 500.3142). Interest turns on the payment being overdue, not on any finding that the insurer behaved unreasonably.

Subsection (3) adds a timing rule for medical benefits: if the bill for a product, service, accommodation, or training under MCL 500.3107(1)(a) is not provided to the insurer within 90 days, the insurer gets an additional 60 days beyond the 30-day period before the benefit is overdue.

A separate remedy entitles your attorney to a reasonable fee where the court finds that the insurer “unreasonably refused to pay the claim or unreasonably delayed in making proper payment” (MCL 500.3148(1)). That requires a judicial finding, and an overdue payment alone does not establish it. Subsection (2) runs the other way: a court may award an insurer’s reasonable attorney fees against you or your attorney where the claim was “in some respect fraudulent or so excessive as to have no reasonable foundation.”

Why Choose Vahdat Weisman Law?

[ATTORNEY REVIEW: confirm this describes actual firm practice.] We test the examining physician’s qualifications, request the reports under MCL 500.3152 with the reciprocal consequences explained first, pursue discovery into that physician’s financial relationship with the insurer, and work through the MCL 500.3145 analysis before filing.

From our Livonia office, we represent injured people across Michigan. Founding partners Kara E. Weisman and Jordan S. Vahdat have each been honored as Super Lawyers Rising Stars. Our attorneys are members of the State Bar of Michigan and active in the Michigan Association for Justice. We advance case costs, we work in English and Spanish, and we are available 24/7.

Frequently Asked Questions

• The examining doctor spent eight minutes with me. Does that matter? It can. Examination length, what was tested, what records the physician reviewed, and whether the report reflects the examination that actually happened are all fair subjects.
• They cut off my benefits. Do I have to keep treating? Talk to your doctors about what your health requires, and talk to us before you stop: gaps in treatment get used later to argue the injury resolved.
• Is it worth fighting over a few months of physical therapy? A cutoff usually signals that the insurer intends to dispute the injury itself, which reaches attendant care, wage loss, and future medical coverage. Our attendant care and replacement services page covers what else may be at stake.

About the Author

Jordan S. Vahdat is a founding partner of Vahdat Weisman Law in Livonia and handles negligence, premises liability, auto accident, and insurance dispute cases. He has been admitted to all Michigan state courts since 2014, practices in the Eastern District of Michigan, and has served as a case evaluator for the Washtenaw Circuit Trial Court and the 15th District Court since 2020. He is fluent in Spanish.

Talk to a Michigan No-Fault Benefits Lawyer

If an insurance medical exam ended your benefits, call Vahdat Weisman Law at (734) 469-4994 or contact us online for a free consultation. Available 24/7, serving all of Michigan, with Spanish-speaking staff. Our no-fault PIP benefits disputes page explains the benefits system.

Dedicated to Justice. Devoted to You. Winning for Your Future.

Reviewed by Jordan S. Vahdat, Vahdat Weisman Law. Last reviewed September 2026.

This information is for educational purposes only and does not constitute legal advice. Every case is unique, and prior results do not guarantee future success.