Background
DK suffered a traumatic brain injury after a pickup truck struck him while he was riding a bicycle in 2016. He later underwent several courses of hyperbaric oxygen therapy, or HBOT, after his mother and some treating physicians reported improvements in symptoms including anxiety, sleep difficulties, attention problems, and impulsivity. Corewell Health Taylor Hospital sought $899,690 from State Farm for HBOT provided during 2021 and 2022 under a no-fault policy issued to DK’s father.
Coverage under the policy was undisputed, but State Farm contested whether HBOT was an allowable expense under MCL 500.3107(1)(a). The record contained conflicting evidence: some physicians cited studies, medical data, MRI comparisons, and reported improvements supporting treatment, while others questioned its necessity or declined to prescribe it. HBOT remains an off-label, experimental treatment for traumatic brain injuries and is not approved by the FDA for that use. The circuit court granted summary disposition to State Farm because the treatment was experimental and not approved for traumatic brain injuries.
The Court’s Holding
The Court of Appeals reversed, holding that a treatment’s experimental status and lack of FDA approval do not by themselves make it noncompensable under Michigan’s No-Fault Act. Under MCL 500.3107(1)(a), the relevant question is whether the treatment was objectively reasonable and reasonably necessary for the insured’s care, recovery, or rehabilitation. An experimental procedure may qualify when supported by objective and verifiable evidence of efficacy.
Viewed in Corewell’s favor as the nonmoving party, the evidence created genuine factual disputes about whether scientific literature supported HBOT for traumatic brain injuries and whether objective evidence—including medical observations, neuropsychological findings, and MRI reports—showed that it benefited DK. But the conflicting testimony about HBOT’s acceptance, efficacy, and necessity also precluded summary disposition for Corewell. Those issues must be resolved by the trier of fact, so the court remanded for further proceedings.
Key Takeaways
- Experimental or off-label treatment is not categorically excluded from allowable expenses under MCL 500.3107(1)(a).
- A claimant must present objective and verifiable evidence that the treatment was efficacious and reasonably necessary for care, recovery, or rehabilitation.
- Patient and parent reports may be considered alongside objective evidence, although subjective reports alone cannot establish compensability.
Why It Matters
The decision confirms that Michigan courts may not resolve no-fault medical-expense claims merely by labeling a treatment experimental or noting the absence of FDA approval. Courts must instead examine the evidence concerning the treatment’s objective reasonableness, necessity, and efficacy for the particular insured.
Providers and insurers litigating unconventional-treatment claims should expect fact-intensive scrutiny of scientific literature, diagnostic testing, medical records, and treating-provider testimony. Conflicting evidence on those subjects may require a trial rather than summary disposition.