Background
Eight-year-old DK suffered a traumatic brain injury after a pickup truck struck him while he was riding a bicycle in 2016. He later received hyperbaric oxygen therapy, or HBOT, after his mother reported that earlier treatments improved his anxiety, sleep, attention, and behavior. Corewell Health Taylor Hospital sought nearly $900,000 from State Farm for HBOT administered during 2021 and 2022 under a no-fault policy issued to DK’s father.
Medical testimony was mixed. Some physicians described HBOT as an off-label and experimental treatment for traumatic brain injuries, and one treating physician declined to prescribe it because supporting documentation was insufficient. Other testimony identified case studies, foreign medical data, reported symptom improvement, and MRI comparisons that arguably supported the treatment’s efficacy. The circuit court granted summary disposition to State Farm because HBOT was experimental and not FDA-approved for treating traumatic brain injuries.
The Court’s Holding
The Michigan Court of Appeals reversed. It held that a treatment’s experimental status and lack of FDA approval are not independently dispositive under MCL 500.3107(1)(a). An experimental procedure may qualify as an allowable expense if objective and verifiable evidence shows that it is efficacious, objectively reasonable, and necessary for the insured’s care, recovery, or rehabilitation.
Viewing the evidence in Corewell’s favor, the court found genuine issues of material fact concerning whether scientific literature supported HBOT for traumatic brain injuries and whether objective evidence—including medical observations, testing, progress notes, and MRI reports—showed that the therapy benefited DK. But Corewell was not entitled to summary disposition either, given contrary medical testimony questioning whether the therapy was supported or necessary. Those disputes must be resolved by the trier of fact.
Key Takeaways
- Experimental or off-label treatment is not automatically excluded from no-fault coverage under MCL 500.3107(1)(a).
- A claimant must offer objective and verifiable evidence that the treatment is efficacious, reasonable, and 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 cannot reject a no-fault medical-expense claim solely because the treatment lacks FDA approval or general acceptance in the medical community. Courts instead must evaluate the evidence bearing on efficacy and medical necessity under the statutory standard.
Providers and insurers litigating novel-treatment claims should expect fact-intensive disputes over scientific support, objective measures of improvement, and the connection between the treatment and accident-related injuries. Conflicting medical evidence on those questions ordinarily may require a trial rather than summary disposition.