Background
Ilham Elrahazoui suffered injuries in a motor vehicle collision on September 25, 2022, and was insured under a Citizens Insurance no-fault policy. SNM Physical Therapy treated Elrahazoui using Nervomatrix Trigger Point Impedance Imaging (TPII), a device employing “Electric Hyperstimulation Analgesia” to target myofascial trigger points via a proprietary algorithm measuring skin impedance. The treatment allegedly cost $140,300. Elrahazoui assigned her insurance claim to SNM, which sought payment from Citizens. Citizens denied the claim, arguing SNM failed to present evidence that the TPII treatment was medically efficacious. SNM filed suit under MCL 500.3157 seeking payment. Citizens moved for summary disposition under MCR 2.116(C)(10), supported by expert testimony that the Nervomatrix device was not a generally accepted medical treatment and that available studies, including manufacturer-funded research and a randomized controlled trial, showed no superiority over placebo.
The Court’s Holding
The Michigan Court of Appeals affirmed the trial court’s grant of summary disposition, holding that SNM failed to meet its burden of demonstrating the Nervomatrix treatment was reasonably necessary. Under Michigan’s no-fault insurance statute and the Krohn precedent, when a treatment is experimental and not generally accepted within the medical community, the plaintiff seeking reimbursement must present objective and verifiable medical evidence establishing efficacy. The court found that SNM’s expert, Dr. McGee, actually undermined the claim by characterizing the treatment as “novel,” an addition to “conventional” treatments, and as requiring additional research to establish efficacy.
The court determined that defendant’s evidence—including expert testimony that the device’s algorithm was unverified, that the proprietary mechanism was unknown, and that manufacturer-funded studies demonstrated no superiority to placebo—was sufficient to establish as a matter of law that SNM failed to prove the treatment was objectively reasonable or necessary. The trial court properly exercised its authority to grant summary disposition because no genuine issue of material fact existed regarding the treatment’s medical efficacy.
Key Takeaways
- Experimental medical treatments not generally accepted by the medical community must be supported by objective, verifiable scientific evidence of efficacy to qualify as “reasonably necessary” expenses under Michigan’s no-fault insurance statute.
- The plaintiff bears the burden of proving an expense was incurred for a reasonably necessary service; an insurer’s denial of an unproven experimental treatment does not create a question of fact merely because plaintiff presents an expert opinion supporting it.
- Expert characterization of a treatment as “novel,” requiring “additional research,” or supplementing “conventional” treatments can undermine claims that the treatment is established as medically necessary.
- Summary disposition as a matter of law is appropriate when plaintiff fails to present substantive evidence of efficacy for experimental treatments, not merely the possibility that evidence might exist.
Why It Matters
This decision clarifies that Michigan insurers have a strong legal foundation to deny coverage for experimental medical devices and treatments lacking robust, independent scientific validation. For medical providers offering novel treatments, the decision underscores the critical importance of securing objective, peer-reviewed evidence of efficacy—particularly studies independent of manufacturer funding—before expecting no-fault insurers to cover such treatments. The court’s emphasis that merely presenting expert opinion or manufacturer-sponsored research is insufficient protects insurers from subsidizing unproven therapies while creating a clear standard for what constitutes adequate proof.
The ruling also establishes that when an expert witness acknowledges a treatment remains investigational and requires further clinical validation, that admission can be fatal to claims of medical necessity. This has significant implications for the integration of emerging technologies in physical therapy and rehabilitation medicine, as providers must demonstrate established efficacy through rigorous clinical evidence rather than relying on theoretical mechanisms or preliminary studies before seeking insurance reimbursement.