State Farm avoids payment of attendant care obligation
Daniel O'Connell was seriously injured in a motor vehicle collision. His wife was apparently approved to provide attendant care in 2003, but she filed no documentation with State Farm after September of 2003 to support her claim for services. The family then delayed beyond the "one year back" rule before filing suit against State Farm for payment of the services she provided in 2003 and 2004 [under this rule, any no fault benefit not sued upon within one year--even if it is not denied by the insurer--is waived]. The court summarily rejected her claim for "old" benefits and the O'Connells did not appeal that decision.
With respect to more recent attendant care services, the appellate court ruled that since Mrs. O'Connell testified that she expected her 2004 services to be paid through an intermediary, she had not documented an obligation owed by State Farm, and for that reason, she could not collect for these more recent services, either. Thus, without disputing O'Connell's need for attendant care which it had initially approved, State Farm was allowed to avoid payment: the O'Connells were too late in suing for 2003 services and had not provided State Farm with [timely] "reasonable proof of both the fact and amount" of 2004 services. It is cases like this one which document the need for the advice of a good lawyer in addressing No Fault PIP issues. In a better world, insurers would not be released from statutory obligations on a technicality: that is not our world.