Supreme Court holds that no fault PIP insurer need not pay for surgical procedure in Portugal.
Kevin Krohn was paralyzied by a severe spinal fracture. He had PIP auto insurance through Home-Owners Insurance Company, a subsidiary of Auto Owners. He sought payment of the expenses of a surgical procedure performed only in Portugal and intended to improve extremity function. It was agreed that the procedure has not been generally accepted in the U.S. and the insurer deemed it "experimental." Krohn argued that it was a reasonable option for someone with no other alternatives. The Supreme Court held, 4-3, that the insurer's characterization of the procedure as "experimental" would control and that the procedure was not "reasonable and necessary" for Krohn's care and treatment.