Mich. Comp. Laws » Michigan Compiled Laws / Chapter 500 / Act 218 of 1956
Michigan Compiled Laws

Mich. Comp. Laws § 500.3157a (2026)

Provision of treatment, products, services, or accommodations under personal protection insurance; submission of records for utilization review; false or misleading information is a fraudulent insurance act; rules; appeal of determination.

✓ current as of July 2026
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THE INSURANCE CODE OF 1956


Act 218 of 1956


500.3157a Provision of treatment, products, services, or accommodations under personal protection insurance; submission of records for utilization review; false or misleading information is a fraudulent insurance act; rules; appeal of determination.

Sec. 3157a.

    (1) By rendering any treatment, products, services, or accommodations to 1 or more injured persons for an accidental bodily injury covered by personal protection insurance under this chapter after July 1, 2020, a physician, hospital, clinic, or other person is considered to have agreed to do both of the following:

    (a) Submit necessary records and other information concerning treatment, products, services, or accommodations provided for utilization review under this section.

    (b) Comply with any decision of the department under this section.

    (2) A physician, hospital, clinic, or other person or institution that knowingly submits under this section false or misleading records or other information to an insurer, the association created under section 3104, or the department commits a fraudulent insurance act under section 4503.

    (3) The department shall promulgate rules under the administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to 24.328, to do both of the following:

    (a) Establish criteria or standards for utilization review that identify utilization of treatment, products, services, or accommodations under this chapter above the usual range of utilization for the treatment, products, services, or accommodations based on medically accepted standards.

    (b) Provide procedures related to utilization review, including procedures for all of the following:

    (i) Acquiring necessary records, medical bills, and other information concerning the treatment, products, services, or accommodations provided.

    (ii) Allowing an insurer to request an explanation for and requiring a physician, hospital, clinic, or other person to explain the necessity or indication for treatment, products, services, or accommodations provided.

    (iii) Appealing determinations.

    (4) If a physician, hospital, clinic, or other person provides treatment, products, services, or accommodations under this chapter that are not usually associated with, are longer in duration than, are more frequent than, or extend over a greater number of days than the treatment, products, services, or accommodations usually require for the diagnosis or condition for which the patient is being treated, the insurer or the association created under section 3104 may require the physician, hospital, clinic, or other person to explain the necessity or indication for the treatment, products, services, or accommodations in writing under the procedures provided under subsection (3).

    (5) If an insurer or the association created under section 3104 determines that a physician, hospital, clinic, or other person overutilized or otherwise rendered or ordered inappropriate treatment, products, services, or accommodations, or that the cost of the treatment, products, services, or accommodations was inappropriate under this chapter, the physician, hospital, clinic, or other person may appeal the determination to the department under the procedures provided under subsection (3).

    (6) As used in this section, "utilization review" means the initial evaluation by an insurer or the association created under section 3104 of the appropriateness in terms of both the level and the quality of treatment, products, services, or accommodations provided under this chapter based on medically accepted standards.

History: Add. 2019, Act 21, Imd. Eff. June 11, 2019

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Act 218

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Essential Insurance

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No-Fault Insurance
Notes of Decisions
Cited in 11 cases (11 in the last 5 years), 2023–2024 · leading case: True Care Physical Therapy Pllc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023).
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True Care Physical Therapy Pllc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). · cites it 34× “, did not require True Care to administratively appeal Auto Club’s utilization review through the procedures in MCL 500.3157a and Mich Admin Code, R 500.”
True Care Physical Therapy Pllc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). · cites it 34× “, did not require True Care to administratively appeal Auto Club’s utilization review through the procedures in MCL 500.3157a and Mich Admin Code, R 500.”
Total Comfort Physical Therapy v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). · cites it 24× “Defendant -1- conducted a utilization review for each insured pursuant to MCL 500.3157a and determined that both insureds “overutilized” plaintiff’s physical therapy services by receiving treatments in excess of the recommended number of treatments for patients with the…”
Ferndale Rehab. Ctr. v. Auto Club Ins. Ass'n (Mich. Ct. App. 2023). · cites it 23× “116(C)(4) (lack of subject-matter jurisdiction), (C)(8) (failure to state a claim on which relief can be granted), and (C)(10) (no genuine issue of material fact), arguing that the court lacked subject-matter jurisdiction because defendant had previously denied benefits after…”
Waterworks Physical Therapy Pc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). · cites it 22× “116(C)(4) (lack of subject-matter jurisdiction), (C)(8) (failure to state a claim on which relief can be granted), and (C)(10) (no genuine issue of material fact), arguing that the court lacked subject-matter jurisdiction because defendant had previously denied benefits after…”
Prime One Physical Therapy v. Auto Club Ins. Ass'n (Mich. Ct. App. 2023). · cites it 22× “After defendant conducted a utilization review of plaintiff’s treatments pursuant to MCL 500.3157a, it concluded that the number of treatments exceeded recommended guidelines for the treatment of patients with the insured’s injuries.”
Priority Physical Therapy & Rehab LLC v. Auto Club Ins Assn (Mich. Ct. App. 2023). · cites it 21× “Defendant conducted a utilization review of plaintiff’s treatment under MCL 500.3157a and found that its insured received more physical therapy treatments than “Official Disability Guidelines” recommended for patients with similar symptoms.”
Infinity Physical Therapy LLC v. Auto Club Ins. Ass'n (Mich. Ct. App. 2023). · cites it 21× “In August 2021, defendant conducted a utilization review of plaintiff’s services in accordance with MCL 500.3157a. Defendant determined that the insured received treatment in excess of the recommendations for duration and frequency of therapy under the American College of…”
Dearborn Rehab. Inc v. Auto Club Ins. Ass'n (Mich. Ct. App. 2023). · cites it 21× “Defendant conducted a utilization review of plaintiff’s treatments pursuant to MCL 500.3157a and determined that the insured’s 87 physical therapy visits exceeded the recommended number of visits for a patient with the insured’s symptoms.”
Care Plus Physical Therapy v. Auto Club Ins. Ass'n (Mich. Ct. App. 2023). · cites it 21× “Defendant conducted a utilization review of plaintiff’s treatments pursuant to MCL 500.3157a and determined that the number of physical therapy visits exceeded the recommended number of visits for patients with the insureds’ injuries.”
Pro-Line Physical Therapy v. Meemic Ins. Co. (Mich. Ct. App. 2024). · cites it 16× “Meemic initially paid personal protection insurance (PIP) benefits to compensate Pro-Line for the rendered services, but it discontinued paying benefits after conducting a utilization review of Pro-Line’s services under MCL 500.3157a. Pro-Line subsequently brought this…”
— Mich. Comp. Laws § 500.3157a(1)(a) — 11 cases
True Care Physical Therapy Pllc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “, did not require True Care to administratively appeal Auto Club’s utilization review through the procedures in MCL 500.3157a and Mich Admin Code, R 500.”
True Care Physical Therapy Pllc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “, did not require True Care to administratively appeal Auto Club’s utilization review through the procedures in MCL 500.3157a and Mich Admin Code, R 500.”
Waterworks Physical Therapy Pc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “116(C)(4) (lack of subject-matter jurisdiction), (C)(8) (failure to state a claim on which relief can be granted), and (C)(10) (no genuine issue of material fact), arguing that the court lacked subject-matter jurisdiction because defendant had previously denied benefits after…”
Total Comfort Physical Therapy v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “Defendant -1- conducted a utilization review for each insured pursuant to MCL 500.3157a and determined that both insureds “overutilized” plaintiff’s physical therapy services by receiving treatments in excess of the recommended number of treatments for patients with the…”
Priority Physical Therapy & Rehab LLC v. Auto Club Ins Assn (Mich. Ct. App. 2023). “Defendant conducted a utilization review of plaintiff’s treatment under MCL 500.3157a and found that its insured received more physical therapy treatments than “Official Disability Guidelines” recommended for patients with similar symptoms.”
— Mich. Comp. Laws § 500.3157a(1)(b) — 9 cases
Waterworks Physical Therapy Pc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “116(C)(4) (lack of subject-matter jurisdiction), (C)(8) (failure to state a claim on which relief can be granted), and (C)(10) (no genuine issue of material fact), arguing that the court lacked subject-matter jurisdiction because defendant had previously denied benefits after…”
Total Comfort Physical Therapy v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “Defendant -1- conducted a utilization review for each insured pursuant to MCL 500.3157a and determined that both insureds “overutilized” plaintiff’s physical therapy services by receiving treatments in excess of the recommended number of treatments for patients with the…”
Priority Physical Therapy & Rehab LLC v. Auto Club Ins Assn (Mich. Ct. App. 2023). “Defendant conducted a utilization review of plaintiff’s treatment under MCL 500.3157a and found that its insured received more physical therapy treatments than “Official Disability Guidelines” recommended for patients with similar symptoms.”
Prime One Physical Therapy v. Auto Club Ins. Ass'n (Mich. Ct. App. 2023). “After defendant conducted a utilization review of plaintiff’s treatments pursuant to MCL 500.3157a, it concluded that the number of treatments exceeded recommended guidelines for the treatment of patients with the insured’s injuries.”
Infinity Physical Therapy LLC v. Auto Club Ins. Ass'n (Mich. Ct. App. 2023). “In August 2021, defendant conducted a utilization review of plaintiff’s services in accordance with MCL 500.3157a. Defendant determined that the insured received treatment in excess of the recommendations for duration and frequency of therapy under the American College of…”
— Mich. Comp. Laws § 500.3157a(3)(a) — 11 cases
True Care Physical Therapy Pllc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “, did not require True Care to administratively appeal Auto Club’s utilization review through the procedures in MCL 500.3157a and Mich Admin Code, R 500.”
True Care Physical Therapy Pllc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “, did not require True Care to administratively appeal Auto Club’s utilization review through the procedures in MCL 500.3157a and Mich Admin Code, R 500.”
Waterworks Physical Therapy Pc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “116(C)(4) (lack of subject-matter jurisdiction), (C)(8) (failure to state a claim on which relief can be granted), and (C)(10) (no genuine issue of material fact), arguing that the court lacked subject-matter jurisdiction because defendant had previously denied benefits after…”
Total Comfort Physical Therapy v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “Defendant -1- conducted a utilization review for each insured pursuant to MCL 500.3157a and determined that both insureds “overutilized” plaintiff’s physical therapy services by receiving treatments in excess of the recommended number of treatments for patients with the…”
Priority Physical Therapy & Rehab LLC v. Auto Club Ins Assn (Mich. Ct. App. 2023). “Defendant conducted a utilization review of plaintiff’s treatment under MCL 500.3157a and found that its insured received more physical therapy treatments than “Official Disability Guidelines” recommended for patients with similar symptoms.”
— Mich. Comp. Laws § 500.3157a(3)(b)(iii) — 9 cases
Waterworks Physical Therapy Pc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “116(C)(4) (lack of subject-matter jurisdiction), (C)(8) (failure to state a claim on which relief can be granted), and (C)(10) (no genuine issue of material fact), arguing that the court lacked subject-matter jurisdiction because defendant had previously denied benefits after…”
Total Comfort Physical Therapy v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “Defendant -1- conducted a utilization review for each insured pursuant to MCL 500.3157a and determined that both insureds “overutilized” plaintiff’s physical therapy services by receiving treatments in excess of the recommended number of treatments for patients with the…”
Priority Physical Therapy & Rehab LLC v. Auto Club Ins Assn (Mich. Ct. App. 2023). “Defendant conducted a utilization review of plaintiff’s treatment under MCL 500.3157a and found that its insured received more physical therapy treatments than “Official Disability Guidelines” recommended for patients with similar symptoms.”
Prime One Physical Therapy v. Auto Club Ins. Ass'n (Mich. Ct. App. 2023). “After defendant conducted a utilization review of plaintiff’s treatments pursuant to MCL 500.3157a, it concluded that the number of treatments exceeded recommended guidelines for the treatment of patients with the insured’s injuries.”
Infinity Physical Therapy LLC v. Auto Club Ins. Ass'n (Mich. Ct. App. 2023). “In August 2021, defendant conducted a utilization review of plaintiff’s services in accordance with MCL 500.3157a. Defendant determined that the insured received treatment in excess of the recommendations for duration and frequency of therapy under the American College of…”
— Mich. Comp. Laws § 500.3157a(4) — 9 cases
Waterworks Physical Therapy Pc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “116(C)(4) (lack of subject-matter jurisdiction), (C)(8) (failure to state a claim on which relief can be granted), and (C)(10) (no genuine issue of material fact), arguing that the court lacked subject-matter jurisdiction because defendant had previously denied benefits after…”
Total Comfort Physical Therapy v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “Defendant -1- conducted a utilization review for each insured pursuant to MCL 500.3157a and determined that both insureds “overutilized” plaintiff’s physical therapy services by receiving treatments in excess of the recommended number of treatments for patients with the…”
Priority Physical Therapy & Rehab LLC v. Auto Club Ins Assn (Mich. Ct. App. 2023). “Defendant conducted a utilization review of plaintiff’s treatment under MCL 500.3157a and found that its insured received more physical therapy treatments than “Official Disability Guidelines” recommended for patients with similar symptoms.”
Prime One Physical Therapy v. Auto Club Ins. Ass'n (Mich. Ct. App. 2023). “After defendant conducted a utilization review of plaintiff’s treatments pursuant to MCL 500.3157a, it concluded that the number of treatments exceeded recommended guidelines for the treatment of patients with the insured’s injuries.”
Infinity Physical Therapy LLC v. Auto Club Ins. Ass'n (Mich. Ct. App. 2023). “In August 2021, defendant conducted a utilization review of plaintiff’s services in accordance with MCL 500.3157a. Defendant determined that the insured received treatment in excess of the recommendations for duration and frequency of therapy under the American College of…”
— Mich. Comp. Laws § 500.3157a(5) — 11 cases
True Care Physical Therapy Pllc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “, did not require True Care to administratively appeal Auto Club’s utilization review through the procedures in MCL 500.3157a and Mich Admin Code, R 500.”
True Care Physical Therapy Pllc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “, did not require True Care to administratively appeal Auto Club’s utilization review through the procedures in MCL 500.3157a and Mich Admin Code, R 500.”
Total Comfort Physical Therapy v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “Defendant -1- conducted a utilization review for each insured pursuant to MCL 500.3157a and determined that both insureds “overutilized” plaintiff’s physical therapy services by receiving treatments in excess of the recommended number of treatments for patients with the…”
Prime One Physical Therapy v. Auto Club Ins. Ass'n (Mich. Ct. App. 2023). “After defendant conducted a utilization review of plaintiff’s treatments pursuant to MCL 500.3157a, it concluded that the number of treatments exceeded recommended guidelines for the treatment of patients with the insured’s injuries.”
Ferndale Rehab. Ctr. v. Auto Club Ins. Ass'n (Mich. Ct. App. 2023). “116(C)(4) (lack of subject-matter jurisdiction), (C)(8) (failure to state a claim on which relief can be granted), and (C)(10) (no genuine issue of material fact), arguing that the court lacked subject-matter jurisdiction because defendant had previously denied benefits after…”
— Mich. Comp. Laws § 500.3157a(6) — 11 cases
True Care Physical Therapy Pllc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “, did not require True Care to administratively appeal Auto Club’s utilization review through the procedures in MCL 500.3157a and Mich Admin Code, R 500.”
True Care Physical Therapy Pllc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “, did not require True Care to administratively appeal Auto Club’s utilization review through the procedures in MCL 500.3157a and Mich Admin Code, R 500.”
Waterworks Physical Therapy Pc v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “116(C)(4) (lack of subject-matter jurisdiction), (C)(8) (failure to state a claim on which relief can be granted), and (C)(10) (no genuine issue of material fact), arguing that the court lacked subject-matter jurisdiction because defendant had previously denied benefits after…”
Total Comfort Physical Therapy v. Auto Club Grp. Ins. Co (Mich. Ct. App. 2023). “Defendant -1- conducted a utilization review for each insured pursuant to MCL 500.3157a and determined that both insureds “overutilized” plaintiff’s physical therapy services by receiving treatments in excess of the recommended number of treatments for patients with the…”
Priority Physical Therapy & Rehab LLC v. Auto Club Ins Assn (Mich. Ct. App. 2023). “Defendant conducted a utilization review of plaintiff’s treatment under MCL 500.3157a and found that its insured received more physical therapy treatments than “Official Disability Guidelines” recommended for patients with similar symptoms.”
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