Will CURE Auto Insurance question the treatment determinations of your doctors and the medical necessity of your medical care after a car accident?
Or, to put it a different way, will CURE refuse to pay for your surgery, medical care and treatment, and necessary services and products based on CURE’s own determination that they are “not medically necessary”?
CURE has done it before.
And according to its own sworn statements, CURE Auto Insurance has admitted that it “assesses” the medical necessity of treatment for its insureds who have been injured in car accidents and it reviews the “determinations” of those insureds’ “treating physicians.”
CURE questions whether a spinal surgical procedure is “medically necessary” to treat a car accident victim
In case 22-2144, CURE Auto Insurance refused to pay a “spinal surgical procedure” that was performed on a car accident by the victim’s doctor, who had determined that the “surgery was necessary to treat” the victim’s medical condition that was “caused by the trauma during the MVA,” i.e., motor vehicle accident.
In refusing to pay, CURE “determined that medical necessity was not supported” and that the “spinal surgical procedure” was “not medically necessary to treat” the victim.
The board-certified neurosurgeon “with 30 years of experience” and “recent experience in treating patients with the same or similar condition” to the crash victim, who was assigned by the Michigan Department of Insurance and Financial Services (DIFS) to review the case, concluded that “medical necessity [for the spinal surgical procedure] was supported on the date of service at issue and the treatment was not overutilized in frequency or duration based on medically accepted standards.”
The mission of the independent, third-party physicians that DIFS appoints to review cases is to evaluate whether the surgery, medical care and treatment, services and products in question were provided to a car accident victim are in compliance with “medically accepted standards.” The standards that these independent doctors use include “generally accepted practice guidelines, evidence-based practice guidelines, or any other practice guidelines developed by the federal government or national or professional medical societies, boards, and associations.”
This independent board-certified neurosurgeon also stated that the spinal surgical procedure “was not overutilized and was medically necessary . . . and was justified and in accordance with the standard of care.”
Consequently, DIFS’s board-certified neurosurgeon recommended that DIFS reverse CURE Auto Insurance’s refusal to pay for the medical treatement.
DIFS Special Deputy Director Sarah Wohlford entered an order directing CURE to pay for the crash victim’s pain management treatment.
CURE questions whether a pain management treatment is “medically necessary” to treat a car accident victim
In case 24-1052, CURE refused to pay for the “pain management treatment” that was provided to a car accident victim.
CURE Auto Insurance based its refusal to pay on its determination that the pain management treatment was “not medically necessary to treat” the victim.
The board-certified physician (physical medicine and rehabilitation with a sub-specialty in pain management), who was assigned by DIFS to review the case, concluded that “medical necessity [of the “pain management treatment”] was supported on the date of service at issue and the treatment was not overutilized in frequency or duration based on medically accepted standards.”
The board-certified physician stated that the pain management treatment “is medically necessary and appropriate for aggravation of the [injured person’s] known lumbar [degenerative disc disease] with stenosis and recurrence of radiculopathy.”
Consequently, DIFS’s board-certified physician recommended that DIFS reverse CURE Auto Insurance’s refusal to pay for the medical treatment that was provided.
DIFS Special Deputy Director Jeffrey Hayden entered an order directing CURE to pay for the crash victim’s pain management treatment.
CURE questions whether non-emergency medical transportation services are “medically necessary” for a car accident victim
In case 24-1606, CURE Auto Insurance refused to pay for the “non-emergency medical transportation services” that were provided to a car accident victim based on “a Disability Certificate signed by a physician.”
CURE Auto Insurance based its refusal to pay on a third-party bill reviewer’s determination that “the transportation was not medically necessary.”
The board-certified physician (family medicine), who was assigned by DIFS to review the case, concluded that “medical necessity [for the non-emergency medical transportation services”] was supported on the dates of service at issue and the services were not overutilized in frequency or duration based on medically accepted standards.”
The board-certified physician stated that the “transportation provided would be considered medically necessary.”
Consequently, DIFS’s board-certified medical physician opined that CURE Auto Insurance’s “denial is overturned” and, thus, recommended that DIFS reverse CURE’s refusal to pay.
DIFS Special Deputy Director Jeffrey Hayden entered an order directing CURE to pay for the crash victim’s medical transportation services.
CURE questions whether surgical injections and drug products are “medically necessary” for a car accident victim
In case 23-1510, CURE refused to pay for the “surgical injections and drug products” that was provided to a car accident victim on 6 occasions.
CURE Auto Insurance based its refusal to pay on its determination that the “surgical injections and drug products” were “not medically necessary to treat” the victim.
The board-certified physician (physical medicine and rehabilitation with a sub-specialty in pain management), who was assigned by DIFS to review the case, concluded that “medical necessity was supported for [four of] the dates of service . . . based on medically accepted standards.”
The board-certified physician stated that the “surgical injections and drug products” on four of the dates of service “are considered medically necessary.” The board-certified physician also “elect[ed] to certify the dates of service 7/27/2023, 8/3/2023, 8/10/2023, and 8/17/2023 based on medical necessity.”
Consequently, DIFS’s board-certified physician recommended that DIFS reverse CURE’s refusal to pay with regard to those four dates of service.
DIFS Special Deputy Director Sarah Wohlford entered an order directing CURE to pay for the crash victim’s “surgical injections and drug products” on the four specified dates of service.
CURE Auto Insurance also questions whether surgery is “medically necessary” for a New Jersey car accident victim
I’ve previously written about the high number of consumer complaints about CURE Auto Insurance in both Michigan and in New Jersey, CURE’s home state. I’ve also written about how the number of complaints against CURE has increased dramatically in recent years in both states.
CURE Auto Insurance’s questioning of a treating doctor’s best determinations of medical care and treatment has also been occurring in New Jersey, as well as in Michigan.
In Citizens United Reciprocal Exchange (CURE) v. Northern NJ Ortho Specialists, a 2017 ruling from the New Jersey Court of Appeals, the doctors for CURE’s insured recommended and performed surgery on the insured “following an automobile accident.”
CURE Auto Insurance refused to pay for the surgery under the insured’s PIP coverage, contending the surgery was “not medically necessary” because “independent medical examinations concurred [that the] insured reached maximum medical improvement.”
The case went to arbitration where the arbitrator “concluded” the insured’s evidence “rebutted CURE’s claim that the surgery was not medically necessary.” The arbitrator “entered an award for” the insured.
The trial judge who affirmed the arbitration award “confirmed the arbitrator’s decision was grounded in substantial evidence found in the record.”
CURE’s appeal to the Superior Court of New Jersey Appellate Division was dismissed.
CURE Auto Insurance acknowledges it may assess the “medical necessity” of a crash victim’s treatment
In a January 20, 2025, sworn statement filed in the U.S. District Court for the Eastern District of Michigan, CURE Auto insurance states that it “assess[es] . . . the medical necessity of treatment” for CURE policyholders and it “review[s]” the “treatment records, diagnoses, and determinations of insureds’ treating physicians . . .”
In a November 13, 2024, sworn statement filed in the U.S. District Court for the Eastern District of Michigan, CURE states that it “assess[es] . . . the medical necessity of treatment” for CURE policyholders and it “review[s]” the “treatment records, diagnoses, and determinations of insureds’ treating physicians . . .”
In an August 28, 2024, sworn statement filed in the Wayne County Circuit Court, CURE states that it “review[s] treating doctor’s determinations.”
It is important to know that Michigan’s No-Fault law requires auto insurers to pay No-Fault PIP benefits within 30 days after receiving proof of the fact/amount of loss and if the auto insurer fails to meet that deadline then the benefits are “overdue” and the auto insurer is liable for penalty interest. (MCL 500.3142(2) and (4)).
Was Your Michigan Car Accident Medical Claim Denied by CURE Auto Insurance?
If CURE Auto Insurance has not been treating you fairly and is improperly denying your medical claim in Michigan, you can file a complaint and share your experience in any of the following ways:
- To file a customer complaint against CURE with the Michigan Department of Insurance and Financial Services (DIFS), click here.
- To file a complaint against CURE with the Better Business Bureau, click here.
- To leave a review on the Better Business Bureau’s customer reviews page for CURE, click here.
- Share your experience on Reddit in any of the following subreddits: Cure insurance claims/customer service experience, Any experience with Cure Auto Insurance?, Auto Insurance – Metro Detroit, and Any experiences with Cure Auto?, Wrong VIN On Insurance, Customer Service, Rates Doubled, Nightmare, Incorrect VIN on Insurance, and Cancelled Policy.
Injured in a car accident in Michigan? Call the attorneys at Michigan Auto Law for a free consultation!
If you were injured in a car accident in Michigan and wondering how your CURE car insurance coverage impacts your claim, call now (800) 968-1001 for a free consultation with an experienced car accident lawyer. There is no cost or obligation. You can also visit our contact page or use the chat feature on our website.
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