Michigan Family Attendant Care: The 56-Hour Cap & Reasonable Rate

By Attorney Manny Chahal · Updated May 2026 · Reading time: ~7 min

If a spouse, parent, or adult child is providing in-home care after a Michigan auto crash, the insurer is required to pay for that work as a personal injury protection (PIP) benefit under MCL 500.3107(1)(a). For care rendered after July 1, 2021, however, the 2019 amendments to MCL 500.3157(10) impose a 56-hour-per-week limitation on certain family-provided care unless the insurer agrees in writing to pay for more. Many claimants are told the cap is absolute. It is not.

What Family Attendant Care Is—and Why Insurers Owe It

Attendant care is the hands-on, non-medical assistance an injured person needs to live safely at home after a serious crash: help with bathing, dressing, toileting, medication reminders, transfers, supervision against falls or wandering, behavior cueing after a traumatic brain injury, and similar personal services. The Michigan no-fault act treats this work as an allowable expense for “care, recovery, or rehabilitation” under MCL 500.3107(1)(a), and Michigan courts have long held that the statute does not distinguish between care delivered by a licensed agency and care delivered by a relative living in the home.

That principle was confirmed by the Michigan Supreme Court in Douglas v. Allstate Insurance Co., 492 Mich 241 (2012). Family-provided attendant care is compensable on the same footing as agency care so long as the claimant proves four elements at trial.

The 56-Hour Cap: What MCL 500.3157(10) Actually Says

Public Act 21 of 2019 rewrote MCL 500.3157 and added subsection (10), effective July 1, 2021. The subsection limits an auto insurer’s obligation to pay for in-home attendant care to 56 hours per week when the care is performed by any of three categories of caregiver:

• A relative of the injured person.
• A person domiciled in the household of the injured person.
• A person with whom the injured person had a business or social relationship before the injury.

The cap is tied to the hourly rate ceiling in MCL 418.315 of the Worker’s Disability Compensation Act, which the no-fault statute incorporates by reference. The cap applies only to care rendered in the injured person’s home; it does not apply to care delivered in a skilled nursing facility, adult foster care home, group home, or other professional setting, and it does not apply when care is provided by an unrelated, non-domiciled professional caregiver such as a home health aide hired through an agency.

What the 56-Hour Cap Does Not Mean

The Department of Insurance and Financial Services published Bulletin 2021-31-INS in August 2021 specifically to correct misunderstandings that surfaced as soon as the cap took effect. The bulletin states three things every catastrophically injured claimant should know.

1. The cap is not a blanket ceiling on total attendant care

If a brain-injury survivor needs 24-hour supervision (168 hours per week), the insurer cannot pay only 56 hours and walk away. The remaining 112 hours must be staffed by professional caregivers or by family caregivers under a contract that the insurer has agreed to, and the insurer must pay for those additional hours at the reasonable rate.

2. The injured person is entitled to all reasonably necessary hours

DIFS expressly states that consumers are entitled to as many hours of attendant care as are reasonably necessary, just as they were before the 2019 amendments. The 56-hour cap is a payment ceiling for one specific category of caregiver; it is not a clinical opinion about how much care the patient needs.

3. Insurers can—and most have agreed to—contract for additional family hours

Bulletin 2021-31-INS reported that insurers representing more than 90% of Michigan’s personal auto market communicated to DIFS their willingness to enter contracts paying family caregivers for hours beyond the 56-hour cap. A follow-on bulletin, Bulletin 2021-33-INS, sets out requirements for those contracts. If your insurer refuses to discuss a family-care contract or strings the request out for months while care goes unpaid, that conduct supports a first-party PIP suit under MCL 500.3148.

Before vs. After: How the 56-Hour Rule Changed the Math

Why Policy Language Still Matters After Reform

Statutory limits are only part of the story. In Smejkal v. Beck, ___ Mich App ___ (2024) (Docket No. 363394, decided April 18, 2024), the Michigan Court of Appeals held in a published opinion that where an insured selected “unlimited” allowable-expense coverage and the policy expressly included attendant care within those allowable expenses, the insurer could not rely on the 56-hour limitation because it had contracted to provide broader coverage. MCL 500.3157(11) expressly permits an insurer to contract for more than the subsection (10) hourly limitation. The outcome is fact- and policy-specific, but it underscores why we always obtain and dissect the full policy, declarations page, and any PIP endorsements before accepting an insurer’s “cap” as the last word.

Setting the Right Hourly Rate (Hardrick and Douglas)

For hours that the insurer must pay—whether inside or outside the 56-hour limitation—a fight over the rate is almost guaranteed. Insurers commonly classify family caregivers as low-skill “home health aides” and pay $10 to $13 per hour. Hardrick v. Auto Club Insurance Association, 294 Mich App 651 (2011), and the Michigan Supreme Court’s later decision in Douglas v. Allstate Insurance Co., 492 Mich 241 (2012), together reject that one-size-fits-all approach—though neither case sets a fixed statewide rate.

Hardrick involved a young man with a traumatic brain injury whose parents were prescribed around-the-clock supervision. ACIA paid them at a basic home-health-aide rate. The jury returned a verdict of $28 per hour after hearing agency evidence for behavioral technicians performing comparable tasks. The Court of Appeals ultimately vacated that specific verdict on a discovery-sanction issue (the trial court had improperly barred ACIA from presenting evidence) and remanded for a new trial. The case is widely cited, however, for the proposition that the appropriate hourly rate is fact-specific and that agency evidence is probative of the value of family-provided attendant care—particularly when the caregiver’s actual job classification matches a higher-skilled tier (behavioral technician, certified nurse aide, LPN, registered nurse).

Douglas sharpened the evidentiary rule. A fact-finder may base the hourly rate for a family member’s care on what health-care agencies compensate their employees—i.e., agency wage data. What the agency charges its patients (the billing rate, which includes overhead and profit), the Supreme Court held, is too attenuated from a reasonable rate for family-provided services and is not by itself probative.

The practical lesson: subpoena local agency wage data and rate schedules, match each documented task to the corresponding skill tier, and present that evidence to the adjuster early. Used correctly, Hardrick and Douglas supply a powerful evidentiary framework for pushing the rate well above the insurer’s opening offer—though neither imposes a fixed statewide floor.

Documentation Playbook for the Family Caregiver

Most attendant-care denials are not about whether the care was needed—they are about whether the claimant proved that it was rendered. Build the proof in real time.

• Prescription. Obtain a written prescription or order from the treating physician specifying the number of hours per day and the level of supervision required. Re-issue at every IME or progress visit.
• Daily logs. Maintain dated, signed logs broken down by task and time. Each entry should match a category in the prescription. Vague entries (“helped Dad all day”) are the most common reason for partial denials.
• Caregiver agreements. Reduce the family-care arrangement to writing. State the hourly rate, hours, tasks, and expectation of payment—this satisfies the “incurred” element under Douglas.
• Agency rate comparables. Pull rate schedules from two or three local agencies offering the same tier of care. Save them and attach them to the demand.
• Submit on time. Submit invoices to the insurer at least monthly. The one-year-back rule under MCL 500.3145(2) bars recovery of expenses incurred more than a year before suit (subject to tolling under MCL 500.3145(3)). Late paperwork is the most expensive avoidable error in attendant-care cases.

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