was independent of the method of stroke
ascertainment, suggesting that the finding
PUTTING IT ALL TOGETHER
So let’s put the medical literature
summarized above together in the context
of a true-to-life hypothetical.
Suppose again the patient/client is a
young, married mother who suffered
serious orthopedic injuries in an auto
collision. Before her injury, she worked fulltime,
social network of friends and family. But
her orthopedic injuries have prevented
her from returning to work, made it
impossible to exercise and, because she
cannot get out, caused her to be become
isolated from her social network. She then
becomes depressed. Suppose further that
her husband must now work 60 hours each
week to pay the bills.
According to the medical literature,
the motor vehicle collision caused the
following health changes to both the wife
• The wife’s lack of physical activity has
rendered her the health equivalent of
an obese person.6
• The wife’s lack of social relationships
has turned her into the health
equivalent of a smoker.7
• The wife’s depression has doubled her
risk of stroke.8
• The husband’s long work hours have
tripled his risk for stroke.9
In sum, simply in terms of lifestyle changes
alone, this injury has turned an otherwise
healthy couple into the following: a wife
who is now the health equivalent of an
obese smoker with a two-fold increased
risk of stroke, and a husband with a tripled
risk of stroke.
IMPROVING ACCESS TO CARE
The medical literature, however, is not
all bad news. Rather, it can help medical
providers and attorneys advocating for
auto accident victims establish that certain
services are compensable under the
regularly exercised and had a healthy
Innovative Health - Summer 2017
Michigan No-Fault Act.
Under MCL 500.3107(1)(a), a no-fault
insurer is required to pay “allowable expenses
consisting of all reasonable charges
incurred for reasonably necessary products,
services and accommodations for an
injured person’s care, recovery, or rehabilitation.
” In addition, Michigan courts have
told us that we must look closely at the
words of the statute. Only those services
that fall within the ambit of “care, recovery,
and rehabilitation” are compensable.
What exactly do these words mean? The
Michigan Supreme Court has given us
this definition: “Expenses for ‘recovery’
or ‘rehabilitation’ are costs expended in
order to bring an insured to a condition
of health or ability sufficient to resume his
Let’s apply this concept to a real-world
situation. Suppose again that, as result of
a serious auto accident, a patient loses
her ability to be independent physically.
Suppose that the patient’s pre-accident
life was full of physical activity and, by
definition, free of the serious health risks
of physical inactivity. Shouldn’t the no-fault
insurer pay for the services, like therapeutic
recreation, that enable the physical activity
needed to bring the patient’s health profile
back to her pre-injury state? Using the
language from the Michigan Supreme
Court, the answer would appear to be yes.
Suppose further that the no-fault insurer
refuses to pay for these services and the
patient goes on to develop coronary
artery disease or diabetes — conditions
that recent medical literature indicates
are known to follow from physical
inactivity. Would the no-fault insurer be
required to pay for treatment of those
serious health conditions? Under existing
case law, the answer appears to be yes.
For example, in Scott v State Farm Mut
Ins Co, 278 Mich App 578 (2008), the
Michigan Court of Appeals held that a
no-fault insurer could be obligated to
pay for hyperlipidemia treatment that the
plaintiff’s treating physicians testified was
caused by the patient’s brain injury.
This gives medical providers and attorneys
an opportunity to present a strong costbenefit
argument. That is, it is obviously
more cost effective to treat the physical
inactivity by giving the patient access to
therapeutic recreation, as opposed to
waiting for the patient to develop known
sequelae of physical inactivity, like coronary
artery disease or diabetes.
We are seeing only the tip of the iceberg.
To date, modern medicine has only begun
to understand the long-term health effects
of lifestyle changes or chronic conditions,
like depression. Yet the findings from
recent studies all share one common
conclusion: the human body is more
interconnected than we ever thought,
and a change in one aspect of a person’s
lifestyle has ripple effects throughout the
As advocates for the injured, medical
professionals and attorneys must
understand all these ripple effects, so
we can minimize the downstream health
consequences that medical literature tells
us accompany a serious injury.
1 I-Min Lee et al., The Impact of Physical
Inactivity on the World’s Major Non-
Communicable Diseases, 380 Lancet 219 (July
2012), available at http://www.ncbi.nlm.nih.gov/
2 Julianne Holt-Lunstand, “Social Relationships
and Mortality Risk: A Meta-Analytic Review,”
7 PLoS Medicine (July 2010), available
3 Paoloa Gilsanz et al., Changes in Depressive
Symptoms and Incidence of First Stroke Among
Middle-Aged and Older US Adults., 4 J. Am.
Heart Assoc. 5 (May 2015), available at http://
4 MCL 500.3107(1)(b).
5 Mika Kivimäki, et al., “Long working hours
and risk of coronary heart disease and stroke:
a systematic review and meta-analysis of
published and unpublished data for 603 838
individuals,” 386 The Lancet 10005 (October
2015), available at http://www.thelancet.com/
6 See note 1, supra.
7 See note 2, supra.
8 See note 3, supra.
9 See note 5, supra.
10 Griffith v State Farm Mut Ins Co, 472 Mich
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