Kevin Krohn v. Home-Owners Ins Co, 490 Mich. 145

Krohn, severely injured paraplegic from a motorcycle crash, seeks no-fault PPI for an experimental olfactory ensheathing glial cell transplantation performed in Portugal.
Procedure was not FDA-approved or legally performable in the United States, and there was no established medical consensus of efficacy.
Experts testified: Hinderer said procedure was highly experimental and not standard care; Lima claimed potential benefit but offered no controlled studies or peer-reviewed support.
Plaintiff incurred travel and surgical costs; defendant initially denied payment but paid post-surgical physical therapy, while seeking a verdict on whether the procedure was reasonably necessary.
The trial court denied a directed verdict for defendant; the jury found in plaintiff’s favor; Court of Appeals reversed; Michigan Supreme Court granted review to address whether the experimental procedure can be a compensable expense under MCL 500.3107(1)(a).
The issue is whether an experimental surgical procedure can be reimbursed under the no-fault act and what standard governs whether such expenses are reasonably necessary.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether experimental surgery can be reasonably necessary under MCL 500.3107(1)(a)	Krohn argues some evidence of efficacy supports reasonableness	Defendant contends experimental procedures cannot be reasonably necessary	Not necessarily barred; must show efficacy via objective evidence
What standard governs reasonableness and necessity	Objectively verifiable medical evidence should establish efficacy	Reasonableness/necessity may be judged by medical judgment and jury	Objective standard applies to reasonableness; efficacy evidence required for experimental procedures
Must an experimental procedure show general medical acceptance?	Not required to gain general acceptance to be compensable	General acceptance should be a factor	General acceptance not required; efficacy evidence sufficient when present
Role of jury vs. court in determining reasonableness	Jury should decide based on expert and factual evidence	Court can decide if evidence shows no material fact	Generally a jury question; but lack of objective efficacy can entitle court to judgment as a matter of law when no genuine issue exists

Nasser v Auto Club Ins Ass’n, 435 Mich 33 (1990) (establishes reasonableness/necessity must be shown; plain language requires reasonableness and necessity)
Griffith v State Farm Mut Auto Ins Co, 472 Mich 521 (2005) (coverage requires causal connection to injury; not all related expenses are covered)
SPECT Imaging, Inc v Allstate Ins Co, 246 Mich App 568 (2001) (trusts expert evidence on medical efficacy for reasonableness/necessity)
Owens v Auto Club Ins Ass’n, 444 Mich 314 (1993) (presence of competing expert opinions can create jury question on reasonableness/necessity)
Allstate Ins Co v Freeman, 432 Mich 656 (1989) (objectivity of standard where reasonableness is involved; uses objective framework in insurance contexts)
Griffith v State Farm Mut Auto Ins Co, 472 Mich 521 (2005) ((duplicate entry))