Michigan Court of Appeals; Docket # 342704; Unpublished
Judges Jansen, Cameron, and Tukel; Per curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
STATUTORY INDEXING:
Persons Disqualified from Receiving Benefits Through the Assigned Claims Facility [§500.3173]
TOPICAL INDEXING:
Not Applicable
SUMMARY:
In this unanimous unpublished per curiam decision, the Court of Appeals affirmed the trial court’s summary disposition order dismissing the plaintiff’s first-party action to recover no-fault PIP benefits. The Court of Appeals determined that the plaintiff, Calvin Sheridan, committed fraud in his application for no-fault PIP benefits through the Michigan Assigned Claims Plan, in contravention of MCL 500.3173a(4). Specifically, the Court found Sheridan to have omitted material information regarding his pre-existing injuries in his application for benefits, and also to have submitted claims for attendant care services on dates for which he could not have received any such services.
Calvin Sheridan was walking down the road when he was struck by a motor vehicle in a hit-and-run collision. As a result, he suffered injuries to his shoulders, arms, left knee, neck, and head, and was hospitalized for a period of time. He was uninsured at the time, and thus submitted an application for no-fault PIP benefits to the Michigan Automobile Insurance Placement Facility. In his application, Sheridan did not disclose any pre-existing medical conditions, and later, he attached documentation of attendant care services he received from his sister and brother.
The MAIPF assigned Sheridan’s claim to Titan Insurance Company, who refused to pay PIP benefits to Sheridan based on misrepresentations it alleged he made on his application for benefits and his subsequent claims for attendant care services. Specifically, Titan alleged that Sheridan claimed attendant care services for days on which he was hospitalized for unrelated conditions, and failed to disclose relevant, prior injuries in his original application. Sheridan then filed suit against Titan, and Titan filed a motion for summary disposition, arguing that the omissions and misrepresentations in Sheridan’s application and claims constituted fraudulent insurance acts under MCL 500.3173a(4), and thus rendered him ineligible for benefits. In response, Sheridan contended that he was confused by the questions in his application, that he may have mistakenly put down the wrong dates on his attendant care forms, and that he did not believe that his pre-existing injuries were relevant because they had healed prior to the collision.
The Court of Appeals affirmed the trial court’s summary disposition order dismissing Sheridan’s claims, finding his argument that any omissions in his application or misrepresentations in his claims were either the result of “confusion” at the questions’ wording or innocent “mistakes” to be unavailing. As for the attendant care claims, the Court asserted that it was “unreasonable to suggest that he mistakenly provided four separate date ranges for attendant care services at the same time he was hospitalized.” Moreover:
. . . Sheridan testified that he and his sister would generally fill out the attendant care forms and sign them the same day, or the day after if they forgot. Given these facts, no reasonable jury could conclude that Sheridan mistakenly—rather than fraudulently— submitted false information regarding his prior medical conditions and the attendant care services he received.
As for Sheridan’s pre-existing conditions, the application specifically asked whether he had previously suffered injuries to his back, neck, ribs, legs, or elbows. He answered, “No,” despite having suffered a left knee injury and undergoing a total knee replacement in 2013. The Court determined that the questioning in the application was unambiguous and that Sheridan’s claims of “confusion” were thus without merit. Moreover, the Court highlighted the fact that Sheridan signed the application acknowledging the veracity of his statements, the information in the application, and the application’s fraud warning.
The Court of Appeals rejected Sheridan’s additional arguments, that because he had no contractual relationship with Titan, “‘the only available penalties against [him] are those expressly stated in the No-Fault Act, i.e., attorney fees and costs,” and that, even if he submitted false information in support of his claim for PIP benefits, his claim could not be dismissed entirely. The Court reasoned that MCL 500.3173a(4) and precedential case law provide that, if an individual’s claim for benefits is supported by a fraudulent insurance act, the entire claim is ineligible for payment under the MACP.
