Michigan Court of Appeals; Docket # 343573; Unpublished
Judges Cameron, Markey, and Borrello; 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In this unanimous unpublished per curiam decision, the Court of Appeals affirmed the trial court’s summary disposition order dismissing the plaintiff’s first-party action to recover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 through the Michigan Assigned Claims Plan. The Court of Appeals agreed with the trial court that the plaintiff, Willie Seals, committed fraud in his application for benefits to the Michigan Automobile Insurance Placement Facility, and that, as a result, his claims were barred under MCL 500.3173(a)(2).
Willie Seals was injured while riding as a passenger in an uninsured vehicle. Seals, himself, was uninsured, and filed an application for no-fault PIP benefits with the MAIPF. Seals later sued the MACP, arguing that MACP unreasonably refused to assign his claims for attendant care services to a no-fault insurer. The MACP ultimately did assign Seals’ claims—to Allstate Insurance Company—and the parties agreed to substitute Allstate as a defendant. Allstate ultimately denied Seals’ claims and moved for summary disposition, arguing that he and his longtime friend and roommate, Walter Bentley, committed fraud based on their deposition testimonies.
As part of discovery, Seals asserted, both in answers to interrogatories and in a deposition, that his longtime friend and roommate, Walter Bentley, had provided attendant care services to Seals. Seals testified in his deposition that Bentley had helped Seals to get in and out of the bath tub and his bed, and had helped him to put on his socks, pants, and shoes. Seals denied needing help actually bathing himself. However, Bentley, in his deposition, specifically denied ever helping Seals dress, bathe, or get out of bed, and he stated that he had only assisted Seals with chores and errands. Bentley also specifically denied ever helping Seals with getting in and out of the bathtub. Bentley also submitted calendars and statements documenting the household services that he performed for Seals, but the statements did not document whether Bentley had assisted with personal or attendant care services.
In response to Allstate’s motion for summary disposition, Seals argued that Allstate could only deny payment of the no-fault PIP benefits that were related to his fraudulent testimony. The trial court disagreed, granting Allstate’s motion for summary disposition.
The Court of Appeals affirmed, noting that MCL 500.3173(a)(2) states that, if a false statement is used “as part of or in support of a claim to the MAIPF,” then the claimant is ineligible for payment of any benefits under the MACP. The Court determined that there was no genuine issue of material fact as to whether Seals submitted false information as part of his no-fault claim, based on the discrepancies between his and his roommate’s depositions. Moreover, it did not matter that the claim had already been assigned to a private insurer, so long as it was originally made to the MAIPF.
The Court also explained that MCL 500.3173a does not mandate that a specific person or entity must receive the false statement or information. Rather, the statement only needs to be used “as part of or in support of a claim to the [MAIPF]” in order to qualify as a fraudulent insurance act. Candler, 321 Mich App at 780, quoting MCL 500.3173a(2) (quotation marks omitted; alteration in original). If the original claim for no-fault benefits was made to the MAIPF, then the provisions of MCL 500.3173a apply, even if the MAIPF or MACP has assigned the claim to a private insurer. Id. at 779-780. Furthermore, the plain language of MCL 500.3173a does not require that the person submitting the false information have an intent to defraud. MCL 500.3173a. Finally, while formal documentation, i.e., bills, statements, or logs, is considered the best way of establishing that no-fault services have been rendered, there is no statutory provision that requires formal documentation to establish a claim for benefits; testimony by a service provider can be sufficient to establish that expenses have been incurred. Douglas v Allstate Ins Co, 492 Mich 241, 269-270; 821 NW2d 472 (2012).
