Michigan Court of Appeals; Docket # 343003; Unpublished
Judges Sawyer, Cavanagh, and Servitto; per curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
STATUTORY INDEXING:
Not applicable
TOPICAL INDEXING:
Actual Fraud
Fraud/Misrepresentation
SUMMARY:
In this unanimous unpublished per curiam decision, the Court of Appeals reversed the trial court’s summary disposition order dismissing the plaintiff’s first-party action to recover no-fault PIP benefits and remanded for further proceedings. The trial court determined that the plaintiff committed fraud in his claims for benefits—specifically, claims submitted for replacement services allegedly provided by his roommate—but the Court of Appeals reversed, finding that a question of fact existed as to whether certain inaccuracies in the claims submitted by the plaintiff’s roommate constituted fraud committed by the plaintiff. The Court determined that there was no evidence that the plaintiff even knew what his roommate was requesting in the claim submissions, or that the plaintiff, himself, made any misrepresentations, let alone any misrepresentations with the intention that the defendant rely on them. The Court further rejected the defendant’s claim that the plaintiff committed fraud by misrepresenting his medical history. The defendant argued that statements the plaintiff made at his deposition contradicted the plaintiff’s medical records, but the Court determined that, at the very least, a question of fact existed as to whether those inconsistencies constituted fraud.
Plaintiff Patrick McCourt was injured in a motor vehicle collision and received replacement services from his roommate, Lonnie Adams. In summarizing McCourt’s claims, the Court of Appeals stated:
Replacement services forms were submitted to defendant for the months of January, February, March, April, May, and July 2016. On the forms, Adams indicated that he cooked for plaintiff day, he walked plaintiff’s dog almost every day, and he did the laundry every Tuesday and Saturday. Adams testified that prior to the accident, generally, he did 70% of the household chores and plaintiff did 30% of the household chores. However, Adam’s also testified that, prior to the accident, he did all of the cooking, laundry, and he also walked plaintiff’s dog, and after plaintiff was injured, he continued to perform these services. Plaintiff testified, however, that prior to the accident, there was no specific arrangement between Adams and plaintiff in regard to household chores, but rather, they split the chores in half depending on who was available. Plaintiff also testified that prior to the accident, he did all household chores that involved his “personal business.” Plaintiff did not specifically indicate what chores those were. Plaintiff testified that after the accident, Adams took over 90% of the household chores because plaintiff was only able to do light cleaning around the house.
Defendant Allstate Insurance Company alleged that the replacement services claims were fraudulent, “because Plaintiff claimed benefits for services that Adams would have performed even if Plaintiff had not been injured.” The Court of Appeals found no evidence, however, that McCourt knew that the forms submitted by Adams contained false information. Thus, there was a question of fact as to whether McCourt, himself, could be said to have committed fraud.
Here, defendant argues that it is apparent that plaintiff knew that Adams had provided false information in the replacement services forms, or at a minimum, plaintiff recklessly allowed incorrect claims to be filed on his behalf without verifying the accuracy of the claims. On appeal, plaintiff does not dispute that Adams listed services on the forms that he had provided prior to plaintiff being injured. However, there is no record evidence that plaintiff in fact knew that Adams had provided false information at the time the forms were submitted to defendant. Adams himself was forthcoming in his deposition and described all of the household chores that he completed prior to the accident and after. There was no indication from Adam’s testimony that he was attempting to misrepresent the services that he provided for plaintiff prior to the injury. Moreover, Adams testified that he completed the replacement services forms and then submitted them to plaintiff’s attorney. During plaintiff’s deposition, plaintiff also indicated that Adams was the person who completed the replacement services forms. Adams also personally signed the forms. The forms were not signed by plaintiff. It is not clear whether plaintiff reviewed the forms; therefore, there is no record evidence that plaintiff in fact knew specifically what Adams was claiming in the forms, or that Adam’s claims were contrary to MCL 500.3107(1)(c). This case is not analogous to Candler, in which it would be unreasonable for a jury to find that the plaintiff therein did not know that his statements contained false information after the plaintiff lied about who provided his services and then forged his brother’s signature in order to receive benefits. Here, there is a question of fact as to whether plaintiff was aware of the specific services that Adams claimed or that the forms contained false information. Thus, there is a genuine issue of material fact as to whether plaintiff himself made a false misrepresentation with reckless disregard for its truth or falsity, and with the intention that the defendant rely on it.
Allstate also argued that McCourt committed fraud by misrepresenting his medical history. In each instance adduced by Allstate, however, the Court of Appeals either determined that there was no inconsistency between McCourt’s deposition testimony and his medical records, or that, at the very least, a question of fact existed as to whether such any such inconsistencies constituted fraud.
