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Parker v Farmers Ins Exch (COA – UNP 1/17/2019; RB #3836)

 

Michigan Court of Appeals; Docket # 339595; Unpublished
Judges Gleicher, Stephens, and O’Brien; 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In this unanimous unpublished per curiam opinion, the Court of Appeals affirmed the trial court’s grant of summary disposition for defendant/third-party plaintiff-appellee Farmers Insurance Exchange (“Farmers”) regarding Plaintiff-appellant Jonathan Parker’s (“Parker”) disqualification from PIP benefits due to his fraud. The Court upheld the trial court’s grant of summary disposition because Parker had knowingly signed his name to false attendant care forms submitted to Farmers.

Parker was involved in two motor vehicle accidents: one on October 2, 2015 and one on November 8, 2015. In both accidents, Parker was in his brother’s uninsured vehicle. Because the car was uninsured and Parker did not otherwise qualify for no-fault coverage, Parker submitted his claim to the Michigan Automobile Insurance Placement Facility (“MAIPF”). MAIPF assigned Farmers to cover Parker’s claim.

Parker submitted attendant-care calendar forms signed by him and his mother, purporting that Parker’s mother provided attendant care. However, it was later revealed that some of these attendant care forms contained claims for reimbursement that Parker’s mother never provided. Parker’s mother explained that she was instructed by employees of an attendant-care provider to backdate the attendant-care forms to dates she did not provide care to Parker. Parker signed these forms attesting to their accuracy. Farmers stopped paying PIP benefits to Parker after it learned of this. Parker brought an action to recover PIP benefits. The trial court granted summary disposition to Farmers under MCL 500.3173a(2). Parker appealed.

The Court of Appeals held that Parker had committed fraud because he signed documents that he knew purported false information about his mother’s attendant care. The Court explained that under MCL 500.3173a(2) a “claim that contains or is supported by fraudulent insurance act as described in this subsection is ineligible for payment or benefits under the assigned claims plan.” Moreover, the Court had addressed a similar issue in Candler v Farm Bureau Mut Ins Co, 321 Mich App 772, 779-780; 910 NW2d 666 (2017) where it held that MCL 500.3173a(2) barred a claim so long as the false statement “was used as part of or in support of a claim to the [MAIPF].”

Here, Parker had signed documents that false purported that his mother provided attendant care. Those false documents supported his claim for first-party PIP benefits from Farmers. Parker argued that he did not know the information was false. However, the Court found that Parker could not have reasonably believed the information was true. The forms represented that he received 24-hour care from his mother and girlfriend on the day of his second accident. The forms then represented that he received 24-hour care when he was receiving inpatient care at the hospital. The Court explained that Parker was clearly aware that he did not receive attendant care from his mother and girlfriend on those days. Even if he was “confused and misled” by the attendant care provider, he still knew the information he was providing was false. The Court then briefly addressed the other elements of fraud and found that there was no issue of genuine fact regarding the fraud. Thus, the Court upheld the trial court’s grant of summary disposition.

“[T]he record contains ample evidence that plaintiff must have known that some of the information in the forms was false: the forms represented that plaintiff received 24-hour care from his mother and girlfriend on the day that plaintiff was driving a car by himself and got into an accident, as well as on the three days after that accident while plaintiff was receiving inpatient care at the hospital. Plaintiff was clearly aware that he did not receive 24-hour attendant care from his mother and girlfriend on those days, and no reasonable juror could conclude otherwise.2 Plaintiff contends that the evidence suggests that he and his mother “were confused and misled” to put false information into the form, but he does not explain how this negates that he still knew that the information in the forms was false.”

Parker then argued that MCL 500.3173a(2) did not bar from receiving benefits because he did not have a direct contract with Farmers. The Court disagreed with this and cited to Candler where it found that MCL 500.3173a(2) barred the plaintiff’s claim even though it was assigned through MAIPF.

“Plaintiff’s argument fails, however, because Candler directly dealt with this issue as well. The Candler Court explained that a “claim [for certain] benefits is part of—and not separate from—the claim that [a person] submits to the MAIPF”; a request for a different benefit is not “a ‘new’ claim separate from the ‘prior’ claim made to the MAIPF.” Candler, 321 Mich App at 780 n 5.”

The Court thus upheld the trial court’s grant of summary disposition for Farmers.

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