Michigan Court of Appeals; Docket # 340441; Unpublished
Judges Jansen, Meter, and Gleicher; per curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
STATUTORY INDEXING:
§500.3157: Lawfully Rendered Treatment
TOPICAL INDEXING:
Not Applicable
SUMMARY:
In this unanimous unpublished per curiam decision regarding the “lawfully rendered” services requirement of MCL 500.3157, the Court of Appeals reversed the trial court’s summary disposition order dismissing the plaintiff’s complaint. The Court determined that a question of fact existed as to whether Plaintiff Insight Healing Center (IHC) was an unlicensed adult foster care facility or nursing home. If so, IHC could not recover no-fault benefits from its patient’s insurer on the basis of an assignment because MCL 500.3157 requires that treatments be “lawfully rendered,” which would not be the case if IHC was operating as an adult foster care facility or nursing home without a license.
Plaintiff IHC, owned by co-Plaintiff Jawad A. Shah, obtained an assignment from its patient and brought this action against the patient’s automobile insurer, Defendant Freemont Insurance Company (Freemont), after Freemont denied payment of no-fault PIP benefits, arguing that “IHC was an unlicensed adult foster care or nursing home that could not seek recompense for its unlawfully rendered services.” The trial court granted summary disposition for Freemont, invoking MCL 500.3157’s requirement that medical treatments be “lawfully rendered” in order to be compensable under the No-Fault Act; since IHC was unlicensed, the trial court ruled that the treatments it was providing were not “lawfully rendered.”
The Court of Appeals reversed the trial court’s grant of summary disposition, finding that a question of fact existed as to whether IHC was in fact an adult foster care facility or nursing home that needed to be licensed in order to provide compensable services under the No-Fault Act. As to whether IHC was an unlicensed adult foster care facility, the Court reasoned:
However, viewing the evidence in the light most favorable to Shah, there remain genuine issues of material fact regarding whether IHC was an adult foster care facility that was required to be licensed. Shah and IHC director, Atif Bawahab, testified that Willhelm received around-the-clock nursing care during his IHC stay. Adult foster care facilities do not provide “continuous nursing care.” While Carpenter and Jones testified that Willhelm and other patients at IHC did not require or receive around-the-clock care, these conflicts in the evidence must be decided by the trier of fact.
Moreover, Shah presented evidence that shortly before Willhelm resided at IHC, Rebecca Sells of the Michigan Department of Health and Human Services, Bureau of Children and Adult Licensing investigated IHC and concluded that it did not require an adult foster care license because the entity that owned the building where IHC operates did not provide direct care services to residents.4 Bawahab also submitted an affidavit stating that IHC had never been informed it was operating illegally and confirmed that all direct care workers were hired through independent contractors. Under these circumstances, there are genuine issues of fact regarding whether IHC was required to hold a license for providing adult foster care services, particularly where the applicable statutes clearly require that the establishment where an adult is residing “provide[] foster care” in the form of “supervision, personal care, and protection” before licensure is mandated. These issues must be resolved before a judgment can be reached.
The Court also determined that a question of fact existed as to whether IHC was an unlicensed nursing home, reasoning:
[Plaintiff] similarly overcame the summary disposition burden on Fremont’s claim that IHC was an unlicensed nursing home. The only additional evidence presented by Fremont in this regard was that IHC had the capacity to care for up to eight residents, and at times held as many as seven. Fremont emphasized Bawahab’s deposition testimony that IHC had not exceeded serving eight patients at a time. The record contains general testimony from Dr. Shah, Carpenter, and Jones that nursing care is provided to residents of IHC. There is also documentary evidence regarding the nursing care provided to Willhelm in the form of answers to interrogatories and nursing notes. However, there are conflicts in the evidence regarding whether the nursing care provided was continuous. Because genuine issues of material fact remain regarding the nature of the nursing care provided at IHC, the circuit court could not resolve as a matter of law whether IHC was an unlicensed nursing home. We, therefore, must vacate the circuit court’s order granting summary disposition in Fremont’s favor.
