Michigan Court of Appeals; Docket # 330852; Unpublished
Judges Murphy, Meter and Ronayne Krause; Unanimous, Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
STATUTORY INDEXING:
When Claimants Can Receive PIP Benefits Through the Assigned Claims Facility [§3172(1)]
Obligation of the Assigned Claims Facility to Make an Initial Determination of Claimant’s Eligibility [§3173a(1)]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this unanimous unpublished per curiam Opinion involving a medical provider’s reimbursement claim submitted to the Michigan Assigned Claims Plan, the Court of Appeals held that summary disposition was proper for the medical provider because it had exercised due diligence in its attempts to locate an applicable no-fault insurance policy.
Plaintiff filed a complaint alleging that it provided $5,997.23 in medical services to Darin Winn after Winn sustained injuries in an auto accident. Plaintiff alleged that it could not identify any applicable no-fault insurance, and so it submitted a reimbursement claim to the Michigan Assigned Claims Plan (MACP). MACP did not assign the claim. Plaintiff then filed this action, claiming the MACP had a duty to assign the claim and requesting a writ of mandamus directing MACP to “promptly assign” plaintiff’s claim. Plaintiff also requested a declaratory judgment that it was entitled to have its claim assigned to a no-fault carrier or to MACP, and that it was entitled to attorney fees, and that the unnamed insurer, JDIC, would be responsible for the $5,997.23 charge and would be obligated to pay within 30 days of assignment of the claim and, if JDIC did not timely pay, it would be responsible for penalty interest and attorney fees. Plaintiff requested a total judgment of $54,217 against JDIC. MACP, however, argued there was evidence that Liberty Insurance had issued a policy that was applicable to the claim. Plaintiff filed a motion for summary disposition, stating that, despite its efforts, it could not identify any applicable no-fault insurance and, therefore, its claim should have been assigned. Plaintiff also stated that even if Liberty had a potential obligation to pay, MACP was still obligated to assign the claim to an insurer, which could then enforce indemnification rights against Liberty. MACP asserted that plaintiff could have discovered the Liberty policy with a minimal amount of due diligence. MACP further argued that there was at least a question of fact regarding whether the entity, believed to be GM Financial, who had repossessed the vehicle in the accident, had applicable insurance. MACP also argued that it properly declined to assign plaintiff’s claim because the claim and documents themselves, particularly the police report, showed the existence of an applicable insurer and plaintiff failed to exercise due diligence in discovering the existence of any insurance. The trial court granted summary disposition for plaintiff, finding that plaintiff had exercised due diligence. The trial court denied MACP’s motion for reconsideration.
On appeal, MACP argued that: 1) plaintiff did not adequately explain why it believed there was no applicable no-fault insurance, and 2) while plaintiff obtained the name of Liberty more than one year after the deadline for filing a claim, the only reason for this was that plaintiff was not diligent in its inquiry.
The Court of Appeals affirmed summary disposition for plaintiff, finding that plaintiff provided sufficient information for an initial determine of eligibility. Regarding plaintiff’s explanation of finding no applicable insurance, the Court said:
“We cannot agree with [MACP’s] argument that it was provided with insufficient information. Indeed, plaintiff submitted an application indicating that there was no insurance in effect on the date of the accident and also included, among other things, the police report, which indicated that the vehicle was being repossessed at the time of the accident and which had a blank space in the box for the insurance carrier, and the report of the private investigator, who detailed his unsuccessful attempts to reach Winn. Plaintiff submitted an adequate application; the pertinent question is whether defendant, upon receiving the claim, properly determined that the claim was ‘obviously ineligible.’”
The Court of Appeals also rejected MACP’s argument that “eligibility could be premised on the provider’s inability to identify coverage, as opposed to the patient’s inability to do so.” As to this argument, the Court said:
“It is well within the range of possibilities that a healthcare provider might be unable to identify applicable insurance due to the inability to contact or obtain information from an injured person. Defendant’s interpretation would lead to unfairness and is not in accord with the statute as written.”
In conclusion, the Court of Appeals held that plaintiff exercised due diligence in its inquiry. The Court stated:
“Plaintiff asked Winn about insurance while he was at the hospital and was informed that Winn was uninsured. Plaintiff ascertained that [another policy] for the vehicle [had been canceled]. Plaintiff hired a private investigator to try to locate Winn but the investigator was unsuccessful in doing so. Also, plaintiff’s attorney represented that … he attempted to obtain the name of [a] no-fault insurer from Lakeside but Lakeside refused to disclose the name. … In addition, and significantly, the record contains a letter dated September 23, 2014, in which plaintiff’s attorney specifically asks Lakeside to open a PIP claim with regard to the accident. Defendant claims that if plaintiff had exercised further diligence it could have discovered an applicable insurance policy through Miller or through the repossessing owner, but overall plaintiff’s actions were reasonable, especially considering that the police report indicated (albeit falsely, as later determined), that the vehicle was in the process of being repossessed at the time of the accident.
We find no basis for reversal.”
