Michigan Court of Appeals; Docket # 328233; Unpublished
Judges Markey, Murphy and Ronayne Krause; Unanimous, Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
STATUTORY INDEXING:
Allowable Expenses for Medical Treatment [§3107(1)(a)]
Allowable Expenses: Incurred Expense Requirement [§3107(1)(a)]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this unanimous unpublished per curiam Opinion, the Court of Appeals held the trial court erred in finding that plaintiff was entitled to recover the difference between the full amount his medical providers billed for his treatment and the reduced payments the medical providers accepted from his health insurer as payment in full, because plaintiff did not “incur” such expenses within the meaning of MCL 500.3107(1)(a).
Plaintiff was seriously injured when his motorcycle was struck by a motor vehicle. As the no-fault insurer of the vehicle involved in the accident, defendant Auto Club was responsible for PIP benefits and was first in priority for paying plaintiff’s medical bills. However, plaintiff’s medical providers ultimately accepted reduced payments from plaintiff’s health insurer, Blue Cross Blue Shield of Michigan (BCBSM), as payment in full. The difference between the total costs and the agreed-upon payments (“BCBSM differential”) totaled $142,561. Auto Club fully reimbursed BCBSM for the payments it had made. Plaintiff then claimed that he was entitled to the BCBSM differential because it reflected “incurred expenses” under §3107(1)(a). The trial court agreed and awarded plaintiff the BCBSM differential, in part, as well as penalty interest.
The Court of Appeals reversed, relying on Bombalski v Auto Club Ins Ass’n, 247 Mich App 536 (2001), and Williams v AAA Mich, 250 Mich App 249 (2002), both of which the Court said “entirely undermined” plaintiff’s argument. The Court in Williams and Bombalski held that under MCL 500.3107(1)(a), plaintiff could recover no-fault benefits “only to the extent that he had incurred charges for reasonably necessary services.”
In this case, plaintiff simply did not “incur” charges relative to the BCBSM differential, the Court of Appeals said. The Court noted the hospital that treated plaintiff indicated there would be no attempts to collect the BCBSM differential from plaintiff or Auto Club, and there was no indication that any other medical provider sought recovery of the BCBSM differential. Also, plaintiff did not even argue that a recovery of the BCBSM differential could be, had been, or might be sought by the provider.
According to the Court, plaintiff attempted to avoid the rulings in Bombalski and Williams by arguing that BCBSM had paid the medical providers by mistake. However, the Court refuted this assertion and concluded:
“[T]he bottom line is that BCBSM did make the payments and the medical providers have declined to pursue recovery of the BCBSM differential from plaintiff or ACIA. Accordingly, plaintiff has not ‘incurred’ charges related to the differential for purposes of MCL 500.3107(1)(a). Plaintiff’s arguments to the contrary are simply unavailing.”
