Michigan Court of Appeals; Docket #328227; Unpublished
Judges Wilder, Cavanagh and Servitto; Unanimous, Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
STATUTORY INDEXING:
Allowable Expenses for Attendant Care [§3107(1)(a)]
Providers Entitled to Charge Reasonable Amount for Services [§3157]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this unanimous unpublished per curiam Opinion, the Court of Appeals held that plaintiff, a provider of attendant-care services, was not entitled to payment under the No-Fault Act for ordinary living expenses that it had provided because it was not licensed as an adult foster care facility pursuant to MCL 400.713(1) and, as a result, had unlawfully provided such services.
Keith Mowrer was seriously injured in an auto accident. He had a no-fault policy with defendant Auto Owners. Plaintiff was a licensed group home that provided 24-hour attendant-care services to Mowrer after his accident. Plaintiff later leased an apartment to Mowrer as part of its residential apartment program. Plaintiff was not licensed as an adult foster care facility. Plaintiff brought this action after Auto Owners refused to pay for the supervisory, attendant-care and household services were provided to Mowrer. Plaintiff also sought a declaratory judgment regarding the application of the No-Fault Act, as well as the amount Auto Owners should pay. Mowrer, through his next friend, intervened in the case and filed a similar complaint against Auto Owners. Auto Owners moved for summary disposition, arguing that plaintiff was not entitled to compensation because it was acting as an unlicensed adult care facility and, therefore, was not lawfully rendering treatment within the meaning of MCL 500.3157. Auto Owners also alleged that plaintiff failed to submit reasonable proof for certain claims, that certain charges (specifically ordinary living expenses) were not reimbursable and that plaintiff made fraudulent statements about the services that were provided. The trial court granted Auto Owners’ motion to the extent that plaintiff was seeking reimbursement for ordinary living expenses, finding they were not compensable under the No-Fault Act, but denied Auto Owners’ motion in all other respects. The trial court specifically held that, to the extent that expenses pertaining to plaintiff’s residential apartment program were reimbursable, the expenses were to be submitted to the factfinder.
The Court of Appeals reversed that portion of the trial court’s decision finding that plaintiff did not unlawfully render treatment, and affirmed the decision in all other respects. In this regard, the Court held that plaintiff had provided adult foster care services to Mowrer even though it was not licensed to provide adult foster care services.
Specifically, the Court noted the services provided to Mowrer included 24-hour, one-on-one attendant care and two-to-one care. The Court also pointed out that Mowrer was unable to cook for himself, do laundry or clean, that he was provided life skills classes and group support, and a staff member attended therapy with him. Based on this, the Court held that plaintiff should have been – but was not – licensed under MCL 400.713(1) to provide adult foster care.
In reaching this conclusion, the Court of Appeals rejected plaintiff’s claim that §3157 did not apply because the services it had provided were not “treatment.” According to the Court, the ruling in Healing Place at N Oakland Medical Center v Allstate Ins Co, 277 Mich App 51 (2007), required it to find that adult foster care services constitute “treatment” under §3157.
The Court of Appeals continued by noting that plaintiff might be able to recover for other services that were lawfully rendered to Mowrer. Thus, the Court said plaintiff should have been given the chance to break down its bill for its residential program and, to the extent that the bill included expenses that were reimbursable, those expenses must be presented to the trier of fact for consideration.
In conclusion, the Court of Appeals said that, while there may have been some exceptions to Mowrer’s 24-hour care, this did not create any issue of fact regarding whether plaintiff engaged in fraud. The Court held:
“Because plaintiff provided some proof and defendant does not deny that a loss occurred, summary disposition in favor of defendant was appropriately denied.”
