Michigan Court of Appeals; Docket # 336999; Unpublished
Judges Cameron, Jansen, O’Connell per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion; Link to Concurrence
STATUTORY INDEXING:
TOPICAL INDEXING:
Fraud/Misrepresentation
CASE SUMMARY:
In this unanimous unpublished per curiam opinion, the Court of Appeals reversed the trial court’s grant of summary disposition to Defendant, American Country Insurance Company (“ACIC”), on the issue of misrepresentation. The Court reversed the trial court because it failed to articulate the reasons it was granting summary disposition and because there were genuine issues of material fact regarding Plaintiff, Carolyn Anderson’s (“Anderson”) alleged acts of fraud or misrepresentation in claiming her no-fault benefits.
In 2014 Anderson was injured in a motor vehicle accident and Anderson sought to recover various claims for PIP benefits from ACIC arising out of the accident. When Anderson applied for no-fault benefits in November 2014, ACIC refused to pay. Anderson subsequently filed a complaint. After discovery ACIC moved for summary disposition. ACIC claimed that Anderson fraudulently misrepresented several aspects of her claim. First, ACIC asserted that Anderson testified she did not require household services or attendant care before the 2014 accident when her medical records showed otherwise. Second, ACIC claimed Anderson wrongly denied receiving past workers’ compensation and Social Security payments. Third, ACIC asserted Anderson had claimed to have no complaints and no medical treatment for her neck or back before the 2014 accident, contrary to her medical records. Fourth, ACIC argued that Anderson overrepresented the amount of care a third-party, Hickson, provided. The trial court agreed and granted ACIC’s motion for summary disposition.
The Court reversed the trial court because it did not provide an explanation for why it was granting summary disposition. The Court analyzed the each one of ACIC’s claims and found an issue of fact regarding each one. The Court first addressed ACIC’s argument that Plaintiff fraudulently misrepresented her past use of attendant care. ACIC cited to a series of epidural injections that Anderson received in 2014 as demonstrating Anderson required attendant care prior to the accident and she did not reveal that fact to ACIC. However, the instructions for the epidural injections merely recommended that an adult stay with Anderson the night and day after the injections. These instructions did not require attendant care be provided for Anderson and there was no evidence that Anderson received attendant care for the injections. Thus, there was no evidence that Anderson received prior attendant care.
The Court then addressed ACIC’s contention that Anderson misrepresented and concealed a pre-existing medical condition. ACIC contended that Anderson had concealed earlier treatment for neck and back injuries. However, Anderson provided her treating physician’s name to ACIC, which contacted the physician. ACIC also maintained that Anderson only complained of back pain, not neck pain. However, the medical records ACIC had from Anderson indicated that she received epidural injections for neck pain. ACIC also claimed that Anderson misrepresented her prior injuries because she claimed to feel “fine” before the injury. However, Anderson qualified that statement by saying she had continued pain in her back and legs. ACIC also asserted that Anderson misrepresented her doctor’s recommendation for surgery, but Anderson’s deposition statement to ACIC was consistent with her doctor’s recommendation for a preventative surgery.
Third, the Court addressed ACIC’s contention that Anderson concealed her Social Security and other benefits from ACIC. While Anderson did indicate on her application that she had not received prior benefits, Anderson explained that she believed the question was asking about benefits arising out of the accident. Anderson revealed her prior benefits at discovery and in her written deposition. Also, Anderson’s work while on Social Security was consistent with the Social Security benefits allowable work limits. Thus, there was still a question of fact regarding Anderson’s intent.
Fourth, the Court addressed ACIC’s contention that Anderson misrepresented the number of hours that Hickson provided attendant care. The Court found that there were reasonable inferences that Hickson could have worked when Anderson was sleeping during the day as well as working during the night. Hickson’s testimony that he showed houses from 11 PM to 4 AM did not demonstrate that he exclusively worked from 11 PM to 4 AM. Without an explanation for why the trial court granted the summary disposition regarding fraud, the Court claimed it could not properly analyze the claim or make a sufficient ruling. Thus, the Court remanded the case for back to the trial court to provide an explanation for why it ruled the way it did.
“In sum, ACIC misinterpreted some evidence and exaggerated other evidence. Unlike other cases with surveillance video or other blatant evidence of fraud, ACIC identified inconsistencies that may or may not reflect fraud. Without the trial court’s explanation of what evidence established fraud, we cannot affirm the trial court’s grant of summary disposition.”
Thus, the Court remanded the order of summary disposition back to the trial court to clarify its reasoning and provide a detailed reason for why it was granting summary disposition. The Court reasoned that without this, it could not make a proper finding on the matter.
Concurrence:
Judge Jansen concurred only with the result.
