Learn more about Sinas Dramis

Injured? Contact us for a free consultation


Schultz v Pioneer State Mutual Ins Co (COA – UNP 6/26/2018; RB #3768)


Michigan Court of Appeals; Docket # 338146; Unpublished
Judges Beckering, Kelly, and O’Brien per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion 


Actual Fraud

In this unanimous per curiam opinion, the Court of Appeals upheld the trial court’s grant of summary disposition for Defendant Pioneer State Mutual Insurance Company (“Pioneer”) regarding Plaintiff Rachel Shultz’s (“Schultz”) fraud in seeking reimbursement for PIP benefits. The Court upheld summary disposition because the caregiver who allegedly provided services did not know who Shultz was and the other caregiver who may have potentially given Schultz care at the stated times did not work at the stated times.

Schultz and her daughter suffered bodily injuries resulting from a motor vehicle accident. Schultz made a claim for replacement services and attendant-care services under the no-fault statute from her no-fault insurer Pioneer. After investigating the matter, Pioneer argued that Schultz had committed fraud. Specifically, Pioneer argued that in January and February of 2015 Schultz represented that she received more hours of care from ABA Home Care, LLC, then she actually received. Moreover, Pioneer argued that in March of 2015 Schultz represented that Victoria Hariton (“Hariton”) provided care for her, but Hariton did not know who Schultz was and never provided any services to Schulz. Pioneer also alleged that Schulz represented that she received benefits at certain times in March 2015 when no potential caregiver would be able to provide such care.

The Court of Appeals upheld the trial court’s grant of summary disposition because Schulz misrepresented who gave her care and when she received care. The Court explained that fraud has four elements: (1) material misrepresentation, (2) that was false, (3) that the insured knew was false at the time, and (4) the individual intended the insurer to act upon it. First, the Court explained that the statements in January and February 2015 did present a question of material fact. A reasonable juror could have concluded that caregiver Nicoll Fuller (“Fuller”) provided services to Shultz, even though she admitted to also providing services to Shultz’s daughter. However, the Court found that the March 2015 statements did not present a question of fact and a reasonable juror could not find that Schultz had not committed fraud. First, the alleged caregiver, Hariton, testified that she never provided services to Schultz at any time and she did not know who Schultz was. Additionally, Schultz represented that she received assistance from 11AM to 1PM; however, the only potential caregiver, Fuller, testified that she stopped working in March and could not have provided care at those times. The Court found this to be material because it would require Pioneer to pay money. The Court found that it was false because of the unrebutted testimony of Hariton and Fuller. The Court found that the insured knew because she signed documents attesting that she received services should could not have received. Finally, the Court found that this was intentional because Schultz signed the documents with the intention of having the services reimbursed.

“In sum, even viewing the record in the light most favorable to Shultz, it is uncontroverted that Hariton did not provide Shultz with any services in March 2015 and Fuller did not any provide services from 11:00 a.m. to 1:00 p.m. in March 2015. Thus, the March 2015 invoice submitted to Pioneer contained a material misrepresentation insofar as it represented that Shultz had received six hours of combined attendant- and replacement-care services. Accordingly, because Shultz can point to no evidence supporting that she actually received six hours of combine attendant- and replacement-care services in March 2015, she cannot establish a genuine issue of material fact so as to survive summary disposition under MCR 2.116(C)(10).”

Thus, the Court upheld the trial court’s grant of summary disposition for fraud.

Copyright © 2020 Sinas Dramis Law Firm, George Sinas, Stephen Sinas.
All Rights Reserved.
Login (Publishers Only)