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Estate of Simmons v. Auto Club Ins. Assoc. (COA – UNP 3/28/2019; RB #3872)


Michigan Court of Appeals; Docket # 340456; Unpublished
Judges Shapiro, Beckering, and Kelly; per curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion

Entitlement to PIP Benefits: Arising Out of / Causation Requirement [§3105(1)]

Not Applicable

In this unanimous unpublished per curiam decision, the Court of Appeals affirmed the trial court’s grant of summary disposition for defendant Auto Club Insurance Association (“Auto Club”) on the issue of causation. Plaintiff Calvin Simmons (“Simmons”) failed to create a genuine issue of material fact as to whether the care he received in assisted living facility was causally related to the motor vehicle accident.

Calvin Simmons suffered a severe hip injury in an automobile accident in 2011, at the age of 81. As a result of his injuries, he was transferred to an assisted living facility, where he developed an ulcer on his foot—because of immobility while recovering from his hip fracture—which persisted for years. In 2014, Simmons suffered a heart attack, and returned back to the assisted living facility after being discharged from the hospital. Simmons was then evaluated by a medical examiner on behalf of Auto Club, who determined that Simmons no longer required assisted living services for his hip fracture, and that “his continued care in an assisted living facility was solely the result of his other medical conditions.” Auto Club thus refused to pay PIP benefits for medical care incurred after January 1, 2015.

Simmons filed suit against Auto Club to recover PIP benefits, and Auto Club moved for summary disposition, “arguing that the care Simmons received after January 1, 2015 was unrelated to the left hip fracture he suffered in the October 2011 accident.” The trial court granted Auto Club’s motion, finding that the medical reports relied upon by Simmons to create a genuine issue of material fact were inadmissible.

The Court of Appeals affirmed the trial court’s grant, albeit for different reasons. The medical reports relied upon by Simmons were, in fact, admissible, but Simmons failed to present any medical records after 2014 to create a genuine issue of material fact as to whether his post-2014 care was causally related to the 2011 accident. The Court reasoned as follows:

The medical records pre-dating Simmons’s medical crisis in December 2014 establish a question of fact about the reasons that he required assisted living services during that period. It was the hip fracture that initially required his admission to assisted living and the resulting lack of mobility was, at least in part, the reason that continued assisted living care was required as demonstrated by the records through the end of 2014. However, as to services after 2014 we must affirm the grant of summary disposition because the record contains no medical or assisted living records for that time period. We cannot speculate to the content of those records, or Simmons’s condition during that period. Given the lack of post-2014 evidence of Simmons’s status, we affirm the trial court’s dismissal of the action for benefits for January 1, 2015 and thereafter.

The Court of Appeals thus affirmed the trial court’s grant of summary disposition for Auto Club.

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