Michigan Court of Appeals; Docket #346875; Unpublished
Judges Letica, Stephens, and O’Brien; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
STATUTORY INDEXING:
General/Miscellaneous [§500.3173a]
TOPICAL INDEXING:
Not Applicable
SUMMARY:
In this unanimous unpublished per curiam decision, the Court of Appeals affirmed the trial court’s summary disposition order dismissing the plaintiff’s first-party action for no-fault PIP benefits. The plaintiff, Toni Williams, submitted accounting forms for the attendant care services she received from her daughter that conflicted with affidavits she and her daughter executed in support of her claims for benefits. Specifically, the affidavits Williams submitted averred that both of her daughters provided six hours of attendant care per day, while the accounting forms averred that one of her daughters provided eight hours of care on most days. The Court of Appeals held that the trial court properly concluded that Williams committed a fraudulent insurance act by submitting false information in support of her claim for benefits, and therefore was barred from receiving benefits through the Michigan Assigned Claims Plan, pursuant to MCL 500.3173a.
Daphne Williams was injured as a result of being struck by a motor vehicle while crossing the street, and subsequently filed an application for no-fault PIP benefits with the Michigan Automobile Insurance Placement Facility. The MAIPF assigned Williams’s claim to Nationwide Mutual Fire Insurance Company, and after Williams’s release from the hospital, her doctors ordered her to receive 12 hours of attendant care services per day. Her attendant care services were provided by her two daughters, Daphne and Tiffany, with each agreeing to provide six hours of attendant care per day. The three of them executed affidavits averring that this care system was in place for approximately six months after the collision. In addition to the two affidavits, however, Williams also submitted more detailed forms that she had received from her daughter Daphne, in which Daphne averred that she provided eight hours of attendant care on most days. Williams signed all of the forms she received from Daphne, and submitted both the forms and the affidavits in support of her claim for benefits. Nationwide ultimately denied her coverage, and moved for summary disposition in Williams’s resultant first-party lawsuit, arguing that Williams was barred from receiving benefits through the MAIPF under MCL 500.3173a because she made false statements in support of her application for benefits. The trial court agreed, and granted Nationwide’s motion for summary disposition.
The Court of Appeals affirmed the trial court’s summary disposition order in favor of Nationwide by relying on the five-prong test for determining fraud under MCL 500.3173a laid out in Candler v. Farm Bureau Mut. Ins. Co., 321 Mich. App. 772 (2017). The Court first rejected Williams’s argument that she was unaware that the information in the forms she received from her daughter was false. The Court reasoned that Williams erroneously relied on “caselaw in the context of insurance companies seeking to void a policy due to the policyholder’s fraudulent action to generally assert that defendant here was required to prove both knowledge and an intent to defraud,” because the controlling statute in the context of a claim for benefits through the MAIPF, MCL 500.3173a, “contains no such element of intent.”
The Court next rejected Williams’s argument that the documents she submitted in support of her claim contained only inconsistencies, not outright forgeries. Relying on Williams’s and her daughter’s deposition testimony, the Court held that the forms Williams received from her daughter and, in turn, submitted in support of her claim for benefits, were legitimate, “false accountings of the times Daphne provided care,” not merely inconsistencies.
The Court next rejected Williams’s argument that her injuries prevented her from fully understanding the forms that she signed and submitted in support of her claim, despite the existence of a possible brain injury as a result of the collision.
Though plaintiff initially denied any head trauma as a result of the accident, she testified that she was receiving treatment from a neurologist who told her she had a working diagnosis of a brain injury. Plaintiff also testified that she experienced occasional confusion, trouble concentrating, and memory loss, which could have resulted from the aging process or the accident. While this evidence demonstrates that plaintiff had intermittent confusion and memory loss of an undefinable origin, it does not establish that plaintiff was unable to review or lacked the cognitive ability to provide a signature reflecting her review of the ten Home Health Care forms spanning five months. Moreover, this Court in Candler rejected the plaintiff’s contention that a head injury negated his fraudulent insurance act. 321 Mich App at 781-782. While plaintiff here did not actively forge a signature, and, instead, signed off on false information, there is no record evidence suggesting that plaintiff was unaware of or unable to appreciate that Daphne’s forms contained falsehoods at the time that plaintiff signed them.
Lastly the Court rejected Williams’s argument that her false statements were material to her claim for benefits, because the false accounting of the attendant care services she received from her daughter Daphne had a direct bearing on the amount Nationwide would be required to pay Williams as reimbursement.
Here, the false statements plaintiff submitted were material to defendant’s investigation of her claim. Although there is no dispute that plaintiff was entitled to 12 daily hours of attendant care, how that money was paid out was material to her claim. Specifically, although the total plaintiff requested reflected 12 hours a day of attendant care at a rate of $15 per hour, that care was supposed to be split evenly between plaintiff’s two daughters. And, as Daphne reflected in the more detailed Home Health Care forms that she had often provided eight hours of daily care, that could have impacted the total amount of money Tiffany received. Moreover, Tiffany’s affidavit reflected that she provided six hours of care a day and defendant could have relied on the Home Health Care forms to calculate Daphne’s compensation. In that case, the total amount of money defendant would have had to pay for plaintiff’s attendant care services would have exceeded 12 hours per day. Because the forms submitted were related to the hours that Daphne would be paid for her attendant care services, they were material to defendant’s investigation of plaintiff’s claim.
