Michigan Court of Appeals; Docket # 345593; Unpublished
Judges Riordan, Sawyer, and Jansen; per curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
STATUTORY INDEXING:
One-Year Notice Rule Limitation [§3145(1)]
General / Miscellaneous [§3171(1)]
When Claimants Can Receive PIP Benefits Through the Assigned Claims Facility [§3172(1)]
General / Miscellaneous [§3173]
Obligation of the Assigned Claims Facility to Make an Initial Determination of Claimant’s Eligibility [§3173a]
Obligation of the Assigned Claims Facility to Promptly Assign Claim [§3174]
TOPICAL INDEXING:
Not Applicable
SUMMARY:
In this action involving an application for assignment of no-fault PIP benefits through the Michigan Automobile Insurance Placement Facility (MAIPF), the Court of Appeals reversed the trial court’s summary disposition order dismissing the plaintiff’s action. The Court of Appeals reversed because no provision of the no-fault act authorizes the MAIPF to refuse to assign a claim for benefits due to claimant’s failure to submit to an Examination Under Oath (EUO), failure to attend medical evaluations, or for a general “failure to cooperate” with the MAIPF’s investigation of the claim. The Court of Appeals noted that at the time of the plaintiff’s application, the no-fault act only authorized the MAIPF to make an “initial determination of a claimant’s eligibility for benefits” and to deny “an obviously ineligible claim.” The Court of Appeals remanded for further proceedings to determine whether plaintiff was eligible to be assigned benefits through the MAIPF, including the issue of whether plaintiff committed fraud that would render him ineligible for such benefits.
The plaintiff in this case was a passenger in a motor vehicle involved in a collision. As a result of the collision, he sustained numerous injuries, but neither owned an insured motor vehicle nor resided with anyone who did. He submitted a claim for PIP benefits to the MAIPF, but the MAIPF notified him that it could not make an initial eligibility determination because he failed to complete several sections on the application. The MAIPF sent multiple requests for additional information, including proof of loss, and for the plaintiff submit to an examination under oath. In lieu of responding to any of these requests, the plaintiff filed this action alleging that the MAIPF unreasonably refused or delayed paying benefits. The MAIPF filed a motion for summary disposition, alleging that the plaintiff failed to “reasonably cooperate” in its investigation of the claim, as is required by the no-fault act, and asserting that the MAIPF could not be liable for PIP benefits because its only function is to review claims and assign them to insurers. The plaintiff ultimately filed two amended applications for PIP benefits, which included proof of loss, and submitted for a deposition with the MAIPF. He also amended his complaint to request an order compelling the MAIPF to assign his claim to a no-fault insurer, as opposed to a monetary judgement against the MAIPF.
The trial court granted summary disposition for the MAIPF for the following reasons:
. . . the court described plaintiff’s original application for benefits as “woefully inadequate,” observed that plaintiff offered no explanation for his failure to respond to defendant’s first request for additional information or an EUO, and held that the amended applications and supporting documents did not alleviate these defects because they were not submitted until May 2018. The court then held that “plaintiff’s conduct simply cannot be characterized as reasonable cooperation [for] purposes of MCL 500.3171 and MACP 5.1(B), even when the evidence is viewed in the light most favorable to plaintiff.”
The Court of Appeals reversed because it recognized that no provision of the no-fault act authorized the MAIPF to require a claimant to submit to an EUO. Similarly, no provision of the no-fault act authorized the MAIPF to deny a claim due to the claimant’s failure to cooperate. Moreover, the Court ruled that the no-fault act only allowed the MAIPF to make determinations regarding a claimant’s eligibility for benefits, not deny a claim outright for failing to comply with all the MACP’s requirements. The Court stated in pertinent part:
The trial court granted summary disposition for defendant because plaintiff’s conduct “simply cannot be characterized as reasonable cooperation [for] purposes of MCL 500.3171 and MACP 5.1(B), even when the evidence is viewed in the light most favorable to plaintiff.” However, plaintiff’s failure to comply with MACP 5.1(B) was not a proper reason to grant summary disposition because “the authority to adopt a plan does not grant the authority to establish rules governing the processing, timing and review of claims under the MACP; those requirements are enumerated by statute.” Spectrum Health Hosps v Mich Assigned Claims Plan, ___ Mich App ___; ___ NW2d ___ (2019) (Docket No. 343563). At the time of plaintiff’s injury, application for benefits, and complaint in this case, the no-fault act required the MAIPF to make an “initial determination of a claimant’s eligibility for benefits” and authorized the MAIPF to deny “an obviously ineligible claim.” MCL 500.3173a(1), as amended by 2012 PA 204. No provision of the no-fault act authorized the MAIPF to require a claimant to submit to an EUO. Similarly, no provision of the no-fault act authorized the MAIPF to deny a claim due to the claimant’s failure to cooperate. Therefore, the trial court erred by granting defendant’s motion for summary disposition on this basis.
The Court held that the plaintiff was not entitled to an entry of judgement in his favor, however, because he may have submitted false information in his application for benefits. The MAIPF argued that the plaintiff’s false statements rendered his claim ineligible pursuant to MCL 500.3173a(2). The Court recognized that the plaintiff’s alleged fraud could cause him to be ineligible to benefits and ordered that those issues be considered on remand. The Court stated”
Because the question whether plaintiff’s application for PIP benefits qualifies as a fraudulent insurance act was not the basis for defendant’s motion and was presented to the court only as a response to plaintiff’s motion for immediate assignment of the claim to an insurer, the trial court never reached the issue. It determined that its decision granting summary disposition pursuant to MCR 2.116(C)(10) for failure to reasonably cooperate “render[s] moot all the other motions in the matter.” Because the issue was not decided by the trial court and it involves factual allegations that require further development, it is not appropriate for us to address or decide this issue. Mouzon v Achievable Visions, 308 Mich App 415, 419; 864 NW2d 606 (2014); Smith v Foerster–Bolser Constr, Inc, 269 Mich App 424, 427; 711 NW2d 421 (2006) (recognizing that appellate consideration of an unpreserved issue is appropriate if an issue involves a question of law and the facts necessary for its resolution have been presented). Accordingly, we remand for further proceedings. On remand, defendant is free to seek dismissal on this basis in an appropriate motion.
