Michigan Court of Appeals; Docket # 349346; Unpublished
Judges Gleicher, Stephens, and Cameron; Per curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
STATUTORY INDEXING:
Lawfully Rendered Treatment [§500.3157]
TOPICAL INDEXING:
Not Applicable
SUMMARY:
In this unanimous unpublished per curiam decision, the Court of Appeals reversed the trial court’s summary disposition order dismissing the plaintiff’s first-party claim for no-fault PIP benefits. The Court of Appeals held that the trial court erred in determining, as a matter of law, that the plaintiff, Life Skills Residential LLC (LSR), provided “adult foster care” services to its patient without being licensed under the Adult Foster Care Licensing Act (AFCFLA), and that LSR’s treatment was therefore unlawfully rendered, in contravention of MCL 500.3157. The AFCFLA defines adult foster care as including “supervision, personal care, protection, and room and board,” and the Court of Appeals determined that LSR only provided defendant’s insured with supervision.
Alvin Harris was injured in a motor vehicle collision and received treatment from LSR. LSR then sought to recoup no-fault PIP benefits from Harris’s insurer, Titan Insurance Company, after obtaining an assignment of rights from Harris. Titan denied LSR’s claim, arguing that LSR met the statutory definition of “adult foster care” under the AFCFLA, but was not licensed under the AFCFLA, and was therefore rendering unlawful treatment and was precluded from recovering PIP benefits pursuant to MCL 500.3157. In LSR’s subsequent first-party action, the trial court agreed with Titan, and entered a summary disposition order in Titan’s favor.
The Court of Appeals reversed the trial court’s summary disposition order in favor of Titan, noting that, under the AFCFLA, “adult foster care” treatment includes supervision, personal care, protection, and room and board. LSR conceded that it provided supervision to Harris, but disputed having provided him with any of the remaining elements. After analyzing the various services provided by LSR, the Court of Appeals agreed with LSR, holding that LSR did not meet the statutory definition of an “adult foster care” and was therefore not required to be licensed under the AFCFLA.
LSR provided: 1) 24-hour staff availability, 2) daily checks, 3) transportation to medical appointments, 4) prompting, 5) coordination with care teams, and 6) socialization to foster a sense of community. We conclude that these services fall under the category of supervision and not personal care. In Life Skills Village, PLLC, the Court held that reminding a resident “to perform daily activities and conducting daily checks on his health and safety” constituted “supervision” under MCL 400.707(7), as amended by 1987 PA 257. Id. at 5-6. LSR’s transporting Harris to medical appointments also falls under the definition of supervision as part of “[a]ssisting a resident in keeping appointments.” MCL 400.707(7)(c). The availability of 24-hour staff by itself does not equate to providing Harris with personal care. The uncontradicted testimony was that the staff’s assistance was limited to prompting and guiding Harris toward efficacious self-care, not the provision of personal assistance. LSR reported to Harris’s care teams its staff’s observations of the development of Harris’s personal and social skills.
Titan argues that LSR personally assisted Harris with emotional regulation. Titan relies on one instance that Jeff Percyzk, LSR’s residential manager, testified to where Percyzk accompanied Harris to the courthouse. Percyzk testified that he did so that in the event Harris became impatient and angry, Harris did not make a bad decision that would result in police involvement. There was no testimony as to what Percyzk did to mollify Harris other than being present as Harris waited in line. The therapeutic team at Life Skills Village provided the actual assistance of developing skills and strategies with Harris to regulate his emotions.
Because there is no proof that LSR provided Harris with foster care as defined in MCL 400.704(7), LSR was not required to be licensed as an adult foster care facility and its services were lawful.
