Michigan Court of Appeals; Docket # 351838; Unpublished
Judges Tukel, Jansen and Cameron; per curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
In this unanimous unpublished per curiam opinion, the Court of Appeals reversed the trial court’s holding denying summary disposition in favor of defendant on the issue of whether plaintiff committed fraud when seeking reimbursement for replacement services and attendant care and, therefore, barred from pursing her claims for no-fault PIP benefits. In doing so, the Court noted that plaintiff’s submitted affidavits for attendant care and replacement services were inaccurate in that she claimed attendant care and replacement services took place while she was traveling without those she purported to be providing such care. Notably, in reaching its holding that the anti-fraud provision could be enforced to bar plaintiff’s claims for no-fault PIP benefits, the Court relied upon the decision in Bahri v IDS Prop Cas Ins Co, and did not explain how Bahri allowed for this result following the Michigan Supreme Court’s decision in Meemic Ins Co v Forstonand the Michigna Court of Appeals recent decision in William v Mercyland Health Services
This care arose from a motor vehicle accident in which plaintiff sustained injuries consisting of a torn rotator cuff, severe whiplash, severe migraines, fibromyalgia, short-term memory loss, and back and neck issues. Following the accident, plaintiff claimed she was unable to perform household tasks and personal care activities. Accordingly, plaintiff’s boyfriend at the time and son performed household services. The two took on laundry, cleaning, cooking, and helping plaintiff move throughout her home, as well as assisting plaintiff with bathing and dressing. Plaintiff’s daughter also assisted with these activities. When plaintiff submitted a claim for PIP benefits seeking replacement services and attendant care from defendant, defendant refused payment on the basis of fraud, and moved for summary disposition, contending that plaintiff had traveled to Ohio and Florida without her boyfriend and son during the time in which she claimed to have received attendant care and replacement services. In response, plaintiff argued that her son and boyfriend had performed the household tasks noted on her claim for replacement services while she was away, and that personal care services were performed by one of her friends. Plaintiff further contended that her accident-related short term memory loss caused her to forget who performed certain services. The trial court ultimately denied defendant’s motion.
On appeal, the Court considered the defendant’s argument that “the trial court erred in denying its motion for summary disposition because no genuine dispute of fact existed as to whether plaintiff made material misrepresentations with respect to her claim for replacement services and attendant care.” In analyzing this claim, the Court noted that, per Bahri v IDS Prop Cas Ins Co, 308 Mich App 420; 864 NW2d 609 (2014), “an insurer may void an insurance policy when an insured makes fraudulent misrepresentations in support of a claim for benefits.” The Court further noted that, in this case “plaintiff clearly submitted affidavits for attendant care and replacement services that were, in plaintiff’s own words, inaccurate. She submitted affidavits claiming that she received 12 hours of attendant care, as well as household replacement services, from [her boyfriend and son] while she was in Cincinnati, Ohio on a business trip.” Thus, the Court found that these claims were false, and that the misrepresentations were material because it was reasonably relevant to the insurer’s investigation of a claim. In doing so, the Court noted that the evidence was clear that “plaintiff knew the statements were false at the time they were made, or that the statements were made recklessly because plaintiff could not have received replacement services from [her boyfriend or her son] while she was traveling without them.” The Court further found that plaintiff had made the misrepresentations “with the intention that the insurer would act on it,” as evidence by plaintiff seeking compensation for replacement services from defendant “with the expectation of receiving a benefit under the insurance agreement.” Thus, the Court found that there was “no genuine issue of material fact regarding whether plaintiff materially mispresented her need for replacement services during the time she was out of town.” The Court further clarified that because plaintiff submitted fraudulent claims for replacement services under the terms of the insurance contract, defendant was entitled to void the contract.
Notably, the Court provided no further discussion about whether the enforcement of the anti-fraud provision was consistent with the Michigan No-Fault Act or whether fraud in the procurement was recognized under common law as recently discussed by the Michgian Supreme Court in Meemic Ins Co v Fortson and recently by the Michigan Court of Appeals in Wiliams v Mercyland Health Services.