Michigan Court of Appeals; Docket #357144; Unpublished
Judges Letica, Kelly, and Riordan; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
Exception for Occupants [§3114(4)]
When Claimants Can Receive PIP Benefits Through the Assigned Claims Facility [§3172(1)]
Interpretation of Insurance Contracts
In this unanimous, unpublished, per curiam decision, the Court of Appeals reversed the trial court’s denial of Defendant Mid-Century Insurance Company’s (“Mid-Century”) motion for summary disposition seeking dismissal of Plaintiff Michigan Head and Spine Institute’s (“MHSI”) first-party action. The Court of Appeals held that the subject Mid-Century no-fault policy did not offer broader coverage than what is required by the no-fault act, or, more specifically, that the policy’s definition of “insured” did not operate to extend coverage to an individual who would otherwise not have been able to claim no-fault PIP benefits from Mid-Century under the priority scheme set forth in MCL 500.3114.
Stacey Krebs was severely injured in a motor vehicle accident while traveling as a passenger in a vehicle driven by Stephen Basnaw and owned by Charles Basnaw. Charles’s Mid-Century insurance policy, which covered the vehicle Krebs was in at the time of the accident, defined ‘insured’ to include ‘anyone . . . who sustains ‘bodily injury’ . . . while ‘occupying’ a covered ‘auto.’ ’ Based on this policy language, MHSI—Krebs’s medical provider assignee—argued that Krebs was entitled to no-fault benefits from Mid-Century even though she otherwise would have had to claim benefits through the Michigan Assigned Claims Plan (MACP) pursuant to MCL 500.3114(4). In other words, MHSI argued that the Mid-Century policy offered broader coverage than what is required under the no-fault act, such as would make it liable for Krebs’s claim. Mid-Century moved for summary disposition in MHSI’s subsequent first-party action against it, which the trial court denied, agreeing with MHSI and finding that ‘the policy expanded coverage beyond what is required by the No Fault Act on the date of the accident.’
The Court of Appeals reversed the trial court’s denial of Mid-Century’s motion, holding that “[r]egardless of the breadth of Mid-Century’s policy coverage,” the no-fault act’s priority scheme—not the Mid-Century policy—exclusively controls Krebs’s entitlement to PIP benefits and which insurer is responsible for Krebs’s PIP benefits. The Court asserted that this principle was “embodied in the insurance policy itself, which states that liability for PIP benefits is ‘subject to the provisions of the [the no-fault act].”
“Regardless of the breadth of Mid-Century’s policy coverage, the policy does not control whether plaintiffs or Stacey may claim PIP benefits from Mid-Century. As noted, the no-fault act governs the coverages it mandates, while an insurance policy governs optional coverage not required by the no-fault act. Fortson, 506 Mich at 297-298. PIP benefits are mandated by the no-fault act; therefore, entitlement to, and payment of, PIP benefits is governed by statute, not by the insurance contract. Id. at 298. This is embodied in the insurance policy itself, which expressly states that liability for PIP benefits is ‘subject to the provisions of [the no-fault act].’ Accordingly, Lewis is of no help to plaintiffs or Stacey because Mid-Century’s insurance policy mandates that the no-fault act be followed.”
The Court of Appeals also rejected MHSI’s argument that Krebs could not claim PIP benefits from the MACP given the language of MCL 500.3172(1). Specifically, MHSI argued that because Krebs was clearly an “insured” under the Mid-Century policy, her circumstances were not one of the four identified in MCL 500.3172(1) under which a claimant can receive benefits from the MACP. The Court of Appeals again pointed to MCL 500.3114(4), iterating that that subsection mandated that Krebs seek benefits from the MACP.
“According to plaintiffs, MCL 500.3172 does not apply because Stacey has PIP coverage available to her injury because: (1) she is an “insured” under the terms of Mid-Century’s policy; (2) she has identified a policy and submitted a claim to Mid-Century; (3) there is no dispute between two or more carriers; and (4) Mid-Century is able to fulfill its obligations. According to MCL 500.3172(1), therefore, Stacey may not claim PIP benefits from the assigned claims plan. We are not persuaded.
MCL 500.3114(4) specifically applies because Stacey is ‘a person who suffer[ed] accidental bodily injury arising from a motor vehicle accident while an occupant of a motor vehicle who is not covered under a personal protection insurance policy as provided in [MCL 500.3114](1).’ Thus, a claimant such as Stacey ‘shall claim personal protection insurance benefits under the assigned claims plan under [MCL 500.]3171 to [MCL 500.]3175.’ Under MCL 500.3172(a), the assigned claims plan is the appropriate insurer for PIP benefits because, as addressed above, there is no insurance policy otherwise applicable to Stacey’s injuries.”