Michigan Court of Appeals; Docket #359412; Unpublished
Judges Rick, Kelly, and Riordan; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
STATUTORY INDEXING:
Accrual of PIP Benefits [§3110(4)]
One-Year Back Rule Limitation [§3145(1)]
One-Year Back Rule Limitation – tolling under 2019 amendments [§3145(1)]
TOPICAL INDEXING:
2019 PA 21 – Retroactivity
SUMMARY:
In this unanimous, unpublished, per curiam decision, the Court of Appeals reversed the trial court’s denial of Defendant Progressive Michigan Insurance Company’s (“Progressive”) motion for summary disposition, in which Progressive sought dismissal of Plaintiff Krystyna Reid’s action for No-Fault PIP benefits against it. The Court of Appeals held, first, that the pre-2019-amendment version of MCL 500.3145 applied to Reid’s claims for benefits related to services she received prior to June 11, 2019 (the amendment’s effective date), and that the post-amendment version of MCL 500.3145 (which introduced “formal denial” tolling) applied to Reid’s claims for benefits related to services she received after June 11, 2019. Therefore, Reid—who filed her lawsuit on November 4, 2020—was barred from recovery on her pre-June 11, 2019 claims by the former version of the one-year-back rule. The Court also held, however, that Reid was barred from recovery on her post-June 11, 2019 claims, as well, because the facts showed that she did not actually submit those claims until after filing her lawsuit, and thus could not avail herself of “formal denial” tolling.
Krystyna Reid was injured in a motor vehicle accident that occurred on May 24, 2019. She incurred medical expenses for the treatment she received for her injuries, and on November 4, 2020, filed the underlying lawsuit against Progressive. Progressive moved for summary disposition, arguing that, because the date of the accident occurred prior to the effective date of the 2019 amendments to the No-Fault Act, the pre-amendment version of MCL 500.3145 applied to Reid’s claims, which were therefore barred by the pre-amendment version of the one-year-back rule. Reid argued, in response, that the date she filed her lawsuit was the operative date for determining which version of MCL 500.3145 applied, and that, since she filed her lawsuit after June 11, 2019, her claims were preserved by “formal denial” tolling. The trial court ultimately agreed with Reid and denied Progressive’s motion.
The Court of Appeals reversed the trial court’s denial of Progressive’s motion, holding, first, that the operative date for determining which version of MCL 500.3145 applied was neither the date of the accident nor the date Reid filed her lawsuit, but rather the dates the services were provided. ‘Michigan courts have followed the general rule that the relevant inquiry in determining the applicability of a statute is the date on which the cause of action arose,” and, under MCL 500.3110(4), ‘[p]ersonal protection insurance benefits payable for accidental bodily injury accrue not when the injury occurs but as the allowable expense, work loss or survivors’ loss is incurred.” Therefore, Reid’s cause of action for unpaid benefits arose on the dates she received treatment for which payment was ultimately not made, and thus, for dates of service prior to June 11, 2019, the pre-amendment version of MCL 500.3145 applied, and for dates of service after June 11, 2019, the post-amendment version of MCL 500.3145. Accordingly, Reid’s claims for benefits related to treatment she received prior to June 11, 2019 were barred by the former version of the one-year-back rule.
“In this case, the claims in dispute relate to alleged attendant care and replacement services provided to plaintiff after her accident on May 24, 2019. Defendant argues the preamendment version of MCL 500.3145 applies to all of plaintiff’s claims because the accident from which these services arose occurred before the effective date of the no-fault amendments. However, ‘Michigan courts have followed the general rule that the relevant inquiry in determining the applicability of a statute is the date on which the cause of action arose.’ Hill v Gen Motors Acceptance Corp, 207 Mich App 504, 513-514; 525 NW2d 905 (1994). Under MCL 500.3110(4), ‘[p]ersonal protection insurance benefits payable for accidental bodily injury accrue not when the injury occurs but as the allowable expense, work loss or survivors’ loss is incurred.’ Relatedly, ‘[a]n expense is incurred or a patient becomes liable when an agreement to pay is executed and treatment is received.’ Bronson Health Care Group, Inc v USAA Cas Ins Co, 335 Mich App 25, 35-36; 966 NW2d 393 (2020). Therefore, plaintiff’s loss was incurred when she received attendant care and replacement services, and the claims for those services accrued at that time. The preamendment version of MCL 500.3145 applies to plaintiff’s claims for attendant care and replacement services accruing before June 11, 2019, because the amendments became effective on that date. The trial court erred to the extent that it concluded otherwise. Plaintiff’s claims accruing on or after June 11, 2019, are governed by the current version of MCL 500.3145, and are subject to the tolling provision in MCL 500.3145(3), if she made a specific claim for these services to defendant.
Accordingly, plaintiff’s claims for attendant care and replacement services accruing before June 11, 2019, are barred by the one-year-back rule of the preamendment version of MCL 500.3145(1).”
The Court held, second, that Reid’s claims for benefits related to treatment she received after June 11, 2019 were also barred, even by the post-amendment version of MCL 500.3145. The evidence showed that Reid did not actually submit her claims until after filing suit; rather, she only “generally advised or indicated to defendant she needed attendant care and replacement services,” which the Court held does not constitute submission of a ‘specific claim’ under MCL 500.3145(3). Therefore, “formal denial” tolling did not actually apply in this case, and Reid’s claims between June 11, 2019 and the filing date of her complaint were also barred.
“The next issue is whether there is a question of fact as to the applicability of the tolling provision in MCL 500.3145(3) to plaintiff’s claims for attendant care and replacement services accruing on or after June 11, 2019. Defendant asserted that it never received a claim from plaintiff for attendant care and replacement services until after plaintiff filed her complaint on November 4, 2020. For her part, plaintiff failed to come forward with evidence showing submission of specific claims for payment of these benefits at any time before the complaint was filed. Instead, plaintiff speculates that she may have generally advised or indicated to defendant she needed attendant care and replacement services.
However, plaintiff’s speculative or implied need for services is not the equivalent of notice of actual services rendered. In particular, MCL 500.3145(3) permits tolling ‘from the date of a specific claim for payment of the benefits until the date the insurer formally denies the claim.’ (Emphasis added.) In this instance, there is no evidence plaintiff submitted ‘a specific claim’ as required by the statutory language. Use of the word ‘specific’ indicates, in accordance with its common definition, being ‘precise, or particular’ or ‘explicit or definite.’ Random House Webster’s College Dictionary (2005). As such, plaintiff’s mere implication that a particular type of service may be required or necessary, without proof of actual, documented evidence of the provision and receipt of such services is inadequate.
. . .
Based on the lower court record, it does not appear that plaintiff provided any evidence she made specific claims for payment of expenses actually incurred for attendant care and replacement services until after the filing of her complaint. Significantly, plaintiff does not dispute that she did not submit such claims to defendant before filing suit. Since plaintiff did not timely submit claims for attendant care and replacement services to defendant, there is nothing to toll under MCL 500.3145(3). Despite the availability of MCL 500.3145(3), plaintiff remains restricted by the one-year-back rule in regards to reimbursement. Ultimately, the tolling provision of MCL 500.3145(3) does not apply, and plaintiff cannot recover for attendant care or replacement services rendered between June 11, 2019, and November 3, 2019. See MCL 500.3145(2). As such, the trial court erred in denying defendant’s motion for partial summary disposition.”
