Thomas, et al v Old Republic Ins Group, et al (COA – UNP 7/20/2023; RB #4614)
Michigan Court of Appeals; Docket #360898; Unpublished
Judges Markey, Jansen, and Kelly; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
STATUTORY INDEX:
Not Applicable
TOPICAL INDEX:
Interpretation of Insurance Contracts
SUMMARY:
In this unanimous, unpublished, per curiam decision, the Court of Appeals affirmed the trial court’s denial of Defendant Transguard Insurance Company of America’s (“Transguard”) motion for summary disposition, in which Transguard sought dismissal of Plaintiff Justin Thomas’s action for unpaid no-fault PIP benefits. The Court of Appeals found a question of fact as to whether an Illinois insurance policy provided Michigan no-fault coverage to a driver—Thomas—injured while driving a truck for his employer in Wisconsin.
Justin Thomas suffered numerous injuries, including a traumatic brain injury, as a result of a motor vehicle accident in 2019. Thomas, a Michigan resident, was driving through Wisconsin when he lost control of his truck and overturned it. The truck was owned by the Michigan corporation Morse Moving & Storage (“Morse”), and Thomas would later claim that he was driving in the course and scope of his employment with Morse at the time of the accident. Thomas was also covered at the time of the accident under a Transguard ‘Group Vehicle Master [Illinois insurance] Policy.’ The named insured on the Transguard policy was ‘National Association of Independent Truckers, LLC.’ The Court of Appeals explained the details of this policy and its pertinent provisions as follows:
“The Transguard insurance policy at the center of this dispute was issued in Illinois. The insurance policy was a ‘Group Vehicle Master Policy.’ According to the declarations page, the named insured was the ‘National Association of Independent Truckers, LLC’ (NAIT), which was listed as having its address in Naperville, Illinois. The insurance policy’s declarations page also provided that ‘[t]he insurance afforded is only with respect to the Coverage Parts for which a premium is shown below AND a Certificate indicating such coverage has been issued.’ The coverage chart that followed revealed that a ‘basic vehicle policy’ included liability insurance, physical-damage insurance (comprehensive and collision), uninsured/underinsured motorists insurance, and ‘medical payments’ insurance. The ‘medical payments’ section identified two types of benefits that were generally available, which consisted of ‘Occupational Accident Extended’ and ‘Occupational Compensation Extended.’ A ‘description of owned vehicles’ stated: ‘Symbol 7: Specifically Described Autos – As Per Certificates.’
A Transguard ‘evidence of coverage’ document specifically identified plaintiff, a Michigan resident, as a certificate holder and certified that during the relevant period he had the following types of coverage: ‘non-trucking liability,’ ‘non-occupational accident,’ ‘personal contents,’ ‘occupational compensation,’ ‘extended liability,’ ‘physical damage,’ and ‘occupational accident.’ With respect to the ‘occupational accident’ coverage, the certificate provided:
This is not Workers’ Compensation Coverage. This is an Occupational Accident Plan and does not provide coverage for sickness. This policy provides coverage while under dispatch and on duty. Includes Contract Liability.
The ‘limit of liability’ relative to the ‘occupational accident’ coverage stated: ‘See Coverage Summary: Plan O.’ The ‘evidence of coverage’ identified just one piece of ‘equipment,’ listing a 2001 international box truck, with a VIN ending in 7988. The certificate further provided that NAIT was the group policyholder, that the lien holder/loss payee was ME Leasing, Inc., of Romulus, Michigan, and that the ‘motor carrier[s]’ were ‘Morse Moving & Storage,’ which was headquartered in Romulus, Michigan, and ‘Allied Van Lines, Inc.,’ which was headquartered in Illinois. The ‘terms and conditions’ associated with the ‘evidence of coverage’ and expressly pertaining to ‘occupational accident’ coverage required plaintiff’s agreement that he was an independent contractor, that he was not and would not become 'an employee of any motor carrier while this coverage is in force,' and that he would reject and not file a claim for workers’ compensation benefits.
In the body of the insurance policy itself, there was a part covering ‘medical payments – occupational accident extended coverage.’ Section V of this coverage part provided, in pertinent part:
If an insured person incurs covered expenses resulting from an accident which caused an injury while insured under this coverage part, we will pay the reasonable and customary charge of such covered expenses incurred within the medical accumulation period, but not more than the maximum benefit, while insured, for Accident Medical . . . Expense shown in the SCHEDULE OF BENEFITS for the Plan indicated on your certificate.
We will issue payments for a covered expense on behalf of the insured person directly to the physician, hospital or medical service provider who provided such service or supply. If the insured person provides us with proof that he has already paid for the covered expense, we will issue payment to the insured person. [Quotation marks omitted.]
Section V also contained the following language that had to be satisfied before benefits could be recovered:
The benefits for the coverage provided under this coverage part are described in the following benefit provisions. We will pay the benefits set forth below when we receive due proof that:
1. the insured person sustained an injury in an accident; and
2. the injury occurred while performing the usual and customary duties of his occupation while on duty, under dispatch for and under contract to his contract carrier. [Quotation marks omitted].”
Thomas filed a lawsuit against Transguard, arguing that the language in the “evidence of coverage” document provided him with Michigan no-fault benefits under MCL 500.3101(1) and (4). Transguard responded to Thomas’s complaint by moving for summary disposition, arguing, among other things, that its policy was an occupational insurance policy that did not provide no-fault coverage and that, in any event, Thomas failed to present sufficient admissible evidence—Transguard argued a police report for the accident was inadmissible hearsay—to create a question of fact as to whether he was, in fact, working in the course and scope of his employment with Morse at the time of the accident. Indeed, Thomas could not recall working for Morse during his deposition, but he did assert in pleadings that he was employed by Morse at the time of the accident, and adduced the police report for the accident which listed him as the driver of the truck and Morse as the owner of the truck. The trial court ultimately denied Transguard’s motion for summary disposition, ruling that there was a question of fact as question of fact as to whether the policy provided Thomas with Michigan no-fault coverage relative to the accident. Transguard then filed a motion for reconsideration, which the trial court denied, writing, ‘the occupational accident policy of Transguard does not meet the minimum statutory requirements and must be converted to Personal Injury Protection benefits policy under Michigan’s No-Fault Law.’
The Court of Appeals affirmed the trial court’s denial of Transguard’s motion, holding that a question of fact existed as to whether Thomas was, in fact, an employee of Morse at the time of the accident. Contrary to Transguard’s arguments, the Court took into consideration the evidence contained in the police report which, when viewed in a light most favorable to Thomas, created a question of fact as to Thomas’s employment status, even if in his deposition he could not recall working for Morse.
“In this case, we will take into consideration the assertions in the police report. As stated earlier, the police crash report indicated that the truck was ‘in transit’ when the accident occurred, that the crash took place in the town of Union, that the vehicle was a ‘box truck,’ that Ryder Truck Rental, Inc., owned the truck, that Ryder held an insurance policy with Old Republic, that the interstate carrier was ‘Morse Moving and Storage,’ that plaintiff was the driver, that he resided in Michigan, and that plaintiff was ‘driving too fast for conditions.’ (Emphasis added.) Making all legitimate inferences in favor of the nonmoving party, Skinner, 445 Mich at 162, we conclude that the crash-report information creates a genuine issue of material fact regarding whether plaintiff, at the time of the accident, was ‘performing the usual and customary duties of his occupation while on duty, under dispatch for and under contract to his contract carrier.’ Plaintiff was ‘in transit’ in a moving truck outside his state of residence when the accident occurred, with Morse being specifically identified by the police officer as the interstate carrier. A juror could reasonably infer from this evidence that plaintiff was on-the-job as a contractor for Morse at the time of the accident, thereby triggering the ‘occupational accident’ coverage and the right to recover medical payments.”
The Court of Appeals then noted that, although the trial court held that the Transguard policy had to be converted to a PIP policy, it did not provide any reasoning in support of its ruling. Thus, the Court of Appeals directed it to, if necessary, reexamine that issue on remand.
“The trial court also determined that the Transguard policy had to be converted to a PIP policy under the no-fault act. The trial court did not provide any reasoning in support of its ruling, and we cannot ascertain from the record whether the court may have relied on coverages in the insurance policy that were not applicable to plaintiff, as enumerated in this opinion. In light of the fact that we are remanding this case on the issue concerning whether plaintiff is entitled to medical payments under the ‘occupational accident’ coverage, we direct the trial court, if necessary, to reexamine the issue regarding the extent of that coverage, i.e., whether it is limited by the terms of the insurance policy or by the terms of the no-fault act. Of course, that issue is only relevant should it be determined that the 'occupational accident' coverage applies in the first place.”
