Michigan Supreme Court; Docket #122286; Published
Opinion by Justice Corrigan; 4-3 (Justices Weaver, Cavanagh and Kelly dissenting)
Official Michigan Reporter Citation: 472 Mich App 521, Link to Opinion 
STATUTORY INDEXING:
Entitlement to PIP Benefits: Arising Out of / Causation Requirement [3105(1)]
Allowable Expenses for Home Accommodations [3107(1)(a)]
TOPICAL INDEXING:
Not applicable
CASE SUMMARY:
In this 4-3 opinion by Justice Corrigan, the Michigan Supreme Court held that the food expense for an incapacitated person who is being cared for at home is not compensable as an allowable expense under MCL 500.3107(1)(a) of the no-fault act even though the cost of non-medical food is an allowable expense in an institutional setting. In this case, plaintiff’s husband suffered a severe brain injury as a result of an automobile accident. The injured person received in-patient treatment for several years. After he returned home, the no-fault insurer denied plaintiff’s reimbursement request for her husband’s food. The Supreme Court held that because the food was not specifically for the person’s care, recovery or rehabilitation for the injuries sustained in the accident, it was not an allowable expense. In this regard, the court stated:
“Because the food in this case in neither for ‘accidental bodily injury’ under MCL 500.3105(1) nor ‘for an injured person’s care, recovery, or rehabilitation’ under MCL 500.3107(1)(a), we hold that the expenses for it may not be recovered under those provisions of the no-fault act.” In so finding, the Supreme Court reversed the 1993 Court of Appeals decision in Reed v Citizens Insurance Company [Item No. 1597] in which the court held that a person receiving in-home care is entitled to room and board costs to the same extent as if the person were being cared for in an institutional setting. In overturning Reed, the Supreme Court explained: “Plaintiff does not claim that her husband’s diet is different from that of an uninjured person, that his food expenses are part of his treatment plan, or that these costs are related in any way to his injuries. She claims instead that Griffith’s insurer is liable for ordinary, everyday food expenses. . . . It is not contended here that the food expenses at issue are a part of the insured’s ‘recovery’ or ‘rehabilitation.’ Indeed, plaintiff does not allege that the food has special curative properties that might advance Griffith’s recovery or rehabilitation. . . . Griffith’s food costs are not related to his ‘care, recovery or rehabilitation.’ There has been no evidence introduced that he now requires different food than he did before sustaining his injuries as part of his treatment plan. While such expenses are no doubt necessary for his survival, they are not necessary for his recovery or rehabilitation from the injuries suffered in the accident, nor are they necessary for his care because of the injuries he sustained in the accident. Unlike prescription medications or nursing care, the food that Griffith consumes is simply an ordinary means of sustenance rather than a treatment for his ‘care, recovery, or rehabilitation.’ In fact, if Griffith had never sustained, or were to fully recover from, his injuries, his dietary needs would be no different than they are now. We conclude, therefore, that his food costs are completely unrelated to his ‘care, recovery, or rehabilitation’ and are not ‘allowable expenses’ under MCL 500.3107(1)(a).” (emphasis in original)
In reaching its conclusion that non-special dietary food served to an injured person at home is not compensable as an allowable expense, the Court distinguished between food served at home and food served in an institution. In this regard, the Court explained:
“The parties focus on the distinction between food costs for hospital food and food costs for an insured receiving at-home care. Plaintiff contends that there is no distinction between such costs. We disagree. . . . it is ‘reasonably necessary’ for an insured to consume hospital food during in-patient treatment given the limited dining options available. Although an injured person would need to consume food regardless of his injuries, he would not need to eat that particular food or bear the cost associated with it. Thus, hospital food is analogous to a type of special diet or select diet necessary for an injured person’s recovery. Because an insured in an institutional setting is required to eat ‘hospital food,’ such food costs are necessary for an insured’s ‘care, recovery, or rehabilitation’ while in such a setting. Once an injured person leaves the institutional setting, however, he may resume eating a normal diet just as he would have had he not suffered any injury and is no longer required to bear the costs of hospital food, which are part of the unqualified unit cost of hospital treatment.” (emphasis in original)
In reversing the room and board rule set out in Reed, the Court created a new causation test to be utilized in determining an insurer’s liability for allowable expenses under § 3107(1)(a). Utilizing language from both § 3107(1)(a) and § 3105(1), an expense is an allowable expense if: (1) the expense is causally connected to the accidental body injury that triggers entitlement to benefits under § 3105(1); and (2) the expense is causally related to an injured person’s care, recovery, or rehabilitation under § 3107(1)(a). In elaborating on this causation concept, the Court stated:
“Defendant contends that MCL 500.3105(1) requires that allowable expenses be causally connected to a person’s injury. We agree. . . . [A]n insurer is liable only if benefits are ‘for accidental bodily injury. . . .’ ‘[F]or’ implies a causal connection. ‘[A]ccidental bodily injury’ therefore triggers an insurer’s liability and defines the scope of that liability. Accordingly, a no-fault insurer is liable to pay benefits only to the extent that the claimed benefits are causally connected to the accidental bodily injury arising out of an automobile accident. . . . Even if ordinary food expenses were compensable under §3105, an insurer would be liable for those expenses only if they were also ‘allowable expenses’ under MCL 500.3107(1)(a). This section provides that benefits are payable for ‘reasonably necessary products, services and accommodations for an injured person’s care, recovery, or rehabilitation.’ . . . There is no dispute that Griffith is an ‘injured person.’ Thus, the question is whether food is reasonably necessary for his ‘care, recovery, or rehabilitation’ as an injured person. It is not contended here that the food expenses at issue are a part of the insured’s ‘recovery’ or ‘rehabilitation.’ Indeed, plaintiff does not allege that the food has special curative properties that might advance Griffith’s recovery or rehabilitation. The key issue, therefore, is whether the food expenses are necessary for Griffith’s ‘care.’ . . . Therefore, we must neither read ‘care’ so broadly as to render nugatory ‘recovery and rehabilitation’ nor construe ‘care’ so narrowly that the term is mere surplusage. ‘Care’ must have a meaning that is related to, but distinct from, ‘recovery and rehabilitation.’ As an initial matter, it is important to note that the statute does not require compensation for any item that is reasonably necessary to a person’s care in general. Instead, the statute specifically limits compensation to charges for products or services that are reasonably necessary ‘for an injured person’s care, recovery, or rehabilitation.’ (Emphasis added.) This context suggests that ‘care’ must be related to the insured’s injures. . . . It follows that the Legislature intended to limit the scope of the term ‘care’ to expenses for those products, services, or accommodations whose provision is necessitated by the injury sustained in the motor vehicle accident. ‘Care’ is broader than ‘recovery’ and ‘rehabilitation’ because it may encompass expenses for products, services, and accommodations that are necessary because of the accident but that may not restore a person to his preinjury state. Griffith’s food costs here are not related to his ‘care, recovery, or rehabilitation.’ There has been no evidence introduced that he now requires different food than he did before sustaining his injuries as part of his treatment plan. . . . Under MCL 500.3105 and MCL 500.3107(1)(a), defendant is not required to reimburse plaintiff for the food expenses at issue in this case. Such expenses are not necessary ‘for accidental bodily injury’ under MCL 500.3105. In addition, they are not ‘allowable expenses’ under MCL 500.3107(1)(a) because food is not necessary for Griffith’s ‘care, recovery, or rehabilitation’ under that subsection. Because the rule announced in Reed, supra, is contrary to the language of the above provisions, we overrule the Court of Appeals decision in Reed.”
Finally, the Court specifically referenced “cost containment” as an issue which impacted its conclusion. In this regard, the Court stated:
“Plaintiff’s interpretation of MCL 500.3107(1)(a) stretches the language of the act too far and, incidentally, would largely obliterate cost containment for this mandatory coverage. We have always been cognizant of this potential problem when interpreting the no-fault act, and we are no less so today.”
In so stating, the Court, in footnote 15, referenced a number of cases for the proposition that compulsory no-fault insurance must be available at affordable rates so that benefits are provided at the lowest cost to both individuals and the no-fault system.
Justice Weaver dissented, and would hold, “that the reasonable charges incurred for plaintiff’s husband’s food while he is cared for at home are recoverable as ‘allowable expenses’ under the statute.”
Justices Kelly and Cavanagh also dissented, and expressed their belief that Reed was properly decided:
“Reed has been the rule of law in Michigan for twelve years. There are unacknowledged alarming implications in overruling it. If we apply the majority’s reasoning about in-home food, is shelter at home an allowable expense? An uninjured person requires shelter. The majority incentivizes no-fault insurers to refuse to reimburse these and other expenses in the future, even though they are without dispute reasonably necessary for an injured person’s care.”
