Michigan Court of Appeals; Docket #249720; Published
Judges Gage, Meter and Fort Hood; unanimous; Opinion by Judge Meter
Official Michigan Reporter Citation: 266 Mich. App. 597, Link to Opinion 
STATUTORY INDEXING:
One-Year Back Rule Limitation [3145(1)]
TOPICAL INDEXING:
Consumer Protection Act
CASE SUMMARY:
In this unanimous published opinion by Judge Meter, the Court of Appeals held that a claim for attendant care benefits was controlled by the one-year statute of limitations contained in MCL 500.3145(1) of the No-Fault Act even though plaintiff sought to bring it under the Michigan Consumer Protection Act. Therefore, because plaintiff did not file her claim for benefits within one year of the claim being “denied,” plaintiff’s claim should be dismissed as time barred. The plaintiff in this case sustained serious injuries in an automobile accident that occurred in 1995. Plaintiff received in-patient care for a year and was thereafter cared for at home by family members. When defendant compensated family members at $10 per hour, plaintiff’s husband phoned defendant and asked why he was only paid $10 while the agency was compensated at a higher rate. The claims representative stated the lower rate was the rate it paid family members. Plaintiff’s family was compensated at $10 per hour for several years. Eventually, defendant raised the rate to $11 per hour. The plaintiff’s husband (Grant) made numerous inquiries regarding the rate of pay and was given the same answer. The family ultimately incorporated as a health care agency in order to receive the rate defendant paid agencies – $22 per hour. Plaintiff then filed an action to recover the difference between what plaintiff’s family members were paid and the amount defendant paid agencies, citing violation of the Michigan Consumer Protection Act. In rejecting plaintiff’s argument that her claim fell under the MCPA, the court ruled that because she is seeking no fault benefits, the claim is a claim under the No-Fault Act and the one-year back rule found at MCL 500.3145(1) applies. In this regard, the court stated:
“The language [of MCL 500.3145(1)] is plain and unambiguous. . . . Plaintiff ‘may not recover benefits for any portion of [her] loss incurred more than 1 year before the date on which the action [for recovery of personal protection insurance benefits] was commenced. . . . All plaintiff’s losses were incurred more than one year before she filed her complaint. Accordingly, defendant was entitled to summary disposition despite plaintiff’s labeling [the count] as an MCPA claim. . . The claim was nothing more than a claim for no-fault benefits couched in terms of a claim under the MCPA. We will not ‘[rely] on the superficial language of the complaint while ignoring its substance.’ . . . Because the relief plaintiff seeks is barred by the limitation period contained in MCL 500.3145(1), the trial court should have granted summary disposition to defendant with respect to this claim.”
The court also rejected plaintiff’s claim that the one-year statute of limitations was tolled because her requests for additional benefits had never been formally denied. Under Lewis v Detroit Auto Inter-Ins Exchange [RB #936], the court determined that the combination of the repeated requests for a fee increase, the subsequent oral denials and failure to implement a fee increase amounted to formal denial. In so finding, the court explained:
“In this case, plaintiff filed her application for benefits in March 1995. Thereafter, defendant began paying benefits to plaintiff. Grant, on plaintiff’s behalf, periodically inquired of defendant whether the approved rate of ten dollars or eleven dollars an hour for family members had changed. Defendant continually advised Grant that the rate had not changed and compensated plaintiff’s family members at the ten-dollar-an-hour or eleven-dollar-an-hour rate until the fall of 1999, when the family incorporated and was paid the agency rate of twenty-two dollars an hour. We conclude that a ‘specific claim for benefits’ and a ‘formal denial’ of those benefits within the meaning of Lewis occurred in the unique circumstances of this case by virtue of (1) plaintiff’s initial application for benefits, (2) the periodic inquiries by Grant about whether the applicable rate had changed, (3) defendant’s oral denials of increased benefits, and (4) the continual payment by defendant at the lower rate despite Grant’s continued requests for additional compensation.”
