Michigan Court of Appeals; Docket #227096; Unpublished
Judges Griffin, Markey and Meter; unanimous; per curiam
Official Michigan Reporter Citation: Not applicable, Link to Opinion 
STATUTORY INDEXING:
Entitlement to PIP Benefits: Arising Out of / Causation Requirement [3105(1)]
Aggravation of Preexisting Conditions [3105(1)]
Allowable Expenses for Medical Treatment [3107(1)(a)]
Requirement That Benefits Were Unreasonably Delayed or Denied [3148(1)]
Conduct Establishing Unreasonable Delay or Denial [3148]
TOPICAL INDEXING:
Not applicable
CASE SUMMARY:
In this unanimous unpublished per curiam opinion, the Court of Appeals affirmed judgment for plaintiff after a jury trial on plaintiff’s claim for payment of medical expenses under section 3107(a) of the statute. The defendant refused to continue paying plaintiff’s medical expenses for a cervical and arm condition that defendant contended was not related to plaintiff’s earlier motor vehicle accident. The court held that there was a question of fact with regard to the causation issue and thus, it was properly submitted to the jury for its determination. With regard to causation, the court stated:
“To show causation here, plaintiff must prove by a preponderance of the evidence that his cervical and arm condition arose out of the injuries he sustained in the 1990 accident. Defendant suggests that the opinions of two Mayo Clinic neurosurgeons should have removed the question of causation from the province of the jury because the doctors could not definitively include or exclude the 1990 accident as the cause of plaintiff’s cervical complaints. We disagree.... Here, however, the physician who had treated plaintiff for nearly nine years, Dr. John Cilluffo, testified that there was a causal relationship between the accident and plaintiff’s cervical and arm condition. He based his opinion on his long-term relationship with plaintiff and the fact that plaintiff had not experienced cervical and arm pain before the accident. The two Mayo Clinic neurosurgeons’ opinions did not directly contradict plaintiff’s physician; the neurosurgeons were simply unable to include or exclude the 1990 accident as the cause of plaintiff’s condition, as was defendant’s own independent medical examiner. Moreover, plaintiff testified that he had not experienced the problems at issue before the accident. Accordingly, the testimony presented at trial created a question of fact about which reasonable minds could differ, and the testimony did not preponderate so heavily against the verdict that it would be a miscarriage of justice to allow the verdict to stand.”
The court also noted that defendant was not entitled to prevail on the causation issues simply because plaintiff’s injuries may have aggravated a pre-existing medical condition. In this regard, the court noted:
“We further note that injuries sustained in an automobile accident that complicate a plaintiff’s preexisting medical condition do not automatically preclude an insured from no-fault coverage. See Molliter v Associated Truck Lines, 140 Mich App 431, 438; 364 NW2d 344 (1985) [Item No. 811]. Under the evidence presented at trial, the jury reasonably could have concluded that the severity of an earlier condition worsened after the accident.”
The court also affirmed the trial court’s award of attorney fees under section 3148(1) of the statute. In this regard, the court stated, “In a ruling on the reasonableness of an insurer’s delay or refusal to pay an insured’s claim, a trial court may consider the insurer’s inconsistent actions with regard to that claim. ... defendant’s inconsistencies in handling plaintiff’s claim in the instant appeal justified the trial court’s ruling.” In that regard, the court noted that the insurance adjuster, after obtaining an IME report that cast doubt on the medical causation issue, continued to authorize surgery and other medical expenses. Thus, the insurance company was taking action in processing the plaintiff’s claim which was inconsistent with the insurer’s legal position at trial. Therefore, the court properly concluded that defendant’s refusal to pay benefits was not reasonable.
