Michigan Court of Appeals; Docket No. 217489; Published
Judges Gage, Fitzgerald and Markey; unanimous
Official Michigan Reporter Citation: 247 Mich. App. 602, Link to Opinion 
STATUTORY INDEXING:
One-Year Back Rule Limitation [3145(1)]
TOPICAL INDEXING:
Not applicable
CASE SUMMARY:
In this unanimous published opinion by Judge Markey, the Court of Appeals held that plaintiff’s claim for non-coordinated medical expense payments from Hastings Mutual was not barred by the one-year back rule of 3145(1), because plaintiff had submitted a claim on October 29, 1997 for first-party benefits which defendant did not process or formally deny until May 20, 1998. Consequently, the one-year back rule was tolled until that date. The action was filed on July 10, 1998.
Plaintiff was severely injured on February 19, 1997, when his two-wheel vehicle collided with a van. Plaintiff lived with his parents, and their no-fault insurer, Allstate, began paying PIP benefits on a coordinated basis. Hastings, which insured the van, had a non-coordinated medical benefits policy. Hastings had been notified of the accident and the serious nature of plaintiff’s injuries. As early as March, 1997, Hastings believed that it was the primary insurer under the no-fault law, but actively withheld this belief from plaintiff’s attorney and Allstate. On October 29, 1997, it was determined that the vehicle plaintiff was operating was a motorcycle as defined by the No-Fault Act, and therefore, benefits were due from Hastings rather than Allstate. When it was determined that Hastings had a non-coordinated policy, plaintiff’s attorney sent a letter to Hastings on May 13, 1998 requesting payment of non-coordinated benefits.
In finding that the statute of limitations contained in 3145(1) had been tolled, the Court of Appeals relied on Lewis v DAIIE, 426 Mich 93 (1986) [Item No. 936], which held that the one-year back rule was tolled from the date of a specific claim for benefits to the date of a formal denial of liability. The Court of Appeals held that Hastings clearly was on notice of the claim and that Hastings’ medical claims representative had even written to the Michigan Catastrophic Claims Association on March 18, 1997, indicating that defendant believed it was the primary carrier of plaintiff’s claims and was setting the medical reserve at $300,000.
The court also held that plaintiff did, in fact, timely submit a “specific claim for benefits,” under the holding in Lewis. Hastings was aware of the extent of plaintiff’s injuries and medical bills throughout its investigation of who had priority for payment of those expenses. The court held that plaintiff should not be penalized for the time the two insurers spent investigating the issue, which was extended largely because Hastings was aware of its statutory duty but attempted to run the clock on the limitations period.
