Michigan Court of Appeals; Docket No. 217618; Published
Judges Bandstra, Wilder and Collins; unanimous
Official Michigan Reporter Citation: 248 Mich. App. 535, Link to Opinion 
STATUTORY INDEXING:
Allowable Expenses for Room and Board [3107(1)(a)]
Allowable Expenses: Reasonable Necessity Requirement [3107(1)(a)]
TOPICAL INDEXING:
Not applicable
CASE SUMMARY:
In this unanimous published opinion by Judge Wilder, the Court of Appeals reversed the trial court order permanently enjoining AAA from refusing to pay regular in-patient telephone and television access charges for hospitalized insureds, and reversed the trial court certification of a class of plaintiffs consisting of those who have received 14 days or more of in-patient medical treatment and incurred telephone and television access charges that were denied by AAA.
Plaintiff was severely and permanently injured in a bus accident. Her health insurance was paid through her private health insurance coverage and coordinated no-fault medical coverage through AAA. Her medical expenses for an eight week hospitalization were all paid except for $140 of charges for telephone and television use while hospitalized. Both the health insurance company and AAA refused to pay these charges.
The trial court determined that telephone and television access charges under the circumstances were reasonable services to be made available to an injured person under 3107(1)(a). Further, the trial court agreed with plaintiff’s request for certification of a class of plaintiffs consisting of AAA insureds who were hospitalized and who were charged for basic telephone and television service, but had not paid their hospital bill.
The trial court determined that basic in-patient telephone and television expenses were “reasonable accommodations” and “reasonably necessary” under 3107(1)(a) of the No-Fault Act. The court also granted a permanent injunction prohibiting AAA from refusing to pay basic in-patient telephone and television access charges for hospitalized insureds, and ordered AAA to pay reasonable charges for such services.
In reversing the trial court, the Court of Appeals held that the question of whether basic telephone and television services were “reasonably necessary” to a patient’s “care, recovery or rehabilitation” under 3107(1)(a) of the No-Fault Act, is a question of first impression never addressed by our courts. The court held that whether such charges for basic in-patient telephone and television services are allowable expenses under the No-Fault Act is a question of fact subject to a case-by-case analysis in each claim. Therefore, issuance of a permanent injunction was not appropriate.
The court stated that it was not persuaded that telephones and televisions can, in light of the ordinary usage of the words and the plain language of the statute, always be considered to be “reasonably necessary for the care, recovery and rehabilitation” of any person. The court relied on federal decisions interpreting the Medicare Act, 42 USC 1395, et seq, in support of its decision. In those cases, the federal courts have determined that items of “personal comfort” were not reimbursable under the Medicare Act. The court agreed with the federal court conclusions that on the surface, services such as telephones and televisions are more properly seen as personal comfort items that have no relation to a patient’s health care, recovery or rehabilitation. Something more, such as the specific prescription by a physician or medical professional, is required to establish the causal relationship required under the No-Fault Act. In this regard, the court remarked, “As a matter of law, the no-fault act requires more than a general notion that a certain item might assist a patient, for that item to be found to be an ‘allowable expense’ under §3107(1)(a).”
Finally, in light of its conclusion that the question concerning telephone and television services is a fact question to be determined on a case-by-case basis, there was insufficient “commonality” for certification of a class action.
