Michigan Court of Appeals; Docket #302438; Unpublished
Judges Hoekstra, Markey, and Borrello; unanimous; per curiam
Official Michigan Reporter Citation: Not applicable; Link to Opinion 
STATUTORY INDEXING:
Reasonable Proof Requirement [§3142(2)]
TOPICAL INDEXING:
Not applicable
CASE SUMMARY:
In this unanimous unpublished per curiam Opinion, the Michigan Court of Appeals affirmed the trial court's Order granting summary disposition in favor of Defendant Auto-Owners and dismissed the plaintiff's claims for no-fault benefits that the plaintiff had not submitted to Auto-Owners, but was ultimately claiming in his lawsuit for no-fault benefits.
The plaintiff in this case sustained injuries in a motor vehicle accident. On January 25, 2010, plaintiff filed a complaint against Auto-Owners alleging that Auto-Owners had failed to pay no-fault benefits that included "medical and hospital expenses, wage loss benefits, medical mileage and other benefits." Auto-Owners answered the plaintiff's complaint and maintained that it paid all benefits that the plaintiff was entitled to receive. On May 24, 2010, Auto-Owners took the deposition of plaintiff. Plaintiff admitted that Auto-Owners had paid every claim he had submitted and that he had not submitted to Auto-Owners the other benefits he was claiming in the lawsuit. Apparently, at the deposition, plaintiff possessed notes that explained dates and times of his medical appointments, but the notes did not calculate the actual mileage expenses incurred for each appointment. The plaintiff also claimed that he had some receipts for prescription medications, but he admitted he did not know the total dollar amount he was claiming. Notably, the receipts and the notes were not made part of the deposition record and were never presented to the trial court in opposition to Auto-Owners' Motion for Summary Disposition.
In affirming the trial court's Order granting summary disposition with respect to the claims for which plaintiff had not submitted any documentation or proof, the Court of Appeals recognized that under MCL 500.3142(2), no-fault benefits are "overdue if not paid within 30 days after an insurer receives reasonable proof of the fact and of the amount of loss sustained." The court noted that it was clear in this case that the plaintiff could not prove that Auto-Owners received reasonable proof of the fact and the amount of the loss sustained, because the plaintiff admitted that he never actually submitted the claims to Auto-Owners. In this regard, the Court of Appeals specifically stated:
"On appeal, Phillips argues that the trial court erred when it granted summary disposition to Auto-Owners because his deposition testimony created a genuine issue of material fact in regard to whether Auto-Owners failed in its obligations to pay allowable expenses pursuant to the no-fault act. We find that the trial court did not err because Phillips failed to meet his burden under MCR 2.116(C)(10). Phillips did not present any evidence to rebut Auto-Owner's deposition evidence demonstrating that Phillips never submitted any claim to Auto-Owners that was not paid. Personal protection insurance (PIP) benefits are payable for "[a]llowable expenses consisting of all reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person's care, recovery, or rehabilitation." MCL 500.3107(1)(a); Booth v Auto-Owners Ins Co, 224 Mich App 724, 727; 569 NW2d 903 (1997). "Personal protection insurance benefits are overdue if not paid within 30 days after an insurer receives reasonable proof of the fact and of the amount of loss sustained." MCL 500.3142(2). In this case it is clear that Auto-Owners never received reasonable proof of the fact and of the amount of loss sustained because a claim for the benefits was never submitted by Phillips. Accordingly, there is no evidence to support Phillips' representation that Auto-Owners has refused to pay allowable expenses that it is liable for under the no-fault act, and summary disposition in favor of Auto-Owners was appropriate."
