Michigan Court of Appeals; Docket #303217; Unpublished
Judges Krause, Saad, and Borrello; 2-1 Per Curiam; Judge Saad dissenting
Official Michigan Reporter Citation: Not applicable; Link to Opinion
; Link to Dissent
On March 20, 2013, the Michigan Supreme REMANDED this case in part and DENIED leave to Appeal in all other respects; Link to Order
On May 7, 2013, the COA AFFIRMED summary disposition in favor of plaintiff and REVERSED grant of attorney fees to plaintiff; Link to Order
STATUTORY INDEXING:
When PIP Claims Through the Assigned Claims Facility May Be Reduced by Benefits from Other Sources [§3172(2)]
TOPICAL INDEXING:
Medicare Benefits: Amount Owed by No-Fault Insurer in Medicare Reimbursement Cases
In this 2-1 unpublished per curiam Opinion, with Judge Saad dissenting, the Michigan Court of Appeals affirmed the trial court’s Order granting summary disposition in favor of plaintiff regarding whether defendant Farmers was liable to pay PIP benefits for medical expenses that were also being paid by Medicare.
The plaintiff in this case was severely injured in a motor vehicle accident that occurred in 1978. This accident occurred prior to the enactment by the United States Congress of the Medicare Secondary Payer Provision of the Omnibus Budget Reconciliation Act of 1980, 42 USC 1395y(b)(2)(a), which prevents Medicare from acting as the primary payer for auto accident injuries. This statute only applies to accidents that occurred after December 5, 1980. Thus, had plaintiff’s accident occurred after December 5, 1980, defendant would be the primary payer for plaintiff’s medical expenses pursuant to the Assigned Claims Facility statute, MCL 500.3171, et seq.
Given that plaintiff was entitled to no-fault benefits through the Assigned Claims Facility, the Court of Appeals reasoned that the coordination and setoff provisions of MCL 500.3109(1) and 500.3109a had no bearing on plaintiff’s claims for no-fault benefits, because plaintiff had no insurance whatsoever and was claiming benefits through the Assigned Claims Facility. Therefore, any coordination or setoff against Farmers liability for plaintiff’s no-fault benefits is determined by MCL 500.3172(2), which states that PIP benefits paid by the Assigned Claims Facility “shall be reduced to the extent that benefits covering the same loss are available from other sources,” but further states Medicare is not one of those “benefit sources.” The Court further observed that this reading of the plain language of the statute was consistent with the legislative analysis of the 1984 amendment to MCL 500.3172 which explained the Legislature explicitly contemplated not coordinating benefits with Medicaid or Medicare and intended to make the Assigned Claims Facility primary over those government benefits. In this regard, the Court stated:
“Critically, MCL 500.3172(2) states that PIP benefits paid by the assigned claims facility “shall be reduced to the extent that benefits covering the same loss are available from other sources,” but further states that Medicare is not one of those “benefit sources.” House Legislative Analysis, HB 4322, November 27, 1984, indicates that 1984 PA 426, which added the relevant setoff language in MCL 500.3172(2), granted assigned claims insurers a setoff against other benefits but explicitly contemplated not coordinating benefits with Medicaid or Medicare and making the assigned claims facility benefits primary over those government benefits. This is consistent with the plain language of the statute itself.”
The majority further acknowledged the concerns of the dissent that the result in this case was allowing the plaintiff to profit from the no-fault insurance system, especially considering the plaintiff had never purchased no-fault insurance. However, the majority explained that the Michigan Supreme Court has made it clear that appellate courts must apply the statute as written, and that the result reached in this case was consistent with the plain language of the relevant statutory provisions.
After this case was decided, Leave to Appeal to the Michigan Supreme Court was further sought. In lieu of granting leave, the Supreme Court REMANDED this case to the Court of Appeals in part "for consideration of the issue whether the trial court clearly erred in awarding the plaintiff attorney fees pursuant to MCL 500.3148(1)," and DENIED leave in all other respects. Link to Order
