Michigan Court of Appeals; Docket #307506; Unpublished
Judges Sawyer, Saad and Meter; Unanimous; per curiam
Official Michigan Reporter Citation: Not applicable; Link to Opinion:
STATUTORY INDEXING:
General Rule of Priority [§3114(1)]
Named Insured [3114]
One-Year Notice Rule Limitation [§3145(1)]
Effect of Payment on Notice Requirement [§3145(1)]
Tolling of Limitations for Estoppel
Applicability of Limitations to Assigned Claims Cases [3145]
Obligation of Claimant to Make Timely Claim to the Assigned Claims Facility
Time Limitation on a Claimant Making a Claim Through the Assigned Claims Facility
TOPICAL INDEXING:
Equitable Estoppel
In this unanimous unpublished per curiam opinion, the Court of Appeals held that a no-fault PIP claimant who would otherwise be entitled to recover PIP benefits from the Assigned Claims Facility loses that right when the claimant does not submit written notice to the Assigned Claims Facility within one year of the date of the accident or fails to commence a lawsuit within that one-year period. This is true even though the claimant submitted notice within one year to the no-fault insurer of her boyfriend (with whom she lived) and the boyfriend’s insurer mistakenly paid PIP benefits. The Court further rejected plaintiff’s argument that the one-year notice provision should be tolled under the doctrine of equitable estoppel because plaintiff submitted written notice to her boyfriend’s insurer within one year of the accident. In rejecting the estoppel argument, the Court held that “an estoppel argument is meritless if the claimant had access to the same set of facts as the insurer.” Finally, the Court rejected plaintiff’s argument that she was entitled to claim no-fault benefits under the policy issued to her boyfriend because she was listed on that policy as a “named driver,” even though she was not listed as a “named insured.” In rejecting this argument, the Court noted that under the priority provisions of § 3114(1) PIP policies are applicable to only those persons named in the policy, the person’s spouse, and a relative of either domiciled in the same household. Because plaintiff was not related to her boyfriend, she can only claim PIP benefits from his insurer if she was a “named insured” under his policy. She was not a “named insured”; she was only a “named driver.” In reliance upon previous cases, the Court held that “merely listing a person as a designated driver on a no-fault policy does not make the person a ‘named insured’.”
In expressing these rulings, the Court stated in pertinent part:
“Plaintiff first argues that the trial court erroneously held that defendant State Farm was not liable for PIP benefits because she failed to provide notice to the ACF within one year of the incident. Plaintiff contends that her notice to the ACF was timely despite the fact that the notice was provided 22 months after the incident, in apparent violation of MCL 500.3145.” . . . This statute provides two separate rules: the "one-year-back rule" and the one-year notice provision. The term "one-year-back rule" is regularly used in Michigan courts. See e.g., Henry Ford Health Sys v Titan Ins Co, 275 Mich App 643, 646; 741 NW2d 393 (2007). The term "one-year notice provision" will be used to refer to the statutory one-year limitation period. Goethals v Farm Bureau Ins, 471 Mich 892; 688 NW2d 78 (2004). The one-year-back rule "precludes an action to recover benefits for any portion of a loss incurred more than one year before the date on which the action was commenced." Henry Ford Health Sys, 275 Mich App at 646. The one-year notice provision completely bars any action to recover benefits if notice is not provided to the insurer within one year of the accident. Goethals, 471 Mich at 892. . . .
MCL 500.3174 and MCL 500.3145(1), when read together, provide that a claimant must provide notice to the ACF within one year of the accident. See, e.g., Bronson Methodist Hosp v Allstate Ins Co, 286 Mich App 219, 225-226; 779 NW2d 304 (2009) (identifying MCL 500.3145 as applying to ACF claims). If the claimant fails to provide notice to the ACF within one year of the accident, the claimant cannot maintain an action for PIP benefits. See, generally, id.; see also Dolson v Secretary of State, 83 Mich App 596, 598, 600; 269 NW2d 239 (1978). In other words, the ACF is effectively placed in the same position as a private insurer, so the one-year notice provision applies with equal force to private insurers and the ACF. See, generally, id. at 600. Here, it is not disputed that plaintiff failed to provide notice to the ACF within one year of the incident. In particular, plaintiff provided notice to the ACF in June 2010, and the incident occurred in August 2008. This is a difference of about 22 months. Thus, plaintiffs claim for no-fault PIP benefits is barred by the one-year notice provision of MCL 500.3145. Goethals, 471 Mich at 892. . . . Next, plaintiff argues that the trial court erroneously held that there was no genuine issue of material fact with respect to whether she was a "named insured" of defendant Pioneer. Plaintiff contends that she was entitled to PIP and uninsured motorist (UM) benefits under the terms of the insurance policy. We disagree. . . . Under MCL 500.3114(1), "a personal protection insurance policy described in section 3101(1) a lies to accidental bodily injury to the person named in the policy, the person's spouse, and a relative of either domiciled in the same household, if the injury arises from a motor vehicle accident." In other words, MCL 500.3114(1) requires an insurer to provide PIP benefits to the "named insured," the spouse of the named insured, and household relatives of the named insured. See Dobbelaere v Auto-Owners Ins Co, 275 Mich App 527, 532; 740 NW2d 503 (2007).
Unambiguous provisions in an insurance contract must be enforced as written. See Rory v Continental Ins Co, 473 Mich 457, 468-470; 703 NW2d 23 (2005). "[M]erely listing a person as a designated driver on a no-fault policy does not make the person a 'named insured."; Harwood v Auto-Owners Ins Co, 211 Mich App 249, 253; 535 NW2d 207 (1995). To determine whether a person is a "named insured," a court must examine the language of the insurance policy. . . . In this case, the insurance policy was consistent with state law, specifying that a person was entitled to PIP benefits if the person was the named insured, the use of the named insured, or a relative domiciled in the same household as the named insured. . . . The policy provided that plaintiff’s then-fiance was the "named insured." Plaintiff was not a spouse of her then-fiance, nor was plaintiff related to her then-fiance by blood, marriage, or adoption. Therefore, plaintiff was not entitled to PIP or UM benefits under the plain terms of the insurance contract, and defendant Pioneer was not obligated to pay these benefits to plaintiff. The trial court correctly reached this result.”
For all of the foregoing reasons, the trial court was correct in dismissing plaintiff’s PIP claims as to both the ACF insurer (State Farm) and her boyfriend’s no-fault insurer (Pioneer State).
