Michigan Court of Appeals; Docket No. 169113; Unpublished
Judges Doctoroff, Holbrook, Jr., and Corrigan; Unanimous; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion 
STATUTORY INDEXING:
Coordination with Other Health and Accident Medical Insurance [§3109a]
12% Interest Penalty on Overdue Benefits – Nature and Scope [§3142(2), (3)]
Reasonable Proof Requirement [§3142(1)]
Requirement That Benefits Were Overdue [§3148(1)]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this unanimous unpublished per curiam Opinion, the Court of Appeals affirmed the trial court determination that plaintiff was not entitled to attorney fees and interest sanctions against defendant Farmers Insurance Exchange based upon the provisions of §3142 and §3148 of the no-fault act.
In the instant case, plaintiff received injuries in a motor vehicle accident, and was insured by Farmers for the purpose of no-fault benefits. Plaintiffs Farmers' no-fault insurance policy contained coordination of benefits provisions that make plaintiffs health care coverage the primary source for payment of any medical expenses. Plaintiff received her health insurance through defendant Andrews University pursuant to a university health plan, self-funded by the General Conference of Seventh-Day Adventists. Since this health plan was primary, plaintiff was required to submit her medical expenses first to Andrews University for payment of the amounts covered under that plan, and then Farmers would be responsible for the balance.
In the instant case, plaintiff gave Farmers an itemized list of her medical expenses on February 5, 1993. However, Farmers did not receive information from Andrews University regarding the amount the Andrews plan covered until September 21,1993. Plaintiff claimed that Farmers was responsible for overdue interest for medical expenses not paid within 30 days of the February 5, 1993 submission.
In upholding the trial court determination that plaintiff was not entitled to such interest, the Court of Appeals stated that penalty interest under the no-fault act is required only where the expenses are not paid within 30 days after the insurer receives reasonable proof of the "fact and of the amount of loss sustained." In this case, the court held that although Farmers received reasonable proof of the fact of loss on February 3, 1993, the amount of loss was not established until such time as Farmers received notice from Andrews regarding the amount that it would pay. Defendant Farmers had no reasonable proof of the amount of loss for which it would be responsible until that date.
Finally, since the court determined that Farmers' payment of personal protection insurance benefits-was timely, the award of attorney fees under §3148 was also properly denied.
