United States District Court for the Western District of Michigan; Docket No. l:94-CV-338
Honorable Wendell A. Miles; Published
Official Federal Reporter Citation: 911 F.Supp. 279; Link to Opinion 
STATUTORY INDEXING:
Allowable Expenses for Attendant Care [§3107(1)(a)]
Allowable Expenses for Handicapper Motor Vehicles [§3107(1)(a)]
Allowable Expenses for Home Accommodations [§3107(1)(a)]
Allowable Expenses: Incurred Expense Requirement [§3107(1)(a)]
Providers Entitled to Charge Reasonable Amount for Services [§3157]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
This case involved interpretation of the no-fault act and its application to plaintiffs claim for certain home modifications, the purchase of a modified handicap accessible van, and 24 hour attendant care, all alleged to be required because of plaintiff s closed head injury in a motor vehicle accident rendering her a quadriplegic.
Over the course of years since her 1978 accident, the defendants were plaintiffs no-fault insurance carriers who provided her with various allowable expense benefits. The defendants provided plaintiff with the purchase of a 1983 Ford Van equipped with hydraulic lifts to accommodate plaintiffs wheelchair. In 1990, plaintiff purchased a new Ford Van for which defendants contributed partial reimbursement. Defendants also have provided with plaintiff with payment for modifications to her home to make it handicap accessible. Additionally, defendants have paid reimbursement for 24 hour per day in-home nursing care. Plaintiff received such care from the same firm, Memorial Home Health Care, since 1984. In 1994 defendant Nationwide wrote to plaintiff indicating that they had decided to contract her 24-hour care with another nursing care provider, although Nationwide indicated that plaintiff could indicate her preference for another organization or individuals to care for her, but that any reimbursement would be based on reasonable charges for a Michigan vendor providing the same service. Memorial was charging rates higher for such services than the company selected by Nationwide.
Plaintiff commenced this action seeking a restraining order prohibiting the defendants from changing her nursing staff. Additionally, plaintiff claimed entitlement to reimbursement for the purchase of a 1994 hydraulically equipped van at a cost of $34,800, and additionally, plaintiff sought reimbursement for home improvements necessary to accommodate her condition in the amount of $40,000.
Defendants moved for summary disposition on each of plaintiffs claims. With regard to the home modifications, defendants claimed that plaintiff had failed to establish that her claim had been presented within one year of incurring the cost of those modifications. It was agreed that the earliest date defendants received notice of plaintiff s claim, was the date of commencement of her action on April 21,1994. Defendants' factual submissions also established that at least $33,500 of the expenses were incurred on November 2,1992. In holding plaintiffs claim for home modifications to be barred, the court held that plaintiff had simply presented no admissible evidence indicating what, if any, portion of the amount was incurred within one year of the filing of her action.
With regard to the modified van claim, the court held that defendants had properly supported their motion for summary judgment by showing that plaintiffs early replacement of her second modified vehicle was not reasonable. Further, plaintiff had failed to provide any breakdown of the $34,800 purchase price indicating what accessories were included in the price. Therefore, defendants were entitled to summary judgment on plaintiffs claim for the cost of this latest modified vehicle.
With regard to the change in her 24-hour attendant care providers, the court held that Michigan law requires plaintiff to prove that the charges for such services are reasonable. Plaintiffs "emotional bond" with the current care providers is of little, if any, relevance in this determination.
The court held that the no-fault insurer is not obligated to pay unreasonable charges for medical services. However, plaintiffs position is not without factual support that Memorial's charges were reasonable. The court held that Memorial's charges were not unreasonable as a matter of law simply because another provider charges less. Because the defendants had not shown the lack of genuine issue as to the reasonableness of Memorial's charges, the court denied the motion for summary judgment as to plaintiffs claim for attendant care.
