Michigan Court of Appeals; Docket No. 116178; Unpublished
Judges Reilly, Gillis, and Cynar; Unanimous; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion 
STATUTORY INDEXING:
Coordination with Other Health and Accident Medical Insurance [§3109a]
Requirement That Benefits Were Unreasonably Delayed or Denied [§3148(1)]
Conduct Establishing Unreasonable Delay or Denial [§3148]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this unanimous per curiam Opinion, the Court of Appeals reversed the circuit court's decision denying plaintiffs request for attorney fees under §3148 for unreasonable refusal or delay in making payment of plaintiffs medical expenses.
The defendant apparently refused payment of plaintiff s medical expenses on the basis of the determination by Blue Cross, plaintiffs primary health insurer, under his coordinated insurance policy, that plaintiff should have been treated as an out-patient rather than an in-patient. The Court of Appeals held that due to the clear proof of accident and the fact that plaintiff sustained injuries requiring medical attention, the defendant could not reasonably refuse payment of no-fault benefits because of another insurer's assertion that it found inappropriate the choice of in-patient treatment rendered by plaintiff’s physician. The court held that there was no evidence which suggested that Blue Cross' rejection of plaintiff s claimed medical expenses was a valid basis for rejection by State Farm of plaintiff s no-fault benefits claim. Consequently, the plaintiff’s claim for attorney fees under §3148 was proper, and the case was remanded for determination of the amount of attorney fees.
In another issue, the Court of Appeals held that the circuit court committed error in failing to articulate the basis for its determination that defendant was entitled to only 30 hours of attorney fees as mediation sanctions pursuant to MCR 2.403(0). In remanding the case for further proceedings, the circuit court was instructed to determine a reasonable fee based upon the particular facts of the case, as well as the factors set forth by the Court of Appeals in Crawley v Schick, 48 Mich App 728 (1973).
