Michigan Court of Appeals; Docket # 311279; Unpublished
Judges Stephens, P.J., and Saad and Boonstra, JJ; unanimous; Per Curiam
Official Michigan Reporter Citation: Not applicable, Link to Opinion 
STATUTORY INDEXING:
Allowable Expenses for Medical Treatment [§3107(1)(a)]
Allowable Expenses: Reasonable Necessity Requirement [§3107(1)(a)]
Allowable Expenses: Reasonable Charge Requirement [§3107(1)(a)]
Allowable Expenses: Incurred Expense Requirement [§3107(1)(a)]
Allowable Expenses: Causation Requirement [§3107(1)(a)]
Allowable Expenses: Claims by Service Providers [§3107(1)(a)]
Reasonable Proof Requirement [§3142(2)]
TOPICAL INDEXING:
Private Contract (Meaning and Intent)
CASE SUMMARY:
In this unanimous unpublished per curiam opinion, the Court of Appeals affirmed the trial court's Judgment in favor of the injured plaintiff and her medical providers for allowable expense benefit claims for medical treatment rendered in relation to the injuries the plaintiff sustained in the subject motor vehicle accident. In so holding, the Court of Appeals rejected Allstate's argument that a prior agreement entered into by one of the plaintiff's medical providers barred recovery of that provider's expenses at issue in this case. Furthermore, the Court of Appeals affirmed the trial court's award of penalty interest on the basis that the trial court did not abuse its discretion in finding that Allstate received reasonable proof in support of the claims at issue.
Plaintiff Szelesi was involved in an automobile accident, injuring her neck, shoulders, and back. Plaintiff ultimately sought treatments with various medical providers, including a treatment known as manipulation under anesthesia (MUA). After these treatments did not alleviate her symptoms, the plaintiff's doctors determined that surgical intervention on the plaintiff's shoulder was necessary. However, after the treatments and surgeries were performed, Allstate refused to render payment, claiming that the treatments and surgery were not "necessary to assist in Szelesi's recovery." Furthermore, once the litigation commenced, Allstate argued that it did not have to pay one of the medical providers claim in this case, because of an agreement that medical provider signed with Allstate in another case pending in a different court.
In upholding the trial court's decision, the Court of Appeals first determined that the agreement between the provider and Allstate in a different case did not apply to the claims of that provider in this case. In this regard, the Court reasoned that the plain language of the agreement only applied to the claims of that medical provider pending in the other case and did not apply to the claims at issue in this case.
Next, the Court of Appeals found that the trial court did not abuse its discretion in determining that the MUA and shoulder surgery constituted allowable expense benefits under MCL 500.3107(1)(a). In so finding, the Court explained that in order for an allowable expense benefit to be compensable under MCL 500.3107(1)(a), it must be proven that (1) the expense must be for an injured person's care, recovery, or rehabilitation, (2) the expense must be reasonably necessary, (3) the expense must be incurred, and (4) the charge must be reasonable. After looking at the testimony heard at the trial court, the Court of Appeals determined that the trial court did not abuse its discretion in determining that these four elements were satisfied. In this regard, the Court stated:
"Here, plaintiffs demonstrated that the MUAs and shoulder surgery were "reasonably necessary" under MCL 500.3107(1).19 Both procedures were "costs expended" to alleviate Szelesi's neck, back, and shoulder pain, and "bring [her] to a condition of health or ability sufficient to resume [her] preinjury life." Douglas, 492 Mich at 259–260. These treatments and the expenses associated with them were objectively "necessary for [Szelesi's] care, recovery, or rehabilitation," in that the trial court heard testimony from plaintiffs' medical experts (in addition to Szelesi herself) that the procedures were both necessary and effective, as they improved Szelesi's range of mobility and reduced her pain. Krohn, 490 Mich at 160. The expenses were "incurred" because the medical services were "actually rendered" and there was "actual cost expended." Douglas, 492 Mich at 266–267 (emphasis removed). And those charges appear "reasonable," in that they do not seem exorbitant, are documented and explained, and were determined as such by the trier of fact. . ."
The Court of Appeals further held that the trial court did not abuse its discretion in determining that Allstate had received reasonable proof of the expenses at issue and, therefore, was liable for penalty interest under MCL 500.3142. The Court specifically referenced testimony from defendant's adjuster concerning when the bills were received, that an investigation was instigated after receiving the bills, and that the claims were ultimately denied after the investigation concluded almost one year later. Therefore, Court stated that "[t]he trial court did not clearly err when it determined that this bill submission and sequence of events constituted 'reasonable proof of the fact and amount of loss' required by MCL 500.3142."
