Michigan Court of Appeals; Docket No. 288853; Published
Judges Jansen, Cavanagh, and Kelly; unanimous; per curiam
Official Michigan Reporter Citation: 289 Mich. App. 39, Link to Opinion 
STATUTORY INDEXING:
General/Miscellaneous [3105]
TOPICAL INDEXING:
Not applicable
CASE SUMMARY:
In this unanimous per curiam opinion which was decided on April 27, 2010 and approved for publication on June 22, 2010, the Court of Appeals affirmed the trial court Order in which it dismissed the plaintiff’s complaint for first-party benefits, finding that the action was barred by res judicata.
The claimant in this case was allegedly injured in a motor vehicle accident for which he claimed he received attendant care services and other medical treatment. Defendant, the claimant’s no-fault insurer, refused to pay the claimant personal injury protection benefits. Therefore, the claimant sued the defendant in an earlier action in which the jury found that the claimant’s claim for attendant care benefits was fraudulent. This finding supported the defendant’s denial of benefits based on its exclusionary clause which provided:
“There is no coverage under this policy if you or any other person insured under this policy has made false statements with the intent to conceal or misrepresent any material fact or circumstance in connection with any claim under this policy.”
Therefore, the trial court entered a judgment of no cause of action against the claimant.
Plaintiff alleged that it provided the claimant with therapeutic and rehabilitative services for injuries he sustained in the accident. The defendant refused to pay for plaintiff’s services, arguing that the claimant’s fraudulent submissions voided the policy. After the judgment against the claimant was entered, the defendant moved for summary disposition in this case arguing that the earlier judgment barred plaintiff’s claim under the doctrine of res judicata. The trial court agreed, and the Court of Appeals affirmed.
In finding for the defendant, the court noted that there is no dispute whether the judgment in the first case was a final judgment on the merits. The court noted that the jury found that the claimant submitted a fraudulent claim for benefits and a judgment was entered. In addition, the court found there were no questions whether the plaintiff in this action could have asserted its claims in the earlier action. The court explained that the plaintiff, who was seeking payment under the policy, is standing in the claimant’s shoes. Therefore, the court stated there is no question that the plaintiff was privy to the claimant. Furthermore, the court noted that the jury in the earlier action found that the claimant submitted a fraudulent claim. In this action, the plaintiff is simply re-litigating the same issue to obtain payment under the policy. Thus, the trial court properly determined that the plaintiff’s action was barred by res judicata. In this regard, the court stated:
“Here, there is no serious dispute whether the judgment in the first case was a final judgment on the merits. The jury determined that Afful submitted a fraudulent claim for benefits and a judgment pursuant to verdict was entered on June 3, 2008. Further, there is no question whether plaintiff’s claims were, or could have been, resolved in the first lawsuit. This is because the essential evidence presented in the first case sustains dismissal of both actions. See Bd of Co Road Comm’rs, 205 Mich App at 375. Plaintiff, by seeking coverage under the policy, is now essentially standing in the shoes of Afful. Being in such a position, there is also no question that plaintiff, although not a party to the first case, is a ‘privy’ of Afful. ‘A privy of a party includes a person so identified in interest with another that he represents the same legal right. . . .’ Begin, 284 Mich App at 599. As noted, the jury determined that Afful submitted a fraudulent claim. The result under the plain language of the exclusion provision litigated in the first action is that Afful and his privies are not entitled to coverage under the policy. Plaintiff is simply attempting to re-litigate precisely the same issue in order to obtain coverage under the policy. The trial court properly dismissed plaintiff’s suit to the extent that it found its claim was barred by res judicata. For this reason, plaintiff’s claim of appeal fails.”
