United States District Court, Eastern District of Michigan; Case #12-13896
Hon. Lawrence P. Zatkoff
Official Michigan Reporter Citation: Not Applicable; Opinion Not Available 
STATUTORY INDEXING:
Allowable Expenses: Incurred Expense Requirement [§3107(1)(a)]
Allowable Expenses: Claims by Service Providers [§3107(1)(a)]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this written Opinion involving a claim for “allowable expenses” under MCL 500.3107(1)(a), Judge Lawrence P. Zatkoff rejected a no-fault insurer’s claim that the cost of case management services for a brain-injured child were never actually “incurred” because: 1) the company that provided the services did not directly submit bills to the insured, and 2) the company’s website included a statement that said, “Our services are provided at no cost to you under the terms of Michigan law.”
Plaintiff was in a car accident when she was 8 months old that left her with a severe traumatic brain injury. Michelle White, the mother, filed a claim against defendant for allowable expenses under her no-fault policy. Quality Care Consulting (QCC), which provided case management services for the child, intervened and sought reimbursement. Defendant asserted that some of plaintiff’s expenses were not allowable under §3107(1). QCC claimed that documentation of the services was provided to defendant in a timely manner, but defendant refused to pay benefits. Defendant further argued that expenses were never incurred because QCC’s website says, “Our services are provided at no cost to you under the terms of Michigan law” and because QCC never submitted any bills directly to plaintiff.
Judge Zatkoff rejected defendant’s arguments, saying:
“Defendant makes much of the fact that QCC’s website had the following message: ‘Our services are provided at no cost to you under the terms of Michigan law.’ Because of this, Defendant contends, Plaintiff never ‘incurred’ any medical expenses and therefore QCC cannot seek reimbursement of such. The Court finds Defendant’s theory is misplaced. Quite obviously, Plaintiff contracted with Defendant for — and was insured under — a no-fault insurance policy. Plaintiff, like other individuals who seek private health insurance, purchased this insurance and paid premiums to Defendant under the impression that Defendant would cover potential costs of medical care — costs for which Plaintiff would otherwise be obligated to pay. Solely because QCC is sending the medical bills to Defendant does not translate into Plaintiff failing to ‘incur’ medical expenses. In fact, despite Defendant’s selective picking from QCC’s website, it appears QCC contemplates an insurer/insured relationship by also stating on its website that, ‘Under the provisions of the Michigan No-Fault Auto Law case management services are covered by the patient’s auto insurance provided. QCC b ills the auto insurance company directly. The patient and his/her family are never charged for case management services.’ Here, that is precisely what happened — QCC billed Defendant, instead of Plaintiff, and Defendant has refused to pay the invoices. Defendant is therefore denied summary judgment on QCC’s intervening claim for payment of services provided to AC.”
Judge Zatkoff went on to reject defendant’s argument that it should not be liable for the benefits in question because of the Court of Appeals decision in Duckworth v Continental National Indemnification Co, 268 Mich App 129 (2005). The appeals court found Duckworth to be inapplicable to the facts in the present case, and noted that it “question[ed] Defendant’s heavy reliance on such an inapposite case.”
Accordingly, Judge Zatkoff denied defendant’s motion for partial summary judgment.
