United States District Court, Eastern District of Michigan; Case #13-11822
Hon. David M. Lawson
Official Michigan Reporter Citation: Not Applicable; Opinion Not Available 
STATUTORY INDEXING:
Entitlement to No-Fault PIP Benefits: Bodily Injury Requirement [§3105(1)]
Allowable Expenses for Attendant Care [§3107(1)(a)]
Allowable Expenses for Medical Treatment [§3107(1)(a)]
Allowable Expenses: Incurred Expense Requirement [§3107(1)(a)]
Work Loss Benefits: Nature of the Benefit [§3107(1)(b)]
Replacement Service Expense Benefits: Nature of the Benefit [§3107(1)(c)]
Replacement Service Expense Benefits: The Incurred Requirement [§3107(1)(c)]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this written Opinion concerning a claim for benefits under MCL 500.3107(1), Federal Judge David M. Lawson held the insured did not sustain an accidental bodily injury and was not entitled to any benefits.
Specifically, Judge Lawson ruled the insured did not: 1) receive any “products, services, or accommodations” from any “medical, service, or transportation provider” related to the accident; 2) receive any products, services, or accommodation that were “reasonable and customary in cost” or “reasonably necessary to his care, recovery, or rehabilitation”; 3) incur any lost wages or any future lost wages; 4) incur any replacement services; and 5) incur any charges for “allowable expenses” relating to any injury.
After he was involved in an auto accident, defendant sought allowable expenses, work loss, and replacement services from plaintiff, his no-fault insurer. Plaintiff denied coverage, claiming defendant did not sustain any injuries in the accident. Plaintiff filed a complaint, asking for a declaration that it had no obligation to pay benefits.
In declaring that plaintiff was not obligated to pay PIP benefits “of any sort” to defendant, Judge Lawson said defendant did not prove that he was entitled to benefits under §3107(1). The judge said:
“As to his claim for ‘allowable expenses’ for medical treatment, the defendant admitted that he received no treatment, that he did not receive any services that were reasonable and necessary for his care, and that in fact he did not suffer any injury as a result of the accident. The defendant therefore has not established that he incurred any ‘allowable expenses,’ and the plaintiff is not obligated to pay any such benefits to him or on his behalf. … As to his claims for lost wages, the defendant admitted that he has not incurred any lost wages and will not incur any lost wages in the future, and because he admitted that he was not injured as a result of the accident, he cannot show that he suffered a disability that caused any alleged loss of income. He therefore is not entitled to recover any benefits for any lost wages. … As to his claims for ‘replacement services,’ the defendant admitted that [he] did not receive any products, services, or accommodations from any medical, service, or transportation provider in connection with the accident, and that he did not receive any products, services or accommodations that were reasonable and customary in cost, or reasonably necessary to his care, recovery or rehabilitation. He therefore is not entitled to recover any benefits for ‘replacement expenses.’”
Judge Lawson further held that, because defendant was not entitled to PIP benefits, he could not prevail on his counterclaim alleging that plaintiff unreasonably denied or delayed payment of benefits.
Accordingly, Judge Lawson granted plaintiff’s motion for summary judgment and ordered that defendant’s counterclaim be dismissed with prejudice.
