Michigan Court of Appeals; Docket #317864; #317866; Unpublished
Judges Beckering, Borrello, and Gleicher; Unanimous; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion 
On 11/25/2015, the Michigan Supreme Court directed the clerk to schedule mini-oral argument on whether to grant leave to appeal; Link to Order
STATUTORY INDEXING:
Disqualification from PIP Benefit Entitlement [§3113]
When Claimants Can Receive PIP Benefits Through the Assigned Claims Facility [§3172(1)]
Assigned Claims Facility Determination of Eligibility [§3173a]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this unanimous unpublished per curiam Opinion involving a direct action by a health-care provider against the Michigan Assigned Claims Facility, the Court of Appeals held that summary disposition in favor of the Assigned Claims Facility was premature because the trial court record was not sufficiently developed on the issue of whether the injured person for whom benefits were sought “failed to maintain statutorily required insurance for his vehicle.”
This action was brought to recover for medical care given to a person injured in an auto accident involving an alleged uninsured vehicle. Plaintiff Bronson Methodist Hospital rendered treatment to the injured person, Cody Esquivel. Bronson filed an application for benefits with the Michigan Assigned Claims Facility, which is now the Michigan Assigned Claims Plan (MACP). The MACP denied Bronson’s application, arguing that Esquivel was the owner of an uninsured motor vehicle. The trial court granted summary disposition for MACP on this basis. The Court of Appeals reversed, finding that the trial court “jumped the gun” in granting summary disposition in favor of MACP.
According to the Court of Appeals, the trial court record was not sufficiently developed, and further discovery was needed to vet the issue of whether Esquivel was insured or uninsured. In this regard, the Court of Appeals said a question of fact remained and summary disposition was inappropriate. The court reasoned:
“It is not clear on this undeveloped record, however, that one of these scenarios exist. Esquivel’s insurance status remains unknown. When he is deposed, the material fact missing from the no-fault equation will emerge. MACP has not yet carried its burden as the moving party to demonstrate with admissible evidence, rather than speculation, that Bronson was ‘obviously ineligible’ to make a claim for benefits. The MACP proffered the Michigan State Police accident report with its summary disposition motion. The report identified the vehicle involved in the accident, including its vehicle identification and license plate numbers. The vehicle was at that time registered to Cody Eleazar Esquivel. The report contains no information regarding Esquivel’s no-fault insurance, or lack thereof. A corresponding fire department incident report also identified the vehicle and driver, but left blank sections designated for insurance information. The MACP provided Bronson’s application for claim assignment, indicating that Esquivel’s insurance information was ‘unknown.’ Finally, the MACP attached a letter that it had sent to Bronson, expressing its belief that the burden fell on Bronson to establish entitlement to benefits before the claim would be assigned. Bronson supplemented the record evidence with its medical records pertaining to Esquivel’s treatment. The records indicate that when Esquivel first arrived at the hospital, he was intubated, rendering him unable to communicate. Once extubated, Esquivel remained too intoxicated or confused to appropriately answer questions. When Esquivel’s parents arrived, medical personnel asked them medical and psychological history questions. However, there is no indication in the medical records that Bronson staff questioned Esquivel, once he was sober, regarding his no-fault automobile insurance. The records also do not include any reference to Esquivel’s health insurance provider, if any. Bronson also provided evidence of its attempts to locate Esquivel to secure insurance information after his release. Bronson made a Freedom of Information Act request to the Michigan State Police for the accident report. Bronson submitted the letter it sent to Esquivel three months after the accident at the address listed in the police report. Bronson included a copy of the enveloped returned as undeliverable and stamped ‘Attempted – Not Known, Unable to Forward.’ Bronson attached identification and address information provided by the Secretary of State and discovered through an ‘Accurint’ Internet search, both of which led to some stale contact information. Mail submitted to the most current address discovered for Esquivel went unanswered and unreturned. Ultimately, nothing in the record establishes that Esquivel was actually uninsured. And no applicable insurance has been identified, despite Bronson’s efforts. Thus, at this juncture, Bronson’s claims fall squarely within that portion of MCL 500.3172(1) addressing claims for which ‘no personal protection insurance applicable to the injury can be identified.’ The existence of a central material fact question — whether or not Esquivel had insurance at the time of the accident — precluded summary disposition, and the circuit court erred in granting the MACP’s motion and request for sanctions.”
