Michigan Court of Appeals; Docket # 325886; Unpublished
Judges O’Connell, Owens, Borrello; unanimous, per curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion 
STATUTORY INDEXING:
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this unanimous unpublished per curiam Opinion, the Court of Appeals held that attendant care benefits under MCL 500.3107 were properly awarded to plaintiff, as the guardian of the injured insured, because plaintiff rendered sufficient documentation to defendant insurer that she provided attendant care to the injured insured. The Court of Appeals further held the trial court miscalculated the award of penalty interest under MCL 500.3142 and improperly awarded attorney fees under MCL 500.3148, because the insurer did not unreasonably delay the payment of benefits.
When plaintiff’s son, Michael Shane, suffered a head injury in a 1990 auto accident, plaintiff became his guardian and took care of him. Defendant, Michigan Property & Casualty, paid attendant care benefits through December 2009, at which time plaintiff was placed on an automatic payment schedule and was told that she did not have to submit daily duty logs for payment. However, at the time, defendant did not have an updated prescription for Michael’s attendant care. Plaintiff provided defendant with information regarding Michael’s physician, but Michael’s medical records were not released because the proper authorization form was not submitted. Defendant’s representative then decided to verify that Shane still required attendant care. When the appropriate documentation was sent to defendant, it failed to indicate that Michael still required attendant care and, in 2011, plaintiff was informed that defendant was discontinuing benefits because a doctor would not opine regarding Michael’s need for attendant care. Plaintiff then filed this action seeking benefits. After the suit was filed, defendant received a prescription for Michael’s attendant care benefits. However, defendant did not resume paying benefits, asserting plaintiff had not provided a daily services log to verify that she was actually performing attendant care. The trial court held that defendant was aware of Michael’s ongoing need for attendant care services and that defendant was obligated to pay plaintiff $20 a day from October 15, 2012, until January 8, 2014. The trial court also found that, following the prescription that was submitted on January 8, 2014, defendant should have paid plaintiff $15 per hour for six hours, and that defendant’s refusal to pay was an unreasonable denial of benefits. Accordingly, the trial court awarded plaintiff penalty interest under §3142 and attorney fees under §3148.
The Court of Appeals affirmed in part and reversed in part, finding that plaintiff was entitled to attendant care benefits, but that penalty interest was miscalculated and attorney fees were erroneously awarded because defendant did not unreasonably delay or refuse payment.
Regarding defendant’s argument that there was insufficient evidence to award attendant care benefits, the Court of Appeals said it was not convinced the trial court made a mistake in this regard. Reviewing the record, the Court rejected defendant’s assertions and held the trial court’s finding that Michael required attendant care was not clearly erroneous.
The Court of Appeals further rejected defendant’s claim that the trial court erred when it found that plaintiff actually rendered attendant care services after January 8, 2014, although she did not provide contemporaneous daily logs of her activities. The Court pointed out that plaintiff submitted a services summary and that defendant did not request logs until June 4, 2014, and had specifically informed plaintiff that she no longer had to submit such logs. According to the Court:
“And when [plaintiff] submitted her services summary, the [defendant] did not claim that it was insufficiently detailed, but instead refused payment on the basis that there was no medical need for the services. … We conclude that the trial court did not clearly err when it found that [plaintiff] actually provided Shane with attendant care services.”
The Court of Appeals further held the trial court miscalculated penalty interest and improperly awarded attorney fees, finding there was a legitimate factual uncertainty regarding Michael’s need for attendant care when defendant initially refused to pay benefits in August 2011. As a result, the Court held that plaintiff was entitled to prejudgment interest from January 8, 2014, but reversed the trial court’s determination of unreasonableness prior to that date, remanding for a determination on what portion of interest was attributable to the denial after that date.
