Michigan Court of Appeals; Docket #261101; Published
Judges Saad, Hoekstra, and Markey; unanimous
Official Michigan Reporter Citation: 268 Mich. App. 129, Link to Opinion
Allowable Expenses: Incurred Expense Requirement [3107(1)(a)]
Canadian Accidents and Citizens
In this unanimous published opinion interpreting the “incurred” requirements of §3107 of the No-Fault Act, the Court of Appeals held a Canadian citizen entitled to receive health benefits under the Ontario Health Insurance Plan, a universal health plan under Canadian law, did not “incur” the expenses of his medical care where such expenses were paid by the Ontario Health Insurance Plan.
Plaintiff, a Canadian citizen, was injured in 2001, sustaining injuries in Canada in an accident involving a semi-tractor trailer insured by an Ohio insurance company licensed to do business in Michigan. Plaintiff received medical treatment and the Ontario Health Insurance Plan, Ontario’s public health insurance program, covered his medical expenses. The Ontario Health Insurance Plan is a provincially-administered health care coverage program controlled and subsidized by the Canadian government. Under that system, medical care providers do not bill for the medical services rendered, therefore, physical injuries to Canadian citizens are automatically covered by the plan, and except in limited circumstances, the citizen is not legally liable for any of the expenses of his medical care.
Despite the provisions of this plan, plaintiff claimed he “incurred” expenses for his treatment within the meaning of §3107 of the No-Fault Act which provides the applicable insurer will pay “(a) allowable expenses consisting of all reasonable charges incurred for reasonably necessary products, services, and accommodations for an injured person’s care, recovery, or rehabilitation.”
The Court of Appeals, in upholding the trial court grant of summary disposition in favor of the insurance company, held that because plaintiff bore no “legal responsibility for the disputed cost of his medical care and, accordingly, did not ‘incur’ the medical expenses under the no-fault act,” plaintiff was not entitled to seek reimbursement for these expenses from the insurer.
The court rejected the plaintiff’s reliance upon Clute v General Accident Assurance Company of Canada, 179 Mich App 527 (1989), an opinion which addressed a similar issue involving a claim of entitlement to “setoff” benefits paid by the Canadian government. The court noted that here, the issue is not a setoff, but rather, whether the plaintiff has “incurred” the expenses.
The court also rejected plaintiff’s reliance upon Shanafelt v Allstate Insurance Company, 217 Mich App 625 (1996), which addressed the meaning of “incurred” under §3107(1)(a). Plaintiff, in reliance on Shanafelt, argued he incurred the medical expenses when he “accepted medical treatment.” The Court of Appeals, in reliance on the subsequent decision in Bombalski v Auto Club Insurance Association, 247 Mich App 536 (2001), held this court clarified that to incur or to “become liable for” means “responsible or answerable in law; legally obligated.” Here, under the Ontario universal health coverage system, plaintiff bore legal responsibility for the disputed expenses and, therefore, did not incur them.