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Raterink v. State Farm Mutual Insurance Company; (COA-UNP; 5/3/2011; RB #3177)

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Michigan Court of Appeals;  Docket No. 295084; Unpublished
Judges Shapiro, Fitzgerald, and Borrello; Unanimous; per curiam 
Official Michigan Reporter Citation: Not applicable, Link to Opinion


STATUTORY INDEXING: 
Entitlement to PIP Benefits: Arising Out of / Causation Requirement [§3105(1)] 
Aggravation of Preexisting Conditions [§3105(1)] 
12% Interest Penalty on Overdue Benefits – Nature and Scope [§3142(2) (3)] 
Requirement That Benefits Were Unreasonably Delayed or Denied [§3148(1)] 
Bona Fide Factual Uncertainty / Statutory Construction Defense

TOPICAL INDEXING: 
Not applicable


CASE SUMMARY: 
In this unanimous unpublished per curiam opinion, the Court of Appeals addressed whether the plaintiff’s claim for medical treatment expenses arose out of the first of two motor vehicle accidents in which the plaintiff was involved.  The court also addressed issues of case evaluation and no fault attorney fee awards.  The Court of Appeals affirmed in part and reversed in part. 

This case arose from a motor vehicle accident on April 26, 2002.  The plaintiff received orthopedic injuries which triggered subsequent complications including diabetes.  The plaintiff then was in a subsequent motor vehicle accident in late 2006 which, together with complications from her pre-existing medical conditions, made her condition worse.  In December 2007 the plaintiff suffered a heart attack, was admitted to the hospital, and then discharged from the hospital to Heartland Home Care for an inpatient stay from January to June, 2008.  The trial court granted summary disposition in plaintiff’s favor concerning entitlement to payment of the medical expenses of treatment, and awarded case evaluation sanction attorney fees, but denied the plaintiff’s claim for penalty interest and no fault attorney fees under MCL 500.3148. 

On appeal, defendant contended that the expenses related to Heartland Home Care were unsupported in the record and the trial court erred in granting summary disposition in the plaintiff’s favor on those claims.  The Court of Appeals noted that the “arising out of” language of MCL 500.3105:

“does not require a showing of proximate causation, but rather something more than a showing that the causal connection between the injury and the use of the motor vehicle was merely incidental, fortuitous, or ‘but for.’”

The Court of Appeals held that a review of the record below reveals that the plaintiff did not present sufficient evidence that the expenses of inpatient treatment in the Heartland Home Care facility were related to the first motor vehicle accident in 2002.  Therefore, reasonable minds could differ and a genuine issue of material fact exists with respect to the expenses related to Heartland.

Concerning expenses related to attendant care, treating physicians and case manager, the Court of Appeals held that the decedent required such treatment for complications from her diabetic condition that was triggered by the first vehicular accident.  The court found that the evidence presented by the defendant in the trial court was not sufficient to refute the opinions of the plaintiff’s experts.  Further, the court noted that the plaintiff may recover if the plaintiff can demonstrate that the accident aggravated a preexisting condition.  Therefore, the grant of summary disposition for these expenses was affirmed.

The Court of Appeals also affirmed the trial court’s award of case evaluation sanctions under MCR 2.403(O) because even upon remand, if the plaintiff does not prevail as to the Heartland Home Care bill, the amount of the judgment arising from those portions according to which the Court of Appeals affirmed summary disposition is in excess of the case evaluation findings. 

In addressing the plaintiff’s claim that the trial court should have awarded attorney fees under MCL 500.3148, the Court of Appeals held that a bona fide factual uncertainty initially existed as to whether the benefits sought by the plaintiff were related to the first accident, which uncertainty was resolved on summary disposition.  Therefore, the trial court did not err in refusing to award no fault attorney fees where a legitimate question of factual uncertainty existed concerning a material issue in dispute.

Concerning the plaintiff’s claim for penalty interest, the Court of Appeals held that the trial court should have awarded penalty interest, even though most of the claims were not documented until the time of the motion for summary disposition.  The Court of Appeals held that the plaintiff’s filings in the trial court below with the corresponding attachments constituted reasonable proof of loss, and therefore, penalty interest should be awarded 30 days from the filing of the plaintiff’s motion for summary disposition.


Lansing car accident lawyer Stephen Sinas is the lead editor of the appellate case summaries published on this site regarding the Michigan auto insurance law. To learn more about how Stephen Sinas and how the Sinas Dramis Law Firm can help you if you have been injured in a Michigan auto accident, visit SinasDramis.com.

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