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Harry v State Farm Mutual Automobile Insurance Company; (COA-UNP, 7/13/2006, RB #2762)


Michigan Court of Appeals; Docket #257539; Unpublished
Judges Sawyer, Wilder, and Hood; unanimous; per curiam
Official Michigan Reporter Citation: Not applicable, Link to Opinion courthouse graphic

Entitlement to PIP Benefits: Arising Out of / Causation Requirement [3105(1)]
Entitlement to PIP Benefits: Transportational Function Requirement [3105(1)]
Entitlement to PIP Benefits: Motor Vehicle Involvement [3105(1)]

Uninsured Motorist Coverage: Exclusions from Uninsured Motorist Benefits

In this unanimous unpublished per curiam opinion, the Court of Appeals reversed judgment in plaintiff’s favor in this action for first-party no-fault benefits as well as for uninsured motorist coverage, finding that plaintiff failed to show that her foot injury arose out of “ownership, operation, maintenance or use of motor vehicle as a motor vehicle” as required by MCL 500.3105(1). The plaintiff in this case alleged an ill-defined foot and ankle injury about which she first complained several weeks after the accident and received treatment for more than 16 months later. At plaintiff’s trial, her doctor testified that it would be difficult to correlate treatment for her ankle that occurred 16 months later to her motor vehicle accident. Nonetheless, the trial court denied defendant’s motion for a directed verdict on both the claim for PIP benefits and the uninsured motorist coverage claim based on lack of causation. The Court of Appeals reversed, finding that plaintiff failed to prove that her injury was related to the accident. In this regard, the court stated:

For first-party coverage, ‘an insurer is liable to pay benefits for accidental bodily injury arising out of the ownership, operation, maintenance or use of a motor vehicle as a motor vehicle. . . .’ MCL 500.5105(1). The first-party insurer’s liability is conditioned upon plaintiff’s showing that the injury or loss would not have occurred but-for the accident. . . . ‘Proof of causation requires both cause in fact and proximate cause.’ . . . Cause in fact requires a showing that but for the negligent conduct, the injury would not have occurred. . . . Michigan law prohibits speculation in proving causation. ‘Cause in fact may be established by circumstantial evidence, but such proof must be subject to reasonable inferences, not mere speculation.’ . . . ‘An explanation that is consistent with known facts but not deductible from them is impermissible conjecture.’ . . . Although the foregoing discussions are from the medical malpractice context, no legal authority restricts these causation principles to medical malpractice claims. . . . In light of Dr. Pike’s opinion failing to support causation, and the absence of other proofs supporting causation, the trial court erroneously denied defendant’s motion for a directed verdict with respect to the uninsured motorist coverage claim.

The injury claimed by plaintiff for her PIP claim was the same; therefore, the causation analysis remains the same. There is no known authority that the causation standard for a PIP claim is lower than that for other automobile accident claims. Causation in fact must be proven, without speculation. . . . Therefore, the speculative nature of plaintiff’s causation theory also bars her PIP claim.

Taking the evidence in a light favorable to plaintiff, the evidence is too tenuous to overcome the prohibition against using speculation in a theory of causation. The trial court erred in denying defendant’s motion for a directed verdict.”

Michigan auto accident attorney 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

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