Justia Insurance Law Opinion Summaries

Alan Jesperson was injured in a motor vehicle accident when his motorcycle was struck from behind by a vehicle owned by Mary Basha and driven by Matthew Badelalla while Badelalla was making deliveries for Jet’s Pizza. Auto Club Insurance Association (ACIA) was notified of Jesperson’s injuries and that it was the highest-priority no-fault insurer. It began making payments to Jesperson shortly after it received that notice. Jesperson brought an action against Basha, Badelalla, and Jet’s seeking damages for the injuries he had sustained. He later moved to amend his complaint to add a claim against ACIA after it stopped paying him no-fault benefits. The trial court entered a default judgment against Badelalla and Basha, entered an order allowing Jesperson to amend the complaint, and entered an order severing Jesperson’s claims for trial. A jury returned a verdict of no cause of action with regard to Jesperson’s claims against Jet’s. Before trial on the remaining claim, ACIA moved for summary judgment, arguing that Jesperson’s claim against it was barred by the statute of limitations in MCL 500.3145(1). The court agreed that the statute of limitations barred Jesperson’s claim and granted ACIA’s motion for summary disposition. On appeal, the Court of Appeals affirmed, holding that the exception in MCL 500.3145(1) to the one-year limitations period when the insurer has previously made a payment applied only if the insurer has made a payment within one year after the date of the accident. Jesperson appealed, and the Supreme Court reversed. The Supreme Court found that the insurer's payment of no-fault benefits more than a year after the date of the accident satisfied the second exception to the one-year statute of limitations in MCL 500.3145(1). The Court vacated the trial court's order granting summary judgment in favor of the insurer and the case was remanded for further proceedings. View "Jesperson v. Auto Club Insurance Association" on Justia Law

Lejuan Rambin sued Allstate Insurance Company and Titan Insurance Company, seeking payment of personal protection insurance (PIP) benefits under the no-fault act. Rambin had been injured while riding a motorcycle owned by and registered to Scott Hertzog. At the time of the accident, Rambin did not own a motor vehicle. The car involved in the accident was uninsured, but Rambin averred that Hertzog owned a car that Allstate insured. Allstate denied Rambin’s claim for PIP benefits. Rambin alternatively alleged that if Allstate was not the responsible insurer, he was entitled to PIP benefits from Titan, the insurer to which the Michigan Assigned Claims Facility had assigned his claim. Titan and Allstate moved for summary judgment, arguing that Rambin took the motorcycle unlawfully and was therefore barred from recovering PIP benefits. Rambin also moved for summary judgment, arguing: (1) that he had joined a motorcycle club even though he did not own a motorcycle; (2) that Hertzog’s motorcycle was subsequently stolen; (3) that Rambin needed a motorcycle to participate in a club ride; (4) that a colleague offered to loan him a motorcycle; and (5) that during the ride he collided with the uninsured automobile while riding the motorcycle. The trial court granted both insurance companies' motion and Rambin appealed. The Court of Appeals reversed and remanded, holding that Rambin had not taken the motorcycle unlawfully. Allstate appealed. The Supreme Court affirmed the Court of Appeals’ decision insofar as it held that plaintiff was entitled to PIP benefits if the evidence established he did not know the motorcycle he had taken was stolen. The Court disagreed, however, with the Court of Appeals’ conclusion that plaintiff was entitled to a finding as a matter of law that he did not take the motorcycle unlawfully, given the circumstantial evidence presented in this case. "The Court of Appeals improperly made findings in regard to the facts of this case that were still very much in dispute." The Court therefore affirmed in part, reversed in part, and remanded the case to the circuit court for further proceedings. View "Rambin v. Allstate Insurance Co." on Justia Law

Acorn Investment Co. sued the Michigan Basic Property Insurance Association seeking to recover losses suffered in a fire on Acorn’s property. Michigan Basic had denied coverage on the basis that the policy had been canceled before the fire occurred. The case proceeded to case evaluation, which resulted in an award of $11,000 in Acorn’s favor. Acorn accepted the award, but Michigan Basic rejected it. The circuit court granted summary judgment in Acorn’s favor, ruling that the notice of cancellation was insufficient to effectively cancel the policy. The parties then agreed to submit the matter to an appraisal panel as permitted in the insurance policy and by statute. The appraisal panel determined that Acorn’s claim was worth $20,877. Acorn moved for entry of a judgment and also sought interest, case evaluation sanctions, and expenses for the removal of debris. The court entered a judgment in Acorn’s favor for $20,877 plus interest but declined to award case evaluation sanctions or debris-removal expenses. Michigan Basic paid the judgment, and Acorn appealed the denial of the sanctions and expenses. The Court of Appeals affirmed, but the Supreme Court affirmed in part and reversed in part. The Court held that the circuit court could award actual costs to Acorn. The Supreme Court vacated the appellate court with respect to the award of debris-removal expenses: the issue was remanded to the circuit court to determine whether the appraisal panel awarded expenses as part of its award, left them for the circuit court to determine, or whether Acorn waived its right to claim them. View "Acorn Investment Co. v. Michigan Basic Property Insurance Assn." on Justia Law

Grange Insurance Company of Michigan sought a declaratory judgment regarding its responsibility under a no-fault insurance policy issued to Edward Lawrence to reimburse Farm Bureau General Insurance Company of Michigan for personal protection insurance (PIP) benefits it paid after the death of his daughter Josalyn Lawrence following an automobile accident. The accident occurred while Josalyn's mother, Laura Rosinski, was driving a vehicle insured by Farm Bureau. Lawrence and Rosinski were divorced at the time of the accident but shared joint legal custody of the child. Rosinski had primary physical custody. Farm Bureau sought partial reimbursement of the PIP benefits it paid, arguing that Grange was in the same order of priority because Josalyn was domiciled in both parents' homes under MCL 500.3114(1). Farm Bureau counterclaimed. The circuit court granted Farm Bureau's motion for summary judgment; Grange appealed. The Court of Appeals affirmed. Automobile Club Insurance Association (ACIA) also sought a declaratory judgment to recover PIP benefits from State Farm Mutual Automobile Insurance Company under similar circumstances as in "Lawrence." Sarah Campanelli, the daughter of Francis Campaneli and Tina Taylor, died following an automobile accident. At the time of the accident, Sarah's parents, Francis Campanelli and Tina Taylor, were divorced and shared joint legal custody of Sarah; Campanelli had physical custody. Soon after the divorce, the family court modified the divorce judgment, allowing Campanelli to move and to change Sarah's domicile to Tennessee. When the accident occurred eleven years later, Sarah was staying in Michigan to attend school after a summer visit with her mother. ACIA claimed that State Farm was the responsible insurer and that that Sarah was not domiciled in Michigan, therefore it was not responsible for Sarah's PIP benefits. The circuit court granted summary judgment in favor of State Farm; the Court of Appeals reversed, concluding that there was a question of fact as to the child's domicile. Upon review, the Supreme Court reversed and remanded the "Grange" case for entry of summary judgment in favor of Grange; the Court reversed and remanded the "ACIA" case for entry of summary judgment in favor of ACIA. View "Grange Insurance Company of Michigan v. Lawrence" on Justia Law

Brent Harris sued Auto Club Insurance Association (ACIA), seeking to recover a duplicate payment for medical expenses incurred as the result of a motorcycle-motor vehicle accident, which had been paid directly to providers by his health insurer, Blue Cross Blue Shield of Michigan (BCBSM). Harris claimed ACIA was required to pay him directly the same amounts paid by BCBSM to any healthcare provider for the medical expenses. ACIA filed a third-party complaint against BCBSM and Harris filed an amended complaint naming BCBSM as a defendant. The circuit court granted summary judgment to BCBSM and ACIA, concluding that because ACIA's policy was uncoordinated, ACIA was the primary insurer, and that the BCBSM certificate coordinated benefits with the no-fault policy. The Court of Appeals reversed the circuit court, concluding that the BCBSM certificate did not coordinate with ACIA's no-fault policy. Upon review, the Supreme Court reversed in part and reinstated the trial court's judgment: In this case, the Court of Appeals erred in concluding that Harris was entitled to double recovery; Harris was not obligated to pay his medical expenses because, as a matter of law, ACIA was liable for Harris's PIP benefits. ACIA was liable regardless of when the expenses were incurred and BCBSM's certificate that stated it would not cover those services for which Harris legally did not have to pay precluded Harris from receiving double recovery for those medical expenses. View "Harris v. Auto Club Insurance Association" on Justia Law

Petitioner Robert Smitter applied for workers' compensation benefits after being injured on the job working as a firefighter for Thornapple Township. At the time of his injury, Petitioner also worked for General Motors. He earned eleven percent of his income from the township and 89 from GM. The township did not reduce its workers’ compensation obligation by coordinating Petitioner's benefits with his disability benefits under MCL 418.354(1)(b). The township sought reimbursement from the Second Injury Fund under the dual-employment provisions for the entirety of Petitioner's wage-loss benefits. The fund agreed to pay the amount it would have owed if the township had coordinated Petitioner's benefits. The township filed an application for a hearing with the Worker’s Compensation Board of Magistrates, seeking reimbursement from the fund for the uncoordinated amount. The magistrate ordered the fund to reimburse the township for 89 percent of Petitioner's uncoordinated benefits. The Workers’ Compensation Appellate Commission (WCAC) affirmed. The Court of Appeals denied the fund’s application for leave to appeal. After its review, the Supreme Court concluded that when the injury employment provided less than 80 percent of the employee’s wages, the fund is required to reimburse its portion of the coordinated amount of benefits. Because the Township did not coordinate in this case, the appellate court erred in its analysis. Accordingly the appellate court was reversed and the case remanded to the magistrate for further proceedings. View "Smitter v. Thornapple Township" on Justia Law

Plaintiff Kenneth Admire was seriously injured when the motorcycle he was riding collided with a car being operated by an insured of Defendant Auto-Owners Insurance Company. Following the accident, Kenneth required wheelchair-accessible transportation. Through his guardian Russ Admire, brought an action against Auto-Owners Insurance Company, seeking payment of personal protection insurance (PIP) benefits under the no-fault act. Auto-Owners had agreed to pay the full cost of purchasing a van modified to accommodate Kenneth’s wheelchair. Kenneth’s guardian gave Auto-Owners notice of his intent to purchase a new van. In response, Auto-Owners stated that it was not obligated to pay the base purchase price of a new van, but that it would pay for the necessary modifications if Kenneth’s guardian purchased a new vehicle for him. Kenneth’s guardian purchased the new van for Kenneth, and after the cost of the modifications was reimbursed and the trade-in value was applied, Kenneth was left with $18,388.50 in out-of-pocket expenses for the modified van. Kenneth brought suit seeking reimbursement for the out-of-pocket expenses. The Court of Appeals ruled in favor of Kenneth, but the Supreme Court reversed: Auto-Owners met its statutory obligation to pay for the transportation expenses recoverable under the statute, by paying for the van’s modifications and reimbursing him for mileage to and from his medical appointments. The Court of Appeals erred by concluding that the base price of the van was compensable. View "Admire v. Auto-Owners Ins. Co. " on Justia Law

The Supreme Court granted leave in two cases to address the question whether a person injured while driving a motor vehicle that the person had taken contrary to the express prohibition of the owner may avail himself or herself of personal protection insurance benefits (PIP benefits) under the no-fault act, notwithstanding the fact that MCL 500.3113(a) bars a person from receiving PIP benefits for injuries suffered while using a vehicle that he or she "had taken unlawfully, unless the person reasonably believed that he or she was entitled to take and use the vehicle." Upon review, the Supreme Court held that any person who takes a vehicle contrary to a provision of the Michigan Penal Code (including MCL 750.413 and MCL 750.414, the "joyriding" statutes) has taken the vehicle unlawfully for purposes of MCL 500.3113(a). Furthermore, the Court held that the use of the phrase "a person" in MCL 500.3113(a) "clearly and plainly" includes a family member who has taken a vehicle unlawfully, thereby precludes that person from receiving PIP benefits. View "Progressive Marathon Ins. Co. v. Spectrum Health Hospitals" on Justia Law

The Supreme Court granted leave in two cases to address the question whether a person injured while driving a motor vehicle that the person had taken contrary to the express prohibition of the owner may avail himself or herself of personal protection insurance benefits (PIP benefits) under the no-fault act, notwithstanding the fact that MCL 500.3113(a) bars a person from receiving PIP benefits for injuries suffered while using a vehicle that he or she "had taken unlawfully, unless the person reasonably believed that he or she was entitled to take and use the vehicle." Upon review, the Supreme Court held that any person who takes a vehicle contrary to a provision of the Michigan Penal Code (including MCL 750.413 and MCL 750.414, the "joyriding" statutes) has taken the vehicle unlawfully for purposes of MCL 500.3113(a). Furthermore, the Court held that the use of the phrase "a person" in MCL 500.3113(a) "clearly and plainly" includes a family member who has taken a vehicle unlawfully, thereby precludes that person from receiving PIP benefits. View "Spectrum Health Hospitals v. Farm Bureau Mutual Ins. Co. of Michigan" on Justia Law

The issues before the Supreme Court in this case was whether the services provided by plaintiff's wife constituted services "for an injured person's care," whether the Court of Appeals properly remanded this case to the circuit court for findings of fact regarding the extent to which expenses for services for plaintiff's care were actually incurred, and whether the circuit court erred by awarding an hourly rate that corporate agencies charge for rendering services, rather than an hourly rate that individual caregivers receive for those services. Upon review, the Court held that "allowable expenses" must be "for an injured person's care, recovery, or rehabilitation." Because the Michigan no-fault act does not create different standards depending on who provides the services, this requirement applies equally to services that a family member provides and services that an unrelated caregiver provides. For this case, the Supreme Court held that the Court of Appeals correctly determined that plaintiff may recover "allowable expenses" to the extent that they encompass services that are reasonably necessary for plaintiff's care when the care is "related to [plaintiff's] injuries." However, because the circuit court erred by awarding damages for allowable expenses without requiring proof that the underlying charges were actually incurred, the Court agreed with the decision of the Court of Appeals to remand this case to the circuit court for a determination whether charges for allowable expenses were actually incurred. In determining the hourly rate for attendant care services, the circuit court "clearly erred" by ruling that plaintiff was entitled to an hourly rate of $40 for attendant care services because that rate was entirely inconsistent with the evidence of an individual's rate of compensation, including the compensation that plaintiff's wife, actually received as an employee hired to care for plaintiff. The case was remanded to the circuit court for further proceedings. View "Douglas v. Allstate Insurance Co." on Justia Law