Justia Insurance Law Opinion Summaries

In July 2004, while walking through a gas station parking lot, plaintiff was struck by a motor vehicle driven by defendant, who was insured by Allstate Property and Casualty Insurance Company. At the time, plaintiff lived with Harrietta Johnson, her ex-mother-in-law. Neither woman owned a vehicle, and neither was insured. Plaintiff filed a third-party tort claim against defendant, seeking damages for replacement services pursuant to MCL 500.3135(3)(c). The trial court granted summary judgment in defendant's favor, concluding that plaintiff could not recover damages for replacement services pursuant to MCL 500.3135(3)(c).The Supreme Court granted leave to appeal to consider whether, in a third-party tort action, damages for replacement services are recoverable pursuant to MCL 500.3135(3)(c). Because "replacement services" is not among the categories listed in MCL 500.3135(3)(c), damages for replacement services are not recoverable in such an action. Accordingly, the Supreme Court reversed the Court of Appeals' judgment in part and reinstated the trial court's grant of summary disposition in defendant's favor on plaintiff's economic damages claim for replacement services expenses. View "Johnson v. Recca" on Justia Law

Defendant-Appellee McKinley Hyten obtained a provisional driver's license in April 2004. In January 2007, Defendant's driver's license was suspended because of multiple moving violations and two minor traffic accidents. In light of what she perceived as assurances from her probation officer, Defendant anticipated that her license would be restored at a district court hearing scheduled for later that year. Defendant's mother Anne Johnson gave Defendant a vehicle, and given the anticipated restoration of the driver's license, sought to obtain automobile insurance for Defendant. Johnson telephoned an independent insurance agent who, after being told that the license had been suspended, informed Johnson that Defendant could not be insured until her license had been restored. Nonetheless, an application for insurance from Titan Insurance Company was filled out on Defendant's behalf, postdated to August 24, 2007. August 22, 2007, Defendant signed the application for insurance. At an August 24, 2007, hearing, Defendant's driver's license was not restored. Plaintiff-Appellee Titan Insurance Company was not informed of this fact. Subsequently, in February 2008, Defendant was driving the insured vehicle and collided with the vehicle of Howard and Martha Holmes, causing injuries to both. Titan then learned Defendant did not have a valid driver's license when the policy was issued. In anticipation that the Holmeses would be filing claims against Defendant for their injuries, Titan filed suit seeking a declaratory judgment. The trial court granted Defendant's motion for summary judgment. The Court of Appeals affirmed, asserting that once an insurable event occurred and a third party (the Holmeses) possessed a claim against the insured arising out of that event, the insurer was not entitled to reform the policy to avoid paying the third party. Titan appealed, and the Supreme Court reversed the Court of Appeals: in accordance with the Supreme Court's precedent in "Keys v Pace,"(99 NW2d 547 (1959)), the Court found "nothing in the law to warrant the establishment of an 'easily ascertainable' rule." The Court overruled "State Farm Mut Auto Ins Co v Kurylowicz," (242 NW2d 530 (1976)) and its progeny, and remanded the case for further proceedings. View "Titan Ins. Co. v. Hyten" on Justia Law

This case involved a policy for uninsured-motorist (UM) coverage issued by Defendant State Farm Mutual Automobile Insurance Company which contained a 30-day notice provision regarding hit-and-run motor vehicle claims. Upon review, the Court held that an unambiguous notice-of-claim provision setting forth a specified period within which notice must be provided is enforceable without a showing that the failure to comply with the provision prejudiced the insurer. Therefore, State Farm properly denied the claim for UM benefits sought in the instant case because it did not receive timely notice, a condition precedent to the policy's enforcement. In this case, the Court reversed the judgment of the Court of Appeals and remanded the case to the trial court for entry of summary disposition in favor of State Farm.

The issue before the Supreme Court in this case concerned whether insurer Defendant-Appellant Allstate Insurance Company was liable to Plaintiff Mona Lisa Frazier for personal protection benefits under the state no-fault act. Plaintiff was injured when she slipped and fell on a patch of ice while closing the passenger door of her car. She placed a few items inside, and fell when she closed the door. The Court concluded Plaintiff was not entitled to benefits under the no-fault act because her injury did not arise out of the use of a parked vehicle under MCL 500.3106(1). "Before her injury, plaintiff had been standing with both feet planted firmly on the ground outside of the vehicle; she was entirely in control of her body’s movement, and she was in no way reliant upon the vehicle itself. Therefore, she was not in the process of 'alighting from' the vehicle." Because of these circumstances, Defendant did not owe benefits to Plaintiff, and its refusal to pay them was not unreasonable. The Court reversed the appellate court's decision and remanded the case to the trial court for further proceedings.

Plaintiff Kevin Krohn suffered a severe spinal fracture that left him a paraplegic. Plaintiff brought suit under the state no-fault act seeking personal protection insurance benefits from Defendant Home-Owners Insurance Company to cover costs incurred for a surgical procedure performed in Portugal. The procedure was experimental and was not considered a generally accepted treatment for Plaintiff's injury. The issue before the Supreme Court was whether the experimental procedure was a reasonably necessary service for Plaintiff's care, recovery or rehabilitation under state law. Upon review of the record below, the Court concluded that if a medical treatment is experimental and not generally accepted within the medical community, an insured seeking reimbursement for the treatment must present objective and verifiable medical evidence to establish that the treatment was efficacious. In this case, the Court found the procedure was an "understandable" personal decision that offered Plaintiff only a medically unproved "possibility" for an efficacious result. The Court held the procedure was not an allowable expense for insurance reimbursement. The Court affirmed the appellate court that ruled in favor of Defendant.

This appeal challenged the small employer group health coverage act (Act), which establishes requirements for insurance carriers to offer health insurance benefit plans to small employers in Michigan. Priority Health sought a declaratory judgment from the Office of Financial and Insurance Services (OFIS) so that it could allocate a small portion of insurance premiumsâ costs to employers, lessening the financial burden on employees. Priority Health would not renew contracts with employers who did not agree to pay a portion of the premiums. Both the Court of Appeals and the Commissioner of the Office of Financial and Insurance Services (OFIS) concluded that âminimum employer contribution provisionsâ are inconsistent with the Act. They reasoned that an employerâs failure to pay a minimum percentage of its employeesâ premiums is not among the reasons in the Act that a carrier can use to refuse to renew an insurance plan. The Supreme Court disagreed with the appellate court and OFISâ interpretation of the Act. The Court found that just because the Michigan Legislature did not include an employerâs refusal to pay according to a minimum contribution provision as among the reasons for not renewing a contract for benefits, the [Priority Health] provision was unreasonable or inconsistent with the Act. In general, âunless a provision directly conflicts with the enumerated reasons [of the Act], it may be included in a plan so long as it is reasonable and not inconsistent.â The Court remanded the case to the OFIS for further proceedings.