Tag: recovery
No-Fault Insurer Entitled to Judgment on Hospital’s Claim for Reimbursement of Medical Expenses for Motorcyclist’s Injuries for Accident Caused in Avoiding Collision with Motor Vehicle
In DMC v. Progressive, The Court of Appeals reversed a trial court judgment for the plaintiff hospital which sought reimbursement from defendant no-fault insurer of medical expenses for care to an injured motorcyclist.
The motorcyclist suffered serious injuries after he ditched his bike to avoid a collision with an automobile about to cross into his path. The motorcycle never came into contact with the vehicle.
The hospital rendered medical services to the motorcyclist in the amount of approximately $112,000 and then sought reimbursement from the motorcyclist’s household automobile no-fault insurer. The insurer objected on grounds the No-Fault Act, MCL 500.3101, et seq., excludes motorcycles from the definition of motor vehicle. See MCL 500.3101(2)(e). While motorcycles are excluded from the definition of motor vehicles, a sufficient causal connection between a motorcyclist’s accident causing injury and a motor vehicle will allow recovery by the motorcyclist of personal insurance protection benefits under the No-Fault Act. The No-Fault Act provides coverage for accidental bodily injury arising out of the ownership, operation, maintenance or use of a motor vehicle as a motor vehicle. MCL 500.3105(1).
Based on the evidence before it (and, apparently without a jury impaneled), the trial court ruled the hospital was entitled to recovery for the care and treatment of the injured motorcyclist. The insurance company appealed and the Court of Appeals reversed.
Characterizing the question as one of law, to wit, the extent of the motor vehicle’s involvement in the motorcyclist’s decision to ditch his bike, the Court of Appeals engages in a causal relationship test. The Court concludes the nexus between the motorcyclist’s actions and conduct and the alleged fear of collision with the approaching motor vehicle was not sufficient to conclude that his injuries arose out of the use, operation or maintenance of a motor vehicle as a motor vehicle. The Court analogizes the case to the recent McPherson decision, which I previously wrote about here (McPherson v. McPherson), to the causal tenuousness in this case. McPherson however, involved a claim for injuries suffered in a motor vehicle accident when the injured plaintiff suffered a seizure while riding a motorcycle. His injuries were significant in the second accident as he was rendered a paraplegic. However, since he could not recover no-fault benefits for the second accident because he was riding a motorcycle, which is excluded, he sought to have benefits extended by alleging that the earlier motor vehicle accident was the true cause of his seizure, which caused the accident resulting in his injuries. The Supreme Court disagreed.
Here, the Court holds that the perceived, but subjective and unfounded fear of collision with an approaching motor vehicle is not a sufficient nexus of involvement by a motor vehicle to allow recovery of no-fault benefits. Hence, the hospital was not entitled to reimbursement from the no-fault insurer.
In my judgment, the Court of Appeals overstepped its boundaries here by concluding it is a question of law whether the approaching motor vehicle was involved in the accident. After noting the question of such involvement is to be taken on a case-by-case basis, it appears to remove from the province of the trial court that part of the fact-finding function entitled to deference. Having concluded the question is one of pure law, it was free to review the case de novo. Then, it is free to conclude the motorcyclist’s fear of a collision with the vehicle was subjective and unfounded, and that the mere perception of an inevitable collision is insufficient to give rise to the causal connection required to recover no-fault benefits.
These appear to be the types of cases where it would be wise to develop a factual scenario that requires significant factual conclusions on the part of the trial court and / or a jury. Was the testimony of the driver of the motor vehicle offered? Was he or she even identified? Was there any other factual information that could have led the trier of fact to conclude that a pending collision with the motor vehicle was more than an unfounded and subjective perception? Although, the Court of Appeals concludes the facts were insufficient to establish the requisite causal connection, i.e., the proximate cause (a fundamentally mixed question of law and fact ordinarily reserved to the province of the finder of fact in the given case), to sustain the hospital’s claim against the no-fault insurer, this does appear to be a judicial choice made by a higher tribunal, rather than an unequivocal application of the rule of law.
In any event, the case provides an interesting explanation of this panel’s view of the causal relationship test to prove an entitlement to no-fault benefits. I believe the Supreme Court might take a closer look at this case if the hospital were to challenge the ruling.
Michigan Supreme Court Rules “Base Price” of Van Not Included as “Allowable Expense” Under Personal Insurance Protection Benefits of the No-Fault Automobile Insurance Act
In a 4-1 opinion (JJ. Viviano and McCormack not participating), the Michigan Supreme Court ruled the “base price” of a van was not an allowable PIP expense under the No-Fault Act. MCL 500.3107(1)(a) permits an injured person to recover personal injury protection (PIP) benefits from an insurer for “[a]llowable expenses consisting of all reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person’s care, recovery, or rehabilitation.”
Here, the Plaintiff claimed he was entitled to the full purchase price of a van, including the necessary expenses associated with modifying the van to accommodate his disability. The trial court and the Court of Appeals agreed. Here, the Court reverses, holding that the defendant insurance company was only responsible for the modifications because only the modifications are allowable expenses “for an injured person’s care, recovery, or rehabilitation” under MCL 500.3107(1)(a).
Because the base price of the van is an ordinary transportation expense—an expense that is as necessary for the uninjured as the injured—and is easily separated from the modifications, defendant is not required to pay for it under the no-fault insurance act.
The Supreme Court overruled Court of Appeals decisions that held to the contrary.
Read the opinion here: Admire v. Auto Owners Insurance
Amicus Curious 