Bahri v. IDS Property Casualty Insurance
308 Mich. App. 420
| Mich. Ct. App. | 2014Background
- Plaintiff was in two accidents in 2011; the October 20, 2011 accident is at issue. A no-fault policy was issued to plaintiff on October 12, 2011.
- Plaintiff sought PIP and uninsured motorist benefits after the October accident; treating doctors Nouri and Iskander intervened to recover PIP benefits they provided.
- Plaintiff submitted replacement-services statements claiming daily assistance from October 1, 2011 through February 29, 2012, which on its face sought services before the October 20 accident.
- Defendant produced surveillance showing plaintiff performing activities (bending, lifting, driving, errands) on dates she claimed she needed help, undermining replacement-services claims.
- Defendant moved for summary disposition arguing fraud barred PIP recovery and that policy language precluded uninsured motorist benefits because no third vehicle struck plaintiff; the trial court granted summary disposition and this appeal followed.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether PIP benefits are barred by the policy fraud exclusion | Plaintiff contends she is entitled to PIP and replacement services; surveillance and forms do not create a genuine dispute | Fraud exclusion applies because plaintiff submitted false replacement-service statements and surveillance contradicts claimed limitations | Summary disposition affirmed: no genuine issue of material fact; fraud bars PIP benefits |
| Whether intervening providers can recover PIP benefits | Intervenors argue they may recover PIP benefits owed to plaintiff for services they provided | Intervenors stand in plaintiff’s shoes; if plaintiff cannot recover, neither can they | Held for defendant: intervenors cannot recover because plaintiff’s claim is barred by fraud |
| Whether uninsured motorist (UM) coverage applies | Intervenors assert UM benefits should be available based on plaintiff’s accident account | Policy requires physical contact by an uninsured vehicle (hit-and-run definition); plaintiff admitted no contact; fraud also defeats coverage | UM benefits not available under policy; dismissal affirmed |
| Whether sanctions are warranted for defendant’s conduct | Intervenors request sanctions under court rules for alleged misrepresentations and frivolous motion | Sanctions not procedurally preserved below; no persuasive basis given outcome and evidence of fraud | Denied: issue not properly preserved and insufficient grounds for sanctions |
Key Cases Cited
- MEEMIC Ins Co v DTE Energy Co, 292 Mich App 278 (review of MCR 2.116(C)(10) is de novo)
- Greene v A P Prods, Ltd, 475 Mich 502 (court considers evidentiary record in light most favorable to nonmoving party on summary disposition)
- McGrath v Allstate Ins Co, 290 Mich App 434 (insurance contract interpretation principles)
- West v Gen Motors Corp, 469 Mich 177 (definition of genuine issue of material fact)
- Mina v Gen Star Indemnity Co, 218 Mich App 678 (elements for voiding policy for misrepresentation/fraud)
- Citizens Ins Co v Pro-Seal Serv Group, Inc, 477 Mich 75 (ambiguous policy language construed against insurer but plain meaning enforced)
- TBCI, PC v State Farm Mut Auto Ins Co, 289 Mich App 39 (intervenors stand in insured’s shoes)
- Cuddington v United Health Servs, Inc, 298 Mich App 264 (construing trial court summary disposition under MCR 2.116(C)(10))