948 N.W.2d 115
Mich. Ct. App.2019Background
- Victor Caballero, husband of the named insured Maria, was driving a vehicle insured by State Auto when he was injured in an automobile accident. He assigned his PIP claim to Bronson Health Care Group (Bronson).
- State Auto denied PIP coverage because Victor was listed as a "Person Excluded" on a Named Driver Exclusion Endorsement attached to the policy.
- The Endorsement identified excluded coverages (liability, uninsured motorists, physical damage) but did not expressly name PIP; the declarations page and certificate of no-fault insurance, however, contained the statutory warning required by MCL 500.3009(2) and stated an excluded driver is not entitled to PIP.
- Bronson sued to recover PIP benefits assigned by Victor; State Auto moved for summary disposition under MCR 2.116(C)(10).
- The trial court granted summary disposition for State Auto; the Court of Appeals affirmed, holding that statutory exclusions, not contract language, govern entitlement to mandated PIP benefits.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the Endorsement excluded PIP so insurer is not liable | Endorsement did not expressly exclude PIP, so State Auto remains liable for PIP | Naming Victor as an excluded operator plus required statutory warning invokes MCL 500.3009(2)/MCL 500.3113(d), barring PIP | Held: Statutory exclusion applies; Victor not entitled to PIP and insurer not liable |
| Whether entitlement to PIP is governed by contract or statute | Issue is contract interpretation; policy governs coverage | PIP is statutorily mandated; statute controls entitlement, not contract wording | Held: Statutory interpretation controls for mandated PIP benefits |
| Whether policy ambiguity (Endorsement vs declarations) prevents exclusion | Endorsement omission of PIP creates ambiguity in insurer's favor | Policy read as a whole and related documents clearly name an excluded operator and include statutory warning | Held: No ambiguity as to exclusion; declarations and certificate satisfy statutory requirements |
Key Cases Cited
- Zaher v. Miotke, 300 Mich. App. 132 (summary disposition standard and genuine-issue-of-material-fact analysis)
- McCormick v. Carrier, 487 Mich. 180 (de novo review of statutory interpretation)
- Rohlman v. Hawkeye-Security Ins. Co., 442 Mich. 520 (statute governs interpretation of policy language for mandated no-fault benefits)
- Rednour v. Hasting Mut. Ins. Co., 245 Mich. App. 419 (distinguishing contractual versus statutorily mandated coverage)
- Citizens Ins. Co. of Am. v. Federated Mut. Ins. Co., 448 Mich. 225 (policy cannot validly exclude statutorily mandated benefits)
- Bronson Methodist Hosp. v. Mich. Assigned Claims Facility, 298 Mich. App. 192 (validly excluded driver driving insured vehicle renders vehicle uninsured)
- Frankenmuth Ins. Co. v. Poll, 311 Mich. App. 442 (when excluded driver drove vehicle, policy was void and insurer was not the insurer of the vehicle)