944 N.W.2d 412
Mich. Ct. App.2019Background:
- On Aug 30, 2016 Robin Benoit was injured as a passenger; Spectrum Health provided over $129,000 in treatment and Benoit had no no‑fault insurance.
- At admission Spectrum obtained only verbal consent (witnessed) for a general assignment; no signed assignment specific to MACP/MAIPF was retained before Spectrum filed an application.
- Spectrum filed an application with the MACP/MAIPF on Aug 10, 2017; Spectrum’s agent signed as preparer but the “injured person or representative” signature line was left blank; several items were marked “unknown.”
- The MACP/MAIPF denied the application with a generic form letter. Spectrum later located Benoit, obtained a signed written assignment on Aug 28, 2017, and faxed it to MACP/MAIPF on Aug 30 (the filing deadline).
- The MACP/MAIPF refused to process the claim, asserting the initial application was invalid because it lacked the claimant’s signature; the trial court granted summary disposition for MACP/MAIPF. Spectrum appealed.
- The Court of Appeals held the MACP/MAIPF may only deny an "obviously ineligible" claim under statute and that the absence of the claimant’s signature did not render the claim obviously ineligible; it reversed and remanded for entry of summary disposition for Spectrum.
Issues:
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Spectrum provided the notice required to trigger MACP assignment duty | Spectrum timely notified MACP (application within statute and lawsuit served as supplemental timely notice); it showed inability to identify PIP | MACP argued application was facially deficient and thus ineligible from the start | Held: Spectrum satisfied notice requirements; lawsuit and subsequent proof showed claim was not obviously ineligible |
| Whether MACP could deny the claim for lack of claimant signature on MAIPF application form | Spectrum: statute controls; MACP may deny only "obviously ineligible" claims—minor form defects (no signature) don't meet that threshold | MACP: its Plan requires claimant or representative signature; unsigned application is invalid and can be denied | Held: Signature requirement is a Plan formality; lack of signature does not render claim obviously ineligible under statutory standard |
| Whether MAIPF/Plan can impose additional filing conditions beyond statutory criteria | Spectrum: MAIPF’s rulemaking power is limited to statute; Plan cannot override or add eligibility prerequisites that would defeat statutory purpose | MACP: Plan’s procedural rules (signed, complete application) are binding and justify denial | Held: MAIPF cannot impose substantive eligibility conditions beyond statute; eligibility determined by MCL 500.3172(1) and "obviously ineligible" standard governs |
| Whether MACP complied with obligation to promptly assign when claim was not obviously ineligible | Spectrum: once evidence showed no applicable PIP, MACP had duty to promptly assign and could not ignore application for procedural signature defect | MACP: initial application fatally defective so no obligation to assign | Held: MACP failed to promptly assign; once claim shown eligible, it must assign—reversed summary dismissal and remanded for judgment for Spectrum |
Key Cases Cited
- Shavers v. Attorney General, 402 Mich 554 (1978) (explains no‑fault act’s remedial purpose to assure prompt reparation)
- Perkovich v. Zurich Am. Ins. Co., 500 Mich 44 (2017) (substantial compliance with notice requirements can suffice)
- Covenant Med. Ctr., Inc. v. State Farm Mut. Auto. Ins. Co., 500 Mich 191 (2017) (addressed provider suit rights against insurers)
- W A Foote Mem. Hosp. v. Mich. Assigned Claims Plan, 321 Mich App 159 (2017) (interprets MACP eligibility criteria)
- Allstate Ins. Co. v. State Farm Mut. Auto. Ins. Co., 321 Mich App 543 (2017) (definition of "person entitled to claim")
- Cruz v. State Farm Mut. Auto. Ins. Co., 466 Mich 588 (2002) (insurer cannot enforce contract condition precedent to avoid statutory duty once reasonable proof received)
- Consumers Power Co. v. Pub. Serv. Comm., 460 Mich 148 (1999) (agency/organization rulemaking limited to statutory grant)
- Linden v. Citizens Ins. Co. of Am., 308 Mich App 89 (2014) (notice under statute need not be in writing)