ADMIRE v AUTO-OWNERS INSURANCE COMPANY
Docket No. 142842
Supreme Court of Michigan
Decided May 23, 2013
Rehearing denied, 494 Mich 880
494 MICH 10
Argued November 14, 2012 (Calendar No. 2).
Judgment of the Court of Appeals reversed in part and vacated in part; case remanded to the circuit court for entry of summary disposition in favor of Auto-Owners.
Justice CAVANAGH, dissenting, rejected the majority‘s interpretation of
Justices MCCORMACK and VIVIANO took no part in the decision of this case.
- INSURANCE — NO-FAULT — PERSONAL PROTECTION INSURANCE BENEFITS ALLOWABLE EXPENSES — CARE, RECOVERY, OR REHABILITATION — ORDINARY EXPENSES.
Under the personal protection insurance provisions of the no-fault automobile insurance act, an insurer is liable for allowable expenses consisting of all reasonable charges incurred for reasonably necessary products, services, and accommodations for the injured person‘s care, recovery, or rehabilitation; ordinary, everyday products, services, and accommodations are not compensable under the statute because those expenses are not for the injured person‘s care, recovery, or rehabilitation; a new expense must be of a wholly different essential character than expenses borne by the person
before the accident to show that it is for the injured person‘s care, recovery, or rehabilitation; if an expense is new in its essential character, the statute requires that it be covered in full regardless of whether the expense represents an increase or decrease in the person‘s preaccident costs ( MCL 500.3107[1][a] ). - INSURANCE — NO-FAULT — PERSONAL PROTECTION INSURANCE BENEFITS ALLOWABLE EXPENSES — CARE, RECOVERY, OR REHABILITATION — INTEGRATED PRODUCTS AND ACCOMMODATIONS — COMBINED PRODUCTS AND ACCOMMODATIONS.
Under the personal protection insurance provisions of the no-fault automobile insurance act, an insurer is liable for allowable expenses consisting of all reasonable charges incurred for reasonably necessary products, services, and accommodations for the injured person‘s care, recovery, or rehabilitation; a combined product or accommodation results from an ordinary expense, unchanged as a result of the injury, being joined with an accommodation or product that is actually for the injured person‘s care, recovery, or rehabilitation; an integrated product or accommodation involves the blending of an ordinary expense with one that is for the injured person‘s care, recovery, or rehabilitation in a way that the resulting product or accommodation cannot be separated easily into unit costs; the act requires the insurer to cover integrated products and accommodations in full because the entire expense, including those portions of the expense that might otherwise be considered ordinary, is necessary for the person‘s care, recovery, or rehabilitation; however, when considering a combined product or accommodation only the expenses for those components related to the injured person‘s care, recovery, or rehabilitation are actually compensable (
MCL 500.3107[1][a] ).
Sinas, Dramis, Brake, Boughton & McIntyre, P.C. (by George T. Sinas and Stephen H. Sinas), for Kenneth Admire.
Willingham & Coté, P.C. (by John A. Yeager and Kimberlee A. Hillock), for Auto-Owners Insurance Company.
Amici Curiae:
Kerr Russell and Weber PLC (by Daniel J. Schulte and Joanne Geha Swanson) for the Coalition Protecting Auto No-Fault.
Dykema Gossett PLLC (by Jill M. Wheaton and Joseph Erhardt) for the Michigan Catastrophic Claims Association.
OPINION OF THE COURT
ZAHRA, J. At issue in this case is whether Michigan‘s no-fault insurance act1 requires defendant, Auto-Owners Insurance Company, to pay the entire cost of a van modified to accommodate the plaintiff‘s wheelchair, including both the base price of the van and the separately introduced modifications. We conclude that defendant is only required to pay for the modifications because only the modifications are allowable expenses “for an injured person‘s care, recovery, or rehabilitation” under
I. FACTS AND PROCEEDINGS
In 1987, plaintiff suffered catastrophic injuries when the motorcycle he was riding collided with a car being operated by an insured of defendant. Plaintiff‘s injuries left him unable to speak or walk and rendered his entire right side virtually useless. A family member tends to all of plaintiff‘s personal and financial affairs.
Plaintiff requires wheelchair-accessible transportation to go to work five days a week, visit his family, attend medical appointments, and get around the community. On three prior occasions, defendant agreed to pay the full cost of purchasing a van large enough for plaintiff to get in and out while remaining in his wheelchair. Defendant also agreed to pay the cost of modifying the vehicle to make it wheelchair-accessible. In 1988, 1994, and 2000, plaintiff and defendant entered into contracts under which defendant purchased a van and paid for the necessary modifications with the expectation that the van would last for seven years. At the end of the van‘s life, plaintiff would give defendant notice of his intent to purchase a new van, and the parties would enter a new agreement. The most recent “Transportation Purchase Agreement” was executed on April 26, 2000. It specified that plaintiff was to notify defendant 60 days before purchasing a new van and that the old van‘s value would be applied to the purchase price of the new van.
In December 2006, plaintiff, through his guardian, notified defendant that it was time to purchase a new van. In January 2007, defendant informed plaintiff by letter that it had determined that it was not obligated to pay the base purchase price of a new van under the transportation purchase agreement or the no-fault insurance act. Defendant acknowledged that, pursuant to the transportation purchase agreement, the “current
Plaintiff sued defendant for reimbursement of the $18,388.50, claiming that it was an allowable expense under Michigan‘s no-fault insurance act. Defendant moved for summary disposition, arguing that this Court‘s decision in Griffith v State Farm Mutual Automobile Insurance Co2 required it to pay for medically necessary modifications, but not the base price of the van. Plaintiff argued that conflicting precedent interpreted the no-fault insurance act to require reimbursement for the entire modified van. The Ingham Circuit Court denied defendant‘s motion for summary disposition and instead granted summary disposition in favor of plaintiff.
Defendant appealed by right in the Court of Appeals, which affirmed in an unpublished decision.3 In dicta, the Court of Appeals panel concluded that the transportation purchase agreement was ambiguous regarding who had the responsibility to pay the base price of a new van:
On its face, the contract does not provide that defendant is required to buy a new van. It says that the van shall be
traded in on a replacement van but it does not say that defendant will pay for the replacement. However, the contract also does not say that plaintiff is responsible for buying the new van.4
Accordingly, the panel held that “the trial court erred in evidently concluding that the transportation purchase agreement mandated that it grant summary disposition to plaintiff.”5
The Court of Appeals panel then proceeded to address whether Michigan‘s no-fault insurance act required reimbursement for both the purchase price of a van and the modifications to accommodate the insured‘s disability. Defendant again relied primarily on this Court‘s decision in Griffith, which held that the no-fault insurance act did not require the insurer to reimburse the insured for food costs absent evidence that the food was somehow different than what was required before the plaintiff‘s accident.6 So, reasoned defendant, the base price of the van was not compensable because plaintiff required transportation before and after the accident; the modifications were, however, compensable because they were not required before the accident.
The panel disagreed with defendant‘s characterization of Griffith, instead relying on its own decision in Begin v Michigan Bell Telephone Co.7 As in this case, Begin involved an insurer that had refused to compen-
Defendant sought leave to appeal. After hearing oral arguments on the application,10 we granted leave to appeal to determine whether the no-fault insurance act requires reimbursement for the entire cost of the modified vehicle.11
II. STANDARD OF REVIEW
Whether
III. ANALYSIS
A. LEGAL BACKGROUND
In determining whether the particular expense was for “‘reasonably necessary products, services and accommodations for an injured person‘s care, recovery, or rehabilitation,‘” this Court defined the terms “care,” “recovery,” and “rehabilitation.”18 This Court gave “recovery” and “rehabilitation” their dictionary definitions, defining “recovery” as “‘restoration or return to any former and better condition, [especially] to health from sickness, injury, addiction, etc.,‘” and “rehabilitate” as “‘to restore or bring to a condition of good health, ability to work, or productive activity.‘”19 Defining “care” required this Court to consider the term‘s meaning in light of the statutory terms “recovery” and “rehabilitation“:
Generally, “care” means “protection; charge,” and “to make provision.” Random House Webster‘s College Dictionary (2001). Thus, taken in isolation, the word “care” can be broadly construed to encompass anything that is reasonably necessary to the provision of a person‘s protection or charge. But we have consistently held that “[c]ourts must give effect to every word, phrase, and clause in a statute and avoid an interpretation that would render any part of the statute surplusage or nugatory.” State Farm Fire & Cas Co v Old Republic Ins Co, 466 Mich 142, 146; 644 NW2d 715 (2002). Therefore, we must neither read “care” so broadly as to render nugatory “recovery and rehabilitation” nor construe “care” so narrowly that the term is mere surplusage. “Care” must have a meaning that is related to, but distinct from, “recovery and rehabilitation.”
* * *
“Care” must have a meaning that is broader than “recovery” and “rehabilitation” but is not so broad as to render those terms nugatory. As noted above, both “recovery” and “rehabilitation” refer to an underlying injury; likewise, the statute as a whole applies only to an “injured person.” It follows that the Legislature intended to limit the scope of the term “care” to expenses for those products, services, or accommodations whose provision is necessitated by the injury sustained in the motor vehicle accident. “Care” is broader than “recovery” and “rehabilitation” because it may encompass expenses for products, services, and accommodations that are necessary because of the accident but that may not restore a person to his preinjury state.20
Having determined at the outset that Griffith‘s food could not be for recovery or rehabilitation because it lacked curative properties, this Court proceeded to explain that ordinary food also could not be for Grif-
This Court drew an important distinction between ordinary food eaten by an injured person at home and ordinary food provided by a hospital during the injured person‘s stay, stating that
it is “reasonably necessary” for an insured to consume hospital food during in-patient treatment given the limited dining options available. Although an injured person would need to consume food regardless of his injuries, he would not need to eat that particular food or bear the cost associated with it. Thus, hospital food is analogous to a type of special diet or select diet necessary for an injured person‘s recovery. Because an insured in an institutional setting is required to eat “hospital food,” such food costs are necessary for an insured‘s “care, recovery, or rehabilitation” while in such a setting. Once an injured person leaves the institutional setting, however, he may resume eating a normal diet just as he would have had he not suffered any injury and is no longer required to bear the costs of hospital food, which are part of the unqualified unit cost of hospital treatment.23
This Court specifically noted that
Several Court of Appeals decisions have attempted to interpret
Under the Griffith analysis, plaintiff‘s housing costs are only compensable to the extent that those costs became greater as a result of the accident. Plaintiff must show that his housing expenses are different from those of an uninjured person, for example, by showing that the rental cost for handicapped accessible housing is higher than the rental cost of ordinary housing. In the absence of that kind of factual record, the trial court erred by concluding that plaintiff was entitled to housing costs compensation merely on the basis of the amount plaintiff was currently paying in rent, for a residence that the record does not even demonstrate was handicapped accessible.27
As a result, the court reversed the trial court‘s award of the entire amount of the insured‘s postinjury housing, instead holding that an insurer is only liable for the increase in housing costs attributable to the injury.
Similarly, in Hoover v Michigan Mutual Insurance Co,28 the Court of Appeals applied Griffith to other
At its core, the holding in Griffith requires a court to determine whether expenses would not have been incurred but for the accident and resulting injuries. Stated otherwise, the question is whether the expenses would have been incurred in the course of an ordinary life unmarred by an accident. And if they would have been incurred, like the ordinary food costs at issue in Griffith, a causal connection between the expenses and the accidental bodily injury would be lacking and it could not be said that the act of providing products, services, and accommodations was necessitated by the accidental bodily injury.29
The Hoover Court understood Griffith as requiring a comparison of the injured person‘s preinjury expenses to the injured person‘s postinjury expenses, with the insurer covering the difference.30
But the Court of Appeals adopted a different approach in Begin, which presented a similar factual situation to the instant case: a dispute over whether an insurer was responsible for the base price of a van for the insured plaintiff.31 The Begin Court disavowed any interpretation of Griffith that required a comparison to the injured person‘s preinjury expenses:
[T]he Griffith Court, when discussing the cost of food provided to an injured person in an institutional setting, did not suggest that only the marginal increase in the cost of such food served in an institutional setting would be an allowable expense. Nor did the Court suggest that only the
marginal cost of modifying regular shoes would be a recoverable “allowable expense” under
MCL 500.3107(1)(a) . Rather, in each example, the product, service, or accommodation used by the injured person before the accident is so blended with another product, service, or accommodation that the whole cost is an allowable expense if it satisfies the statutory criteria of being sufficiently related to injuries sustained in a motor vehicle accident and if it is a reasonable charge and reasonably necessary for the injured person‘s care, recovery, or rehabilitation underMCL 500.3107(1)(a) .32
Thus, Begin held, if a particular product, service, or accommodation satisfies the requirements of
B. INTERPRETATION
As stated,
Further, nothing in the statutory language of
Special accommodations or modifications to an ordinary item present a particular challenge. A “combined” product or accommodation results from an ordinary expense, unchanged as a result of the injury, being joined with an accommodation or product that is actually for the injured person‘s care, recovery, or rehabilitation. An “integrated” product or accommodation involves the blending of an ordinary expense with one that is for the injured person‘s care, recovery, or rehabilitation in a way that the resulting product or accommodation cannot be separated easily into unit costs. Unlike an integrated product or accommodation, a combined product or accommodation can be separated easily, both conceptually and physically, so that the fact-finder can identify which costs are of a new character and are thus for the injured person‘s care, recovery, or rehabilitation and which costs are ordinary, everyday expenses that are unchanged after the accident. As this Court suggested in Griffith,
This analysis is consistent with this Court‘s application of
In sum,
C. APPLICATION
Applying this standard here, we conclude that the base price of the van is not an allowable expense under
Certain transportation expenses may be recoverable under
This Court‘s decision in Griffith leads inexorably to this result. The van itself is akin to the food that Griffith was eating at home. The character of plaintiff‘s general need for transportation—like Griffith‘s food requirements—did not change as a result of the accident. And unlike the hospital food in Griffith, the van does not constitute an integrated product because the modified van, as a whole, was not actually for plaintiff‘s care, recovery, or rehabilitation. Hospital food is compensable because the injured person is required to eat that particular food during the hospital stay for his or her care and recovery.48 The Court likened hospital food to a special diet.49 But plaintiff only requires some form
The parties agreed that plaintiff should have a vehicle with modifications as the means for transporting plaintiff on his medically necessary trips. But because the van and the modifications are easily separable, we must determine which expenses are actually for plaintiff‘s care, recovery, and rehabilitation and which are not.50 The modifications indisputably have the object or purpose of effectuating plaintiff‘s care, recovery, or rehabilitation because without the modifications plaintiff could not make use of his ordinary transportation for medically necessary trips. Thus, defendant was required to and did compensate plaintiff for the cost of the modifications pursuant to
Because the character of plaintiff‘s ordinary transportation needs remains unchanged, he is free to meet those needs in the way that best suits him. If plaintiff had already owned a van, defendant could have modified that van. If plaintiff wanted a Mercedes van, he could pay for the added luxury, and defendant could modify the van as required by statute. However, only the modifications and medical mileage—separable elements that actually represent a change in character from plaintiff‘s general preinjury transportation requirements—must be compensated pursuant to
IV. CONCLUSION
Our decision in Griffith was sound, and we reaffirm that decision here. To the extent that the Court of Appeals’ opinions in Ward, Hoover, or Begin are inconsistent with this opinion, they are overruled. In concluding that the base price of the van was compensable, the Court of Appeals in this case misapplied our holding in Griffith. We therefore reverse that portion of the Court of Appeals’ judgment.
Furthermore, the Court of Appeals erred by unnecessarily concluding that the parties’ transportation purchase agreement was ambiguous regarding whether defendant was contractually obligated to reimburse plaintiff for the base price of the van regardless of the no-fault insurance act‘s requirements. In fact, plaintiff waived the contractual argument by failing to raise it in
YOUNG, C.J., and MARKMAN and KELLY, JJ., concurred with ZAHRA, J.
CAVANAGH, J. (dissenting). For nearly a decade now, a majority of this Court has employed what I believe to be an erroneous and confusing statutory interpretation of
I. APPLYING THE GRIFFITH DISSENT
The key provisions of the no-fault act applicable to this case are
Applying the Griffith dissent‘s interpretation of the relevant statutory provisions to this case, plaintiff clearly satisfied
The simplicity of applying the Griffith dissent‘s interpretation of the plain language of
II. THE MAJORITY‘S ERRONEOUS ANALYSIS
The straightforward application of the statutes’ plain language under the Griffith dissent stands in stark contrast to the majority‘s effort to apply the Griffith majority‘s confusing analysis to this case because, in attempting to clarify Griffith, the majority takes an approach that is divorced from the statutory language. Specifically, I agree with the majority that “nothing in the statutory language of
For example, the majority states that an “ordinary, everyday expense” cannot qualify as an allowable expense under
The majority also proclaims that ”the new expense must be of a wholly different essential character than expenses borne by the person before the accident....” Ante at 27 (emphasis added). Again, this undefined statement of what an insured must now show to be eligible for benefits finds no support in the statutes or caselaw. Moreover, the majority‘s explanation of expenses that satisfy
Specifically, the majority defines a “combined” product as one that “can be separated easily, both conceptually and physically, so that the fact-finder can identify which costs are of a new character and are thus for the injured person‘s care, recovery, or rehabilitation and which costs are ordinary, everyday expenses that are unchanged after the accident.” Ante at 28. Given the unique nature of modified products, however, this explanation provides little assistance to the bench and bar. Indeed, the majority concludes that “[w]hen a medical products company produces a custom shoe, the shoe is an integrated product because the medical nature of the shoe... cannot be separated from the ordinary need for shoes by an uninjured person.” Ante at 30. Presumably, the majority considers a “custom shoe” integrated because it cannot be separated “conceptually or physically.” Yet, the majority reaches a different conclusion in this case despite the fact that, as explained later in this opinion, the same is true of plaintiff‘s modified, or “custom,” van. In short, al-
III. APPLYING THE MAJORITY‘S NEW RULE.
Although I would apply the Griffith dissent, I believe that plaintiff is entitled to benefits even under the majority‘s faulty statutory interpretation. As the majority acknowledges, what might otherwise be considered an “ordinary, everyday expense” could constitute, under certain circumstances, an “integrated” product. Specifically, under the Griffith majority, food provided in an institutional setting is an “integrated” product, despite the fact that the exact same food is merely an “ordinary, everyday expense” when provided in a non-institutional setting. Likewise, although plaintiff‘s van is at its core “transportation,” it is nevertheless an “integrated” product because plaintiff is required to use “that particular” form of transportation, given that
The majority apparently believes that plaintiff is not limited to a particular form of transportation, but that is simply not true, as even defendant conceded.7 Thus, plaintiff‘s need for transportation cannot be easily separated from a van on conceptual grounds because no other type of vehicle can accommodate plaintiff‘s wheelchair. Stated differently, contrary to the majority‘s unsupported conclusion that “the character of plaintiff‘s ordinary transportation needs remains unchanged,” ante at 34, because of his injuries the only personal vehicle that plaintiff can travel in is a van. Thus, plaintiff‘s postaccident transportation needs are significantly different from his preaccident transportation needs. In fact, it bears repeating that the van itself is for plaintiff‘s care because a van is the only type of vehicle that can accommodate plaintiff‘s postaccident condition. Before the accident, plaintiff did not require the modifications that the majority concedes are covered by
The majority implicitly acknowledges that plaintiff‘s condition limits him to transportation in a van when it states that ”[i]f plaintiff had already owned a van, defendant could have modified that van. If plaintiff wanted a Mercedes van, he could pay for the added luxury....” Ante at 34 (emphasis added). Fear that an insurer could be automatically required to pay for the full cost of any van an insured selects is misplaced because, as the plain language of
IV. PLAINTIFF DID NOT WAIVE THE CONTRACT ISSUE
Finally, I disagree with the majority‘s conclusion that plaintiff waived the argument that defendant had contractually agreed to reimburse plaintiff for the base price of the van. As the Court of Appeals noted, the basis for the trial court‘s decision to deny defendant‘s motion for summary disposition and instead grant plaintiff summary disposition was not a model of clarity. However, in my view, the transcript of the hearing on the motion for summary disposition reveals that the trial court based its decision on its conclusion that the “Transportation Purchase Agreement” (TPA) required defendant to pay for the reasonable purchase price of a van.9 Moreover, the Court of Appeals opinion clearly considered the issue and ultimately determined that the TPA is ambiguous. See Admire v Auto-Owners Ins Co,
V. CONCLUSION
I dissent from the majority‘s decision to expand the erroneous majority opinion in Griffith. Moreover, even under the majority‘s faulty statutory interpretation, I believe plaintiff is entitled to benefits because the van in this case is no different from the “integrated” products that the majority offers as examples of allowable expenses under
MCCORMACK and VIVIANO, JJ., took no part in the decision of this case.
Notes
Under personal protection insurance an insurer is liable to pay benefits for accidental bodily injury arising out of the ownership, operation, maintenance or use of a motor vehicle as a motor vehicle, subject to the provisions of this chapter.
[P]ersonal protection insurance benefits are payable for the following:
(a) Allowable expenses consisting of all reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person‘s care, recovery, or rehabilitation.
