Lead Opinion
Defendant appeals by right the trial court’s judgment awarding plaintiff no-fault benefits, penalty interest, and attorney fees after granting plaintiffs motion for summary disposition pursuant to MCR 2.116(C)(10). Defendant also appeals the trial court’s granting of plaintiffs motion to compel discovery and the imposition of sanctions. We affirm.
I
Plaintiff brought this action to recover no-fault benefits from defendant, Southern Michigan Insurance Company, after providing medical treatment to Juan Resto for injuries he received in a January 23, 2004, automobile accident. According to an Allegan County Sheriffs Department accident report, Resto was injured while a passenger in a 1993 GMC van operated by Tomas Lucas-Diaz and owned by Francisco Lopez, whom defendant insured. The accident report indicated that Lucas-Diaz was driving the van south on US-131 when he lost control, slid into the median, and rolled over. The police report records the injuries of persons involved in the accident on a scale in descending order of severity from K (which apparently stands for “killed”), to A, B, C, and finally 0 (which apparently indicates no injury). The report indicated that Resto received level-A injuries in the accident and was transported by ambulance to “Borgess” for treatment.
With respect to its direct claim against defendant, plaintiff alleged that defendant provided no-fault insurance to Francisco Lopez on the date of the accident and that Resto did not have no-fault insurance of his own or available to him as a rеsident relative of another. Plaintiff further alleged that defendant had unreasonably refused to pay or delayed paying plaintiff no-fault benefits. Thus, plaintiff alleged that it was entitled to penalty interest under MCL 500.3142 and attorney fees under MCL 500.3148.
Defendant filed its answer on September 3, 2004, neither admitting nor denying most of plaintiffs allegations, professing a lack of present knowledge. But defendant admitted that it had received plaintiffs itemized statements of care and treatment provided to Resto and a UB-92. Defendant claimed lack of knowledge to either admit or deny that the services plaintiff provided Resto were medically necessary. Defendant denied as untrue that plaintiffs charges were customary and commercially reasonable, but also claimed to lack present knowledgе to be able to either admit or deny whether plaintiffs claim of $12,402 consisted of “customary charges for like professional medical services . . . [that] are commercially reasonable.” Defendant admitted that it provided no-fault coverage to Francisco Lopez on the date of the accident and that it had refused and still refused to pay no-fault benefits. As became apparent during discovery, the crux of Southern Michigan’s defense was that after Resto’s release from treatment, neither plaintiff nor defendant could locate him to verify that he had no other available insurance.
On May 27, 2005, plaintiff moved for summary disposition under MCR 2.116(0(10). Plaintiff contended that the facts establishing defendant’s liability for the charges incurred in treating Resto were undisputed: Resto was injured in an autоmobile accident while a passenger in a vehicle owned by Lopez and insured by defendant. Plaintiff asserted that it had provided defendant with its itemized statement, UB-92s, and the affidavit of its financial director attesting to the fact and amount of the loss sustained. According to plaintiff, defendant’s assertion that a hypothetical insurer might exist with a higher priority for paying plaintiffs claim was not a viable defense, and, therefore, plaintiff was entitled to judgment as matter of law.
Defendant responded by asserting that Resto, and therefore plaintiff, had the burden of proving that he had no other insurance of his own or available to him as a resident in the home of a relative who had insurance. Defendant asserted “the burden is upon a party claiming no fault benefits to establish that the orders of priority set fоrth in MCL 500.3114 have been satisfied.”
The trial court ruled there was no dispute that defendant insured the vehicle in which Resto was a passenger when injured. Further, there was no evidence of any other insurance available to Resto, and the court rejected as unreasonable defendant’s argument that plaintiff was required to prove a negative. The court noted that plaintiff made a reasonable inquiry whether other insurance was available; therefore, defendant has primary liability for no-fault benefits. Further, the court noted that defendant could seek reimbursement if another higher-priority carrier were subsequently identified. The trial court stated that defendant’s interpretation of the no-fault act “doesn’t even make sense” and “would defeat the purpose” of the act. Accordingly, the trial court ruled that plaintiff had met its burden of proof regarding defendant’s liability. But the court found plaintiffs evidence lacking with respect to whether its charges were reasonable and reasonably necessary. Nevertheless, the court ruled that plaintiff would be entitled to interest and penalty interest on whatever charges plaintiff establishеd were reasonable and reasonably necessary. The court also ruled that plaintiff would be entitled to attorney fees because defendant could not simply ignore plaintiffs claim on the basis that another carrier might be responsible. Consequently, the trial court granted partial summary disposition to plaintiff and denied defendant’s motion for summary disposition pursuant to MCR 2.116(I)(2).
Plaintiff subsequently moved again for summary disposition with additional affidavits attesting that the services provided to Resto were medically necessary and that the charges were reasonable. Dr. William J. Behrje averred that all the products and services plaintiff provided Resto “were not only medically necessary, but they were essential to Mr. Resto’s care, recovery, and rehabilitation for the injuries that he rеceived as a result of his January 23, 2004, motor vehicle accident.” Carol Lindauer, plaintiffs manager of patient financial services, expanded on Collins’s prior affidavit. Specifically, Lindauer averred that all of plaintiffs charges were established after considering its costs, its nominal return, and regional and national comparisons of similarly situated and sized health-care providers. Lindauer asserted that all of plaintiffs charges were reasonable in light of the factors it considered in setting them and that plaintiff would charge the same amount with or without insurance coverage.
In its brief responding to plaintiffs second motion for summary disposition, defendant asserted that, on the basis of Dr. Behrje’s affidavit, it no longer disputed that plaintiffs “treatment [of] Mr. Resto was reasonably necеssary for his care, recovery, and/or rehabilitation as a result of injuries sustained in the motor vehicle accident....” Defendant only contested the imposition of penalty interest and attorney fees.
At the hearing on the motion, defendant argued that because plaintiff did not establish that its charges were reasonably necessary and reasonable until its second motion for summary disposition, the charges were not “overdue” until 30 days after that
ii
We review de novo a trial court’s decision to grant or deny summary disposition to determine if the moving party is entitled to judgment as a matter of law. Maiden v Rozwood,
Defendant also raises issues of statutory interpretation, which we review de novo. Amerisure Ins Co v Auto-Owners Ins Co, 262 Mich App 10, 14;
An anchoring rule of jurisprudence, and the foremost rule of statutory construction, is that courts are to effect the intent of the Legislature. To do so, we begin with an examination of the language of the statute. If the statute’s language is clear and unambiguous, then we assume that the Legislature intended its plain meaning and the statute is enforced as written. A necessary corollary of these principles is that a court may read nothing into an unambiguous statute that is not within the manifest intent of the Legislature as derived from the words of the statute itself. [Citations omitted.]
In applying these principles, this Court must “consider both the plain meaning of the critical word or phrase as well as ‘its placement and purpose in the statutory scheme.’ ” Sun Valley Foods Co v Ward,
hi
Defendant first argues that the trial court erred by granting plaintiff, rather than it, summary disposition. Defendant argues that plaintiff, in asserting its no-fault claim, stands in the shoes of Resto. Further, defendant argues that MCL 500.3114(4) requires Resto to show that a higher-priority no-fault insurer was unavailable to provide no-fault benefits. In the alternative, defendant argues that when the trial court denied plaintiffs first motion, it should have granted defendant’s cross-motion for summary disposition because the motion hearing was the procedural equivalent of a trial and plaintiff should not have been permitted a “second bite оf the apple.” We disagree.
Defendant’s main argument rests on its contention that MCL 500.3114 required plaintiff to establish as a prima facie element of its case that no other no-fault insurance was available to Resto. Defendant’s argument is based on the faulty premise that plaintiff stands in the shoes of Resto when seeking compensation for “reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person’s care, recovery, or rehabilitation.” MCL 500.3107(1)(a). Defendant cites Lakeland Neurocare Ctrs v State Farm Mut Automobile Ins Co,
(1) Except as provided in subsections (2), (3), and (5), a personal protection insurance policy described in section 3101(1) applies to accidental bodily injury to the person named in the policy, the person’s spouse, and a relative of either domiciled in the same household, if the injury arises from a motor vehicle accident....
(4) Except as provided in subsections (1) to (3), a person suffering accidental bodily injury arising from a motor vehicle accident while an occupant of a motor vehicle shall claim personal protection insurance benefits from insurers in the following order of priority:
(a) The insurer of the owner or registrant of the vehicle occupied.
Ob) The insurer of the operator of the vehicle occupied.
Defendant argues that plaintiff must disprove, as a part of its prima facie case, that the general rule stated in subsection 1, as incorporated by subsection 4, does not apply. Subsection 1 states the general rule of priority among no-fault insurers. MCL 500.3114(1); Belcher v Aetna Cas & Surety Co,
Rather, plaintiffs entitlement to PIP benefits is determined by MCL 500.3105(1), which provides that “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,” as defined in the no-fault act. See State Farm Mut Automobile Ins Co v Wyant,
Moreover, defendant’s interpretation of the statute is contrary to the purрoses the no-fault act and inconsistent with settled caselaw. “Michigan’s no-fault insurance system aims to provide victims of automobile-related accidents with assured, adequate, and prompt payment for economic losses.” Miller v Farm Bureau Mut Ins Co,
Here, although defendant did not dispute that it provided coverage for the accident, defendant denied plaintiffs claim for no-fault benefits only because another carrier with a higher priority to pay the clаim might exist. Michigan caselaw rejects such a defense as a reason to delay paying a no-fault claim. See Bach v State Farm Mut Automobile Ins Co,
The no-fault act is intended to provide prompt compensation to persons injured in automobile accidents without regard to fault. We conclude that subjecting medical providers like plaintiff to protracted coverage and priority litigation would frustrate the core purpose of the no-fault act. See Cannell v Riverside Ins Co,
We find specious defendant’s contention that it was not asserting a priority defense. Defendant asserted a priority defense by arguing that рlaintiff must prove a negative: that no higher-priority insurer was
Defendant also misplaces reliance on M Civ JI 35.02, which provides:
In order for thе plaintiff to recover no-fault benefits from the defendant, the plaintiff has the burden of proof on each of the following:
a. *(that at the time of the accident there existed a valid contract of no-fault insurance between [name of insured] and defendant) [.]
Note on Use
^Delete where not an issue. If an issue, the Court should determine what contractual relationship must be proved under MCL 500.3114, .3115.
This instruction simply does not apply under the circumstances of this case because defendant admitted that it insured Francisco Lopez, the owner of the accident vehicle.
Defendant’s alternative argument also lacks merit. A provider of medical services to a person injured in an automobile accident that submits a no-fault claim bears the burden of proving that its charges were both reasоnable and reasonably necessary for the injured person’s care, recovery, or rehabilitation. MCL 500.3107(l)(a); MCL 500.3157; Williams v AAA Michigan,
At the second hearing on plaintiffs motion, plaintiff produced additional affidavits attesting that its charges with respect to Resto were both reasonable and reasonably necessary for Resto’s care, recovery, or rehabilitation. Defendant no longer disputed this issue and, as discussed earlier, failed to present a legally viable defense. Consequently, the trial court properly granted plaintiffs motion for summary disposition because, on the basis of the undisputed facts, plaintiff was entitled to judgment as a matter of law.
IV
Defendant next argues that the trial court clearly-erred by awarding penalty interest pursuant to MCL 500.3142 because payment of the benefit was not “overdue” until 30 days after plaintiff, at its second motion for summary disposition, supplied an affidavit attesting that the care plaintiff provided Resto was reasonably necessary. Likewise, defendant contends that the trial court erred by awarding
We review a trial court’s award of penalty interest under MCL 500.3142 for clear error. Williams, supra at 265. Likewise, we review for clear error a trial court’s factual findings regarding awarding attorney fees under MCL 500.3148. MCR 2.613(C); Attard v Citizens Ins Co of America,
The trial court did not clearly err by awarding plaintiff penalty interest pursuant to MCL 500.3142. Further, the trial court neither clearly erred nor abused its discretion by awarding plaintiff attorney fees under MCL 500.3148(1).
With respect to penalty interest, MCL 500.3142 provides in relevant part:
(1) Personal protection insurance benefits are payable as loss accrues.
(2) Personal protection insurance benefits are overdue if not paid within 30 days after an insurer receives reasonable рroof of the fact and of the amount of loss sustained. ...
(3) An overdue payment bears simple interest at the rate of 12% per annum.
With respect to attorney fees, MCL 500.3148(1) provides:
An attorney is entitled to a reasonable fee for advising and representing a claimant in an action for personal or property protection insurance benefits which are overdue. The attorney’s fee shall be a charge against the insurer in addition to the benefits recovered, if the court finds that the insurer unreasonably refused to pay the claim or unreasonably delayed in making proper payment.
Before either penalty interest or attorney fees may be awarded to a claimant, PIP benefits must be overdue. First, to be overdue, allowable expenses must actually have been incurred. MCL 500.3142(1); Proudfoot, supra at 485. Second, PIP “benefits are ovеrdue if not paid within 30 days after an insurer receives reasonable proof of the fact and of the amount of loss sustained.” MCL 500.3142(2). Before attorney fees may be assessed against an insurer, the trial court must additionally find “that the insurer unreasonably refused to pay the claim or unreasonably delayed in making proper payment.” MCL 500.3148(1). If benefits are “overdue” within the meaning of MCL 500.3142(2), “a rebuttable presumption of unreasonable refusal or undue delay arises.” Combs v Commercial Carriers, Inc,
But the element of reasonableness does not apply to the conduct of the insurance company when awarding penalty interest under MCL 500.3142. The reasonableness
No-fault interest is awarded as a penalty for the insurer’s misconduct and is not intended to compensate the insured for damages. To recover interest, a plaintiff is not required to prove that the defendant acted arbitrarily or unreasonably delayed in payment of benefits. Instead, the statute “only requires that the insured present the insurer with reasonable proof of loss. If the insurer does not pay the claim within 30 days after receiving this proof, it becomes liable for interest.” [Citations omitted.]
Defendant’s argument that a claimant must provide sufficient proof to prevail on a motion for summary disposition before the statutоry 30-day period begins to run is without merit. A claimant attempting to sue an insurer for no-fault benefits bears the burden of proving that allowable expenses were both reasonable and necessary. MCL 500.3107(1)(a); SPECT Imaging, Inc v Allstate Ins Co,
Defendant never investigated the reasonableness or necessity of plaintiffs charges. Instead, defendant relied on its legal defense that a higher-priority no-fault insurer might be responsible for paying plaintiffs claim. Defendant acknowledged receipt of plaintiffs statements and UB-92s on February 25, March 25, and April 2, 2004. Defendant also received a copy of the police report regarding the accident and conducted its own investigation on March 17 and May 10, 2004, concerning whether Resto was eligible for PIP benefits. Given this record, the trial court did not clearly err in finding that benefits were overdue as of May 29, 2004. Therefore, plaintiff was entitled to penalty interest under MCL 500.3142.
The proof plaintiff provided defendant in this case is similar to that which this Court determined to be reasonable proof of the fact and amount of the loss in Williams. In that case, the claimant provided the no-fault insurer a letter and statement from a health-care provider. Williams, supra at 265-266. This Court held that the claimant had provided the no-fault insurer reasonable proof of the fact and amount of the loss. Id. at 267.
Even though benefits were overdue, a trial court may not award attorney fees to a claimant unless “the insurer unreasonably refused to pay the claim or unreasonably delayed in making proper payment.” MCL 500.3148(1). An insurer does not unreasonably refuse to pay or delay payment of benefits when it does so because of a legitimate question of statutory construction or constitutional law or a bona fide factual uncertainty. McKelvie, supra at 335; Liddell v Detroit Automobile Inter-Ins Exch,
Defendant never created a bona fide factual dispute that plaintiffs charges were unnecessary or unrеasonable. Defendant admitted that its sole basis for denying plaintiffs claim was that plaintiff had not proved that defendant was the highest-priority insurer under the no-fault act. But, under settled caselaw, a priority dispute among no-fault insurers will not justify delay in paying a no-fault claim. Darnell, supra at 12; Bach, supra at 132. “A dispute of priority among insurers will not excuse the delay in making timely payment.” Bloemsma, supra at 697. Thus, “when the only question is which of two insurers will pay, it is unreasonable for an insurer to refuse payment of benefits.” Univ of Michigan Regents, supra at 737. Defendant may not avoid the application of this principle by claiming that its speculation that a higher-priority insurer might exist was not a priority dispute. Defendant’s denial of no-fault benefits was unreasonable. The trial court did not clearly err by awarding plaintiff attorney fees under MCL 500.3148(1).
Finally, defendant has failed to establish that the trial court abused its discretion in determining the amount of attorney fees to award. When a trial court determines that an award of attorney fees under MCL 500.3148 is appropriate, the court must only award a reasonable fee. The statute does not define “reasonable” for purposes of awarding attorney fees. In Liddell, supra at 651-652, this Court adopted the guidelines stated in Crawley v Schick,
There is no precise formula for computing the reasonableness of an attorney’s fee. However, among the facts to be taken into consideration in determining the reasonableness of a fee include, but are not limited to, the following: (1) the professional standing and experience of the attorney; (2) the skill, time and labor involved; (3) the amount in question and the results achieved; (4) the difficulty of the case; (5) the expenses incurred; and (6) the nature and length of the professional relationship with the client.
Likewise, our Supreme Court adopted the Crawley factors for the purpose of determining reasonable attorney fees under MCL 500.3148 in Wood. The Wood Court observed that although “a trial court should consider the guidelines of Crawley, it is not limited to those factors in making its determination.” Wood, supra at 588. Furthermore, a trial court need not make detailed findings regarding each factor the court considers. Id. The trial court’s award “will be upheld unless it appears upon appellate review that the trial court’s finding on the ‘reasonableness’ issue was an abuse of discretion.” Id.
Defendant asserts only two reasons the trial court’s determination of the amount of attorney fees was an abuse of discretion. First, defendant argues that no-fault benefits were not overdue for reasons that we have already discussed and rejected. Second, defendant argues that the trial court overvalued the hourly rate of plaintiffs attorneys. Defendant relies on a graph in a Michigan Bar Journal article, selecting values reported for equity partners below the 25th percentile, for senior associates probably in the lowest tenth percentile, and for associates at the very bottom of reported hourly rates.
v
Finally, defendant argues that the trial court erred by granting plaintiffs motion to compel discovery, ordering sanctions against defendant, and denying defendant’s request for attorney fees because plaintiffs motion was frivolous. We disagree.
We review for an abusé of discretion a trial court’s rulings on a motion to compel discovery. Cabrera v Ekema,
Michigan’s court rules “implement ‘an open, broad discovery policy ....’” Cabrera, supra at 406-407, quoting Reed Dairy Farm v Consumers Powers Co,
(2) The answer must specifically deny the matter or state in detail the reasons why the answering party cannot truthfully admit or deny it. A denial must fairly meet the substance of the request, and when good faith requires that a party qualify an answer or deny only part of the matter of which an admission is requested, the party must specify the parts that are admitted and denied.
(3) An answering party may not give lack of information or knowledge as a reason for failure tо admit or deny unless the party states that he or she has made reasonable inquiry and that the information known or readily obtainable is. insufficient to enable the party to admit or deny.
At the hearing on plaintiffs motion, the trial court noted that in its prior experience with defense counsel’s law firm, counsel had habitually disregarded the court rules. The trial court ordered defendant
VI
In summary, we find that the trial court properly granted plaintiffs motion for summary disposition and denied defendant’s cross-motion. A health-care provider that has furnished “reasonably necessary products, services and accommodations for an injured person’s care, recovery, or rehabilitation,” when the injured person is entitled to no-fault benefits, is not required by the no-fault act to prove as part of its prima facie case against a legally hable no-fault insurer the absence of another insurer standing in a higher priority than the one against which the claim is being made. We hold that defendant’s interpretation of the statute to the contrary is inconsistent with the plain language of the no-fault act, contrary to the purpose of the statute, and conflicts with well-established caselaw. In addition, the failure of one party to establish its entitlement to summary disposition under MCR 2.116(0(10) does not thereby entitle the opposing party to judgment unless, under the undisputed facts, the opposing party is entitled to judgment as a matter of law.
We further hold that the trial court did not clearly err in awarding plaintiff penalty interest under MCL 500.3142, nor did the trial court either clearly err or abuse its discretion by awarding plaintiff attorney fees under MCL 500.3148(1). Also, defendant has not established that the trial court abused its discretion in setting the amount of reasonable attorney fees to award to plaintiff.
Last, defendant has not established that the trial court abused its discretion by granting plaintiffs motion to compel discovery and awarding plaintiff its reasonable attorney fees.
We affirm.
Notes
Apparently a standard medical billing form.
We recognize that this Court’s recent decision in Hatcher v State Farm. Mut Automobile Ins Co,
Concurrence Opinion
(concurring). I write separately simply to state that I do not rely on a statutory distinction between “a person suffering accidental bodily injury” and a claimant under MCL 500.3114(4). Defendant indisputably insured the owner of the occupied vehicle, and no insurer in a higher priority was identified.
