Lead Opinion
Under the terms of the no-fault act,
We hold that “allowable expenses” must be “for an injured person’s care, recovery, or rehabilitation.”
If the fact-finder concludes that a plaintiff incurred allowable expenses in receiving care from a family member, the fact-finder must also determine to what extent any claimed expense is a “reasonable charge[].”
In applying these principles of law to the facts of this case, we hold that the Court of Appeals correctly determined that plaintiff may recover “allowable expenses” to the extent that they encompass services that are reasonably necessary for plaintiff’s care when the care is “related to [plaintiff’s] injuries.”
I. FACTS AND PROCEDURAL HISTORY
In 1996, plaintiff, James Douglas, sustained a severe closed-head brain injury when a hit-and-run motorist struck the bicycle he was riding. Plaintiff was hospitalized for approximately one month after the accident and received therapy and rehabilitation after his discharge. Because the driver of the motor vehicle that struck plaintiff could not be identified, plaintiff sought
In 1999, plaintiff began the first of a series of full-time jobs. However, he was unable to hold a job for very long, and he eventually stopped working. During this time, he twice attempted suicide. After the second suicide attempt, a 2005 letter written by plaintiffs psychiatrist indicated that plaintiff “requires further treatment” because he “continues to suffer from ill-effects as a result of his closed-head injury. . . .” In particular, the psychiatrist emphasized that plaintiff suffered from short-term memory problems and impulsivity as a result of the accident and explained that plaintiff “should have the opportunity to obtain the care that will most likely restore him to a good level of functioning.” Defendant claims that it did not receive this letter before plaintiff initiated this lawsuit.
Plaintiff filed the instant lawsuit on May 31, 2005, in the Washtenaw Circuit Court seeking compensation for
The parties proceeded to a bench trial on the claim for attendant care services that Mrs. Douglas allegedly provided. Defendant’s claims adjuster testified during
Katherine Douglas testified that when she was at home, her entire time was spent “babysitting” and “watching James,” even while she was performing other household chores. She believed that her presence in the house kept plaintiff from being hospitalized or incarcerated. She also testified about a series of forms, each labeled “AFFIDAVIT OF ATTENDANT CARE SERVICES,” all dated June 25, 2007, covering each month between November 2004 and June 2007. These forms totaled up the number of hours during which she claimed to have provided services and outlined the various tasks that she performed, including organizing her family’s day-to-day life, cooking meals, undertaking daily chores, maintaining the family’s house and yard, ordering and monitoring plaintiffs medications, communicating with health care providers and Social Security Administration officials, calling plaintiff from work to ensure plaintiffs safety, monitoring plaintiffs safety, and cueing or prompting various tasks for plaintiff to undertake. However, she admitted that the forms were all completed in June 2007, that she did not contemporaneously itemize the amount of time she spent on any particular item, and that in completing the forms, she went through household bills to reconstruct what had occurred in her life during the relevant period.
Defendant’s medical expert, Dr. Charles Seigerman, testified that he conducted a battery of cognitive tests on plaintiff and concluded that two hours of attendant care services a day are needed to help plaintiff organize the logistics of his treatment and ensure that he takes his medicine. Dr. Seigerman also testified that an appropriate hourly rate for these services was “around $10.00 an hour,” or “[p]erhaps a little higher,” although he acknowledged on cross-examination that he was not an expert on the appropriate rate of compensation for this service.
The circuit court awarded PIP benefits to plaintiff, explaining that he “needs aide care for all of his waking hours.” The circuit court calculated that plaintiff was entitled to a total of 67 hours a week of attendant care for the period between May 31, 2004, and November 1, 2007, and 40 hours a week after November 1, 2007.
The Court of Appeals affirmed in part, reversed in part, and remanded for further proceedings. First, the panel rejected defendant’s claim that the circuit court had erred by denying its final two motions for summary disposition. In particular, the panel concluded that Dr. Rosenbaum’s affidavit created a question of fact regarding whether attendant care services were “reasonably necessary” for the period before Dr. Rosenbaum began treating plaintiff on November 7, 2006.
The Court of Appeals reversed the circuit court’s award, however, because “the trial evidence in this case did not reflect that Katherine maintained records of her claimed attendant care.”
This Court granted defendant’s application for leave to appeal and ordered the parties to brief the following issues:
(1) whether the Court of Appeals erred in remanding this case to the trial court for further proceedings regarding the amount of incurred expenses for attendant care from November 7, 2006, to November 18, 2009, after finding that the trial court clearly erred in awarding attendant care benefits to the plaintiff without requiring sufficient documentation to support the daily and weekly hours underlying the award; (2) whether the plaintiff presented sufficient proofs at trial to support the trial court’s award of attendant care benefits for the period before November 7, 2006; (3) whether activities performed by Katherine Douglas constituted attendant care under MCL 500.3107(l)(a) or replacement services under MCL 500.3107(l)(c); and (4) whether the trial court clearly erred in awarding attendant care benefits at the rate of $40 per hour.[21 ]
II. STANDARD OF REVIEW
This case involves the interpretation of the no-fault act. “Issues of statutory interpretation are questions of
We review de novo the denial of a motion for summary disposition.
In civil actions tried without a jury, MCR 2.517(A)(1) requires the court to “find the facts specially, state separately its conclusions of law, and direct entry of the appropriate judgment.” We review these findings of fact for clear error,
III. ANALYSIS
A. LEGAL BACKGROUND OF THE NO-FAULT ACT
MCL 500.3105(1) establishes that a personal protection insurance provider is liable under the no-fault act “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.” Accordingly, MCL 500.3105(1) imposes two threshold causation requirements for PIP benefits:
First, an insurer is liable only if benefits are “for accidental bodily injury.. ..” “[F]or” implies a causal connection. “[Alccidental bodily injury” therefore triggers an insurer’s liability and defines the scope of that liability. Accordingly, a no-fault insurer is liable to pay benefits only to the extent that the claimed benefits are causally connected to the accidental bodily injury arising out of an automobile accident.
Second, an insurer is liable to pay benefits for accidental bodily injury only if those injuries “aris[e] out of” or are caused by “the ownership, operation, maintenance or use of a motor vehicle ....” It is not any bodily injury that triggers an insurer’s liability under the no-fault act. Rather, it is only those injuries that are caused by the insured’s use of a motor vehicle.[30 ]
MCL 500.3107(1) further limits what benefits are compensable as PIP benefits, allowing unlimited lifetime benefits for “allowable expenses” but limiting “ordinary and necessary services” to a three-year period after the accident and to a $20 daily limit:
*258 Except as provided in subsection (2), personal 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. .. .
(c) Expenses not exceeding $20.00 per day, reasonably incurred in obtaining ordinary and necessary services in lieu of those that, if he or she had not been injured, an injured person would have performed during the first 3 years after the date of the accident, not for income but for the benefit of himself or herself or of his or her dependent.
This Court’s decision in Johnson v Recca clarified that the “ordinary and necessary services” contemplated in subsection (1)(c) — commonly referred to as “replacement services” — constitute a category of expenses distinct from the “allowable expenses” contemplated in subsection (1)(a).
This case requires this Court to consider whether the specific services at issue here were “allowable expenses”
B. allowable expenses
MCL 500.3107(1)(a) defines “allowable expenses” as “all reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person’s care, recovery, or rehabilitation.” We have recognized that the plain language of this provision imposes four requirements that a PIP claimant must prove before recovering benefits for allowable expenses: (1) the expense must be for an injured person’s care, recovery, or rehabilitation, (2) the expense must be reasonably necessary, (3) the expense must be incurred, and (4) the charge must be reasonable.
1. SERVICES “FOR” AN INSURED’S CARE, RECOVERY, OR REHABILITATION
MCL 500.3107(1)(a) requires that allowable expenses must be “for an injured person’s care, recovery, or rehabilitation.” As we explained in Griffith v State Farm Mutual Automobile Insurance Co, “expenses for ‘recovery’ or ‘rehabilitation’ are costs expended in order
“[c]are” must have a meaning that is broader than “recovery” and “rehabilitation” but is not so broad as to render those terms nugatory.... “[RJecovery” 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.[38 ]
We reaffirm here Griffith’s definition of “care” as it relates to the scope of allowable expenses: although services for an insured’s care need not restore a person to his preinjury state, the services must be related to the insured’s injuries to be considered allowable expenses.
A subsequent Court of Appeals panel applied Visconti and allowed the plaintiff to recover no-fault benefits when a family member was “required to serve his meals in bed, bathe him, escort him to the doctor’s office, exercise him in conformity with his doctor’s instructions, assist in formulating his diet, administer medication, and assist him with speech and associational therapy.”
In this case, defendant claims that a judgment of no cause of action should be entered because Mrs. Douglas did not perform any compensable allowable expenses, only replacement services, which are not compensable in this case because of the three-year time limit of MCL 500.3107(1)(c). We disagree with defendant’s claim and conclude that defendant is not entitled to relief on this issue.
Defendant is correct that Mrs. Douglas’s testimony and attendant care forms indicate that she provided many services that are properly considered replacement services, including daily organization of family life; preparation of family meals; yard, house, and car maintenance; and daily chores. These services are prototypical “ordinary and necessary” services that every Michi
The circuit court ruled that Mrs. Douglas “is Plaintiffs caretaker and basically spends her free time making sure that Plaintiff is cared for, and does not harm himself as he tried to do in a suicide attempt.” This factual finding is not clearly erroneous because it is consistent with Mrs. Douglas’s testimony that she was “watching James” even while she was performing household chores by herself. Furthermore, it suggests that the circuit court adopted plaintiffs argument that Mrs. Douglas’s supervision constituted attendant care services.
The Court of Appeals rejected defendant’s claim that Mrs. Douglas only provided replacement services and
2. REASONABLY NECESSARY EXPENSES
MCL 500.3107(1)(a) also requires allowable expenses to be “reasonably necessary.” In Krohn v Home-Owners
Before the circuit court’s ruling on defendant’s third motion for summary disposition, plaintiff offered the affidavit of Dr. Rosenbaum, who explained that plaintiff “is in need of [attendant] care during all waking hours” and that Mrs. Douglas had provided that care “since [the time of] the motor vehicle accident.” The circuit court based its denial of defendant’s motion in part on Dr. Rosenbaum’s affidavit. In reviewing that decision, the Court of Appeals determined that “the affiant relied on the statements of the parties to determine what activity plaintiff’s wife engaged in during the subject period and subsequently evaluated those activities and found them to meet the definition of attendant care.”
Moreover, we conclude that it was not clear error for the circuit court as fact-finder to conclude that attendant care services were, in fact, reasonably necessary for the period before November 7, 2006. There is a factual basis in the record to support the circuit court’s conclusion: Dr. Rosenbaum testified at trial that, as early as 1997, plaintiffs doctors had
3. INCURRED EXPENSES
MCL 500.3107(1)(a) also limits allowable expenses to “charges incurred.” That is, even if a claimant can show that services were for his care and were reasonably necessary, an insurer “is not obliged to pay any amount except upon submission of evidence that services were
cannot be detached from the specific payments involved, or expenses incurred,... [w]here a plaintiff is unable to show that a particular, reasonable expense has been incurred for a reasonably necessary product and service, there can be no finding of a breach of the insurer’s duty to pay that expense, and thus no finding of liability with regard to that expense.[53 ]
This Court has defined “incur” as it appears in MCL 500.3107(1)(a) as “ ‘[t]o become liable or subject to, [especially] because of one’s own actions.’ ”
The fact that charges have been incurred can be shown “by various means,” including “a contract for products and services” or “a paid bill.”
This evidentiary requirement is most easily satisfied when an insured or a caregiver submits itemized statements, bills, contracts, or logs listing the nature of services provided with sufficient detail for the insurer to determine whether they are compensable.
The problem of a caregiver’s failure to provide contemporaneous documentary evidence of allowable expenses is aptly illustrated in this case, in which Mrs.
We underscore the importance of the proofs necessary to establish entitlement to benefits. The circuit court issued a judgment in favor of plaintiff without finding that the expenses were actually incurred given that its determination of the number of hours to award plaintiff had no discernible basis in the evidence presented at trial and did not examine whether Mrs. Douglas had the expectation of payment for her services. While it awarded plaintiff benefits for 40 hours a week of attendant care services for the period beginning November 1, 2007, in accord with Dr. Rosenbaum’s prescription, there is no basis for its findings that Mrs. Douglas actually provided 40 hours of care each week during that period. Indeed, because she was unavailable to provide services during her working hours, there is no basis for compensating her for any hours that she spent working outside the home.
4. REASONABLE CHARGE FOR EXPENSES
Once a fact-finder has concluded that a plaintiff incurred allowable expenses in receiving care from a family member, the fact-finder must determine whether the charge is “reasonable.”
Although this Court has not ruled on the issue, the Court of Appeals in Bonkowski v Allstate Insurance Co stated that a commercial agency’s rate for attendant care services is irrelevant to the fact-finder’s determination of what constitutes a reasonable rate for a family member’s provision of those services. Then Judge ZAHRA, writing for the court, noted that “[i]n determining reasonable compensation for an unlicensed person who provides health care services, a fact-finder may consider the compensation paid to licensed health care professionals who provide similar services.”
The compensation actually paid to caregivers who provide similar services is necessarily relevant to the fact-finder’s determination of a reasonable charge for a family member’s provision of these services because it helps the fact-finder to determine what the caregivers could receive on the open market. While a commercial agency’s fee incorporates this relevant piece of data— the compensation it pays to its caregivers — it also incorporates additional costs into its charge that family members who provide services do not incur, particularly the overhead costs inherent in the agency’s provision of
While we do not adopt the reasoning in Bonkowski in its entirety, we agree with Bonkowski that the fact-finder’s focus must be on an individual’s compensation. Accordingly, we hold that a fact-finder may base the hourly rate for a family member’s provision of attendant care services on what health care agencies compensate their employees, but what health care agencies charge their patients is too attenuated from the appropriate hourly rate for a family member’s services to be controlling.
IV CONCLUSION
Today we reaffirm that MCL 500.3107(1)(a) imposes four requirements that an insured must prove before recovering PIP benefits for allowable expenses: (1) the expense must be for an injured person’s care, recovery, or rehabilitation, (2) the expense must be reasonably necessary, (3) the expense must be incurred, and (4) the
Defendant is not entitled to relief on its claim that Mrs. Douglas provided only replacement services, not allowable expenses, because the circuit court did not clearly err by ruling that Mrs. Douglas is plaintiffs caretaker. Defendant is also not entitled to relief on its claim that plaintiffs attendant care was not reasonably necessary in the absence of a specific prescription for attendant care services because the testimony of Dr. Rosenbaum and defendant’s claims adjuster provided a factual basis for the reasonable necessity of those services at all times relevant in this case.
We affirm the Court of Appeals’ decision to remand this case for further proceedings, but we hold that the consideration on remand must encompass the entire period for which charges are claimed. We also emphasize the necessity that the circuit court, as the fact-finder, must base its ruling on proofs that show the extent to which Mrs. Douglas actually provided compensable attendant care services. Therefore, on remand, the circuit court must apply the standard of proof outlined in this opinion to determine whether plaintiff has proved that “charges” were “incurred” for his care. In particular, the circuit court must determine the extent to which plaintiff has proved the number of hours that Mrs. Douglas actually provided attendant care services and whether she actually expected compensation for those services. Finally, we reverse the Court of Appeals’ decision regarding the circuit court’s assessment of an hourly rate of $40 and conclude that
Affirmed in part, reversed in part, award of attendant care benefits vacated and case remanded for further proceedings consistent with this opinion.
MCL 500.3101 et seq.
MCL 500.3107(1)(a).
Id. (emphasis added).
Griffith v State Farm Mut Auto Ins Co, 472 Mich 521, 535; 697 NW2d 895 (2005).
Visconti v DAIIE, 90 Mich App 477, 481; 282 NW2d 360 (1979), quoting Kushay v Sexton Dairy Co, 394 Mich 69, 74; 228 NW2d 205 (1975).
MCL 500.3107(1)(a).
Griffith, 472 Mich at 532 n 8, quoting Manley v DAIIE, 425 Mich 140, 169; 388 NW2d 216 (1986) (Boyle, J., concurring in part).
MCL 500.3107(1)(a).
Griffith, 472 Mich at 534.
MCL 500.3172(1) provides that
[a] person entitled to claim because of accidental bodily injury arising out of the ownership, operation, maintenance, or use of a motor vehicle as a motor vehicle in this state may obtain personal protection insurance benefits through an assigned claims plan if no personal protection insurance is applicable to the injury, [or] no personal protection insurance applicable to the injury can be identified....
Because defendant paid PIP benefits for medical bills during the pendency of the suit, the only potential PIP benefits at issue were the services that plaintiffs wife provided.
The first motion for partial summary disposition claimed that MCL 500.3145(1) barred any portion of plaintiffs claim that accrued more than one year before plaintiff commenced the suit, that is, before May 31, 2004. The circuit court granted defendant’s motion for partial summary disposition with the consent of the parties. See MCL 500.3145(1), which states, in relevant part, that a claimant “may not recover [PIP] benefits for any portion of the loss incurred more than 1 year before the date on which the action was commenced.”
Dr. Rosenbaum also noted that another of plaintiffs medical providers had recommended in 1997 that plaintiff receive 24-hour supervisory care.
The 67-hour week corresponded to 7 hours each weekday and 32 hours during the weekend (16 hours each on Saturday and Sunday), while the 40-hour week corresponded to Dr. Rosenbaum’s subsequent recommendation.
MCL 500.3107(1)(a).
Douglas v Allstate Ins Co, unpublished opinion per curiam of the Court of Appeals, issued June 23, 2011 (Docket No. 295484), p 5.
Id. at 6.
Id. at 6-7.
Id. at 7.
Id.
Douglas v Allstate Ins Co, 490 Mich 927 (2011).
Griffith, 472 Mich at 525-526.
Koontz v Ameritech Services, Inc, 466 Mich 304, 312; 645 NW2d 34 (2002).
Sun Valley Foods Co v Ward, 460 Mich 230, 237; 596 NW2d 119 (1999), quoting Bailey v United States, 516 US 137, 145; 116 S Ct 501; 133 L Ed 2d 472 (1995).
Griffith, 472 Mich at 526, citing Koontz, 466 Mich at 312.
Saffian v Simmons, 477 Mich 8, 12; 727 NW2d 132 (2007).
Brown v Brown, 478 Mich 545, 551-552; 739 NW2d 313 (2007).
MCR 2.613(C); Adams Outdoor Advertising, Inc v City of Holland, 463 Mich 675, 681; 625 NW2d 377 (2001).
Ross v Auto Club Group, 481 Mich 1, 7; 748 NW2d 552 (2008), quoting Kitchen v Kitchen, 465 Mich 654, 661-662; 641 NW2d 245 (2002).
Griffith, 472 Mich at 531 (alterations in original).
Johnson v Recca, 492 Mich 169, 176; 821 NW2d 520 (2012).
MCL 500.3107(1)(a).
MCL 500.3107(1)(c).
See Griffith, 472 Mich at 532 n 8.
Id. at 535.
Id. at 533.
Id. at 534 (quotation marks omitted).
Id. at 535.
Visconti, 90 Mich App at 481, quoting Kushay, 394 Mich at 74.
Van Marter v American Fidelity Fire Ins Co, 114 Mich App 171, 180; 318 NW2d 679 (1982).
Id.
MCL 500.3107(1)(a).
MCL 500.3107(1)(c).
Johnson, 492 Mich at 176.
Plaintiff also argues that while some of Mrs. Douglas’s tasks might be considered replacement services, there is therapeutic value in ensuring that plaintiff is involved with these activities, although they require Mrs. Douglas’s supervision. However, the testimony adduced at trial undermines this rationale because Mrs. Douglas explained that during the week, when she spent time cooking, washing dishes, cleaning the house, and caring for her children, plaintiff did “ [v] ery little” to assist her in these chores, but instead often watched television.
Morris v Detroit Bd of Ed, 243 Mich App 189, 197; 622 NW2d 66 (2000) (“[O]n-call care is compensable under the [workers’ compensation] statute.”).
Brown v Eller Outdoor Advertising Co, 111 Mich App 538, 543; 314 NW2d 685 (1981) (“The fact that Mrs. Brown might use her ‘on call’ time to perform household tasks does not alter the ‘nature of the service provided’ or the ‘need’ for the service.”).
See Griffith, 472 Mich at 535.
Krohn v Home-Owners Ins Co, 490 Mich 145, 163; 802 NW2d 281 (2011).
Douglas, unpub op at 4.
Although the circuit court’s opinion following the trial referred to Dr. Rosenbaum’s affidavit in its conclusion that attendant care services were reasonably necessary, during trial the court had sustained defendant’s objection to the admission of that affidavit. However, its reason for granting defendant’s objection was that the court had “heard [Dr. Rosenbaum’s] live testimony.” Because that live testimony clearly supports the circuit court’s factual finding, and because the circuit court specifically concluded that Dr. Rosenbaum’s “opinion as to the reasonable attendant care needs of [p]laintiff is both appropriate and convincing,” the circuit court’s error in referring to Dr. Rosenbaum’s affidavit, rather than his live testimony, is harmless. See MCR 2.613(A) (“[A]n error in a ruling or order ... is not ground for granting a new trial, for setting aside a verdict, or for vacating, modifying, or otherwise disturbing a judgment or order, unless refusal to take this action appears to the court inconsistent with substantial justice.”).
Manley, 425 Mich at 159 (emphasis added); see also Proudfoot v State Farm Mut Ins Co, 469 Mich 476, 484; 673 NW2d 739 (2003) (holding that “[b]ecause the expenses in question were not yet ‘incurred,’ the Court of Appeals erred in ordering defendant to pay the total amount to the trial court” for disbursal to plaintiff as expenses are incurred).
Nasser v Auto Club Ins Ass’n, 435 Mich 33, 50; 457 NW2d 637 (1990).
Proudfoot, 469 Mich at 484, quoting Webster’s II New College Dictionary (2001) (alterations in original).
1 Shorter Oxford English Dictionary (6th ed), p 385.
Of course, a caregiver who provides services to a family member need not present a formal bill to the family member or enter into a formal contract with that family member in order to satisfy the requirement that the caregiver have an expectation of payment from the insurer (although those arrangements will, of course, satisfy the evidentiary
Burris v Allstate Ins Co, 480 Mich 1081 (2008).
Id. The dissent reintroduces the Burris dissent’s claim that the interpretation of the word “incur” in Proudfoot “was limited to the facts of that case, in which the plaintiff sought advance payment for future expenses.” Post at 281, citing Burris, 480 Mich at 1088 (Weaver, J., dissenting). However, the Burris concurrence correctly explained that “[t]his factual distinction... is irrelevant to the Proudfoot Court’s discussion of the meaning of the term ‘incur.’ ” Burris, 480 Mich at 1084 (CORRIGAN, J., concurring). Proudfoot adopted the dictionary definition of the word “incur,” which requires “a legal or equitable obligation to pay.” Id. Because “there is no basis to treat family members differently than hired attendant-care-service workers . .., the insured’s family members and friends, just like any other provider, must perform the services with a reasonable expectation of payment.” Id. at 1085. For these reasons, we reject the dissent’s characterization of Proudfoot.
Proudfoot, 469 Mich at 484 n 4.
Because MCL 500.3107(1)(a) does not distinguish “charges incurred” for a family member’s services from “charges incurred” for a professional healthcare provider’s services, it is the dissent’s position that lacks support in the statutory language. Put simply, “charges” must he “incurred” in order to be compensable under the no-fault act. It is this statutory language that we must consider as the expression of legislative intent because “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.” Roberts v Mecosta Co Gen Hosp, 466 Mich 57, 63; 642 NW2d 663 (2002).
See Advocacy Org for Patients & Providers v Auto Club Ins Ass’n, 257 Mich App 365, 380; 670 NW2d 569 (2003) (noting the preponderance of the evidence standard for proof that an allowable expense is reasonable and necessary), aff'd 472 Mich 91 (2005).
In Proudfoot, we reiterated that payments for future services and products are not due until the expenses are actually incurred. For instance, we explained that while “[a] trial court may enter ‘a declaratory judgment determining that an expense is both necessary and allowable and the amount that will be allowed!,] •. . [s]uch a declaration does not oblige a no-fault insurer to pay for an expense until it is actually incurred.’ ” Proudfoot, 469 Mich at 484, quoting Manley, 425 Mich at 157.
Burris, 480 Mich at 1081.
As noted previously, it would seem to be inherent in the notion of expectation of compensation that there is some requirement for the caregiver to give notice to the insurer that payment is being sought for particular compensable services. However, MCL 500.3107(1)(a) does not require a claim for allowable expenses to occur within any particular time. Nevertheless, the one-year-back rule may preclude recovery for a claimant who sits on his or her entitlement to benefits without doing anything to attempt recovery (including commencing a lawsuit). Thus, MCL 500.3145(1) states that a claimant “may not recover benefits for any portion of the loss incurred more than 1 year before the date on which the action was commenced.”
Contrary to the dissent’s suggestion, this observation does not in any way invade the province of the fact-finder, who remains in the best position to weigh the credibility of all the evidence that a claimant presents to support a claim of entitlement to benefits.
Douglas, unpub op at 7.
Id.
Id.
Id. Plaintiff did not cross-appeal the Court of Appeals’ determination that the circuit court clearly erred by awarding PIP benefits for allowable expenses without sufficient proof to support the underlying award.
The court explained, for instance, that “Katherine is the person to [provide care], but she cannot because she is employed full-time outside of the home and because [defendant will not pay the appropriate care rate for any hours of her care for [p]laintiff.”
Defendant claims that the Court of Appeals’ decision to remand was improper because plaintiff already had an opportunity to present proofs regarding the attendant care services that Mrs. Douglas provided.
Douglas, unpub op at 7. The only discernable significance of that date in the record is that November 7, 2006, represents the date plaintiff began treatment with Dr. Rosenbaum. While we considered the significance of this date in determining whether services were “reasonably necessary” in the absence of a specific prescription for attendant care, this date has no independent significance in determining whether services were actually incurred.
We also note the observation of the Court of Appeals that the circuit court failed to consider the extent to which defendant had already paid benefits for the attendant care services that Mrs. Douglas performed while serving as Dr. Rosenbaum’s employee. Any award issued on remand must not include services that have already been reimbursed.
MCL 500.3107(1)(a).
Bonkowski v Allstate Ins Co, 281 Mich App 154, 164; 761 NW2d 784 (2008), citing Van Matter, 114 Mich App at 180-181.
Bonkowski, 281 Mich App at 165.
id.
Contrary to the dissent’s suggestion, we believe that in appropriate circumstances the fact-finder should consider benefits that a full-time attendant care services employee would receive as part of her total compensation package. Indeed, Bonkowski’s use of the term “compensation,” rather than “wage,” further supports this conclusion. Bonkowski, 281 Mich App at 165.
While this case is not about the admissibility of the agency rates, which may in fact be helpful to the fact-finder as a point of comparison in determining a reasonable charge for an individual’s provision of attendant care services, in this instance, we conclude that the fact-finder clearly erred by adopting that rate as the appropriate hourly rate for Mrs. Douglas’s provision of attendant care services.
The dissent’s claim that “the trial court heard testimony from which it could conclude that Mrs. Douglas would need to quit her job outside the home in order to provide plaintiff with the attendant care his doctor prescribed” is simply irrelevant to determining the reasonable charge for attendant care services that were provided while Mrs. Douglas was employed outside the home. Post at 293-294.
See Griffith, 472 Mich at 532 n 8.
Id. at 534.
Dissenting Opinion
(dissenting). I dissent from the majority’s erroneous interpretation of the phrase “charges incurred” in MCL 500.3107(1)(a) and the resulting creation of evidentiary requirements that lack any basis in the statutory language. Likewise, I dissent from the majority’s misguided limitation on the scope of evidence that may be considered when determining whether a charge is “reasonable” under MCL 500.3107(1)(a).
Although the rules of statutory interpretation are well established, a brief review is warranted, given the majority’s failure to adhere to these principles. This Court’s primary goal is to “discern and give effect to the intent of the Legislature.” Sun Valley Foods Co v Ward, 460 Mich 230, 236; 596 NW2d 119 (1999). “The words of a statute provide the most reliable evidence of its intent. ...” Id. (quotation marks and citation omitted). When the language of a statute is unambiguous, “the
I. “CHARGES INCURRED”
Under MCL 500.3107(1)(a), personal protection insurance (PIP) benefits include “allowable expenses.” The statute goes on to explain that an “allowable expense” consists of, among other things, “charges incurred” for certain qualifying products or services. From the words “charges incurred,” the majority mysteriously divines new evidentiary requirements that an insured must satisfy in order to obtain PIP benefits. Specifically, the majority determines that, in order to show that charges were incurred, an insured must establish (1) that the caregiver expected compensation for the services rendered, see ante at 267, and (2) that the caregiver’s expectation of payment arose “at the time [the caregiver] provided the services,” see ante at 271.
A. CAREGIVER’S EXPECTATION OF COMPENSATION
I disagree with the majority’s conclusion that MCL 500.3107(l)(a) requires a showing that the caregiver expected compensation. Rather, I continue to believe that the caregiver’s expectation of payment is irrelevant because the obligation to pay “charges incurred”
In addition, I disagree with the majority’s effort to further hamstring insureds’ ability to recover PIP benefits to which they are entitled by imposing burdensome and statutorily unsupported preferences for specific documentary evidence. See ante at 269-270 (stating that the “best way of proving” that a caregiver expected payment is a “formal bill” or “memorialized state
Although the majority may be correct that certain types of evidence may be more persuasive under the specific circumstances of a particular case, by discussing the persuasiveness of various forms of evidence in absolutes, the majority invades the province of the fact-finder. See People v Wolfe, 440 Mich 508, 514; 489 NW2d 748 (1992) (“[A]ppellate courts are not juries, and . . . they must not interfere with the jury’s role[.]”). Indeed, this error in the majority’s approach is exposed in its discussion of the specific facts of this case, particularly the majority’s statement that failure to provide certain documents “implicates [the caregiver’s] credibility .. . .” Ante at 271. However, contrary to the majority’s willingness to weigh in on witness credibility, this Court has frequently stated that appellate courts
must remember that the jury is the sole judge of the facts. It is the function of the jury alone to listen to testimony, weigh the evidence and decide the questions of fact.... Juries, not appellate courts, see and hear witnesses and are in a much better position to decide the weight and credibility to be given to their testimony. [Wolfe, 440 Mich at 514-515 (quotation marks and citation omitted).]
In summary, I disagree with the majority’s conclusion that an insured must prove that a family caregiver expected compensation in order to prove that charges were incurred for purposes of MCL 500.3107(1)(a). In my view, the insurer incurs the charge by way of its
B. TIMING OF EXPECTATION AND REQUEST FOR PAYMENT
The majority creates another unsupported and previously nonexistent requirement when it states that a caregiver must expect compensation “at the time the services were rendered.” Ante at 269-270; see, also, ante at 271 (stating that the “circuit court failed to make a finding regarding.. . whether Mrs. Douglas expected compensation or reimbursement at the time she provided the services”) (emphasis added). Again, the majority fails to identify any support for this new timing requirement in either the caselaw or the statutory language of MCL 500.3107(1)(a). The reason for the majority’s failure to do so is obvious: there simply is no support for the majority’s judicially created requirement. This is particularly notable given that members of the majority have often railed against extratextual requirements. See, e.g., People v Schaefer, 473 Mich
Although the lack of support in the statutory language is reason enough to reject the majority’s analysis, the practical implications of the majority’s burdensome
Additionally, by requiring that the caregiver expect compensation at the time the services are provided, the majority fails to recognize the reality of situations in which attendant-care services are needed. Specifically, claims for PIP benefits arise out of automobile-related accidents, which were typically sudden, unexpected events. Accordingly, family members may unexpectedly be called upon to immediately provide care to a loved one. Given the nature of most families, I believe that in the vast majority of situations, the family member would be willing to provide the care, at least initially, without any contemporaneous expectation of compensation from anyone. Thus, I believe that it may be fairly common that the caregiver is initially not even aware of the possibility of compensation and the process that must be completed in order to recover that compensation. Indeed, not every citizen is an attorney well versed in the intricacies of the no-fault act. As a result, at the time the services were provided, the caregiver would have no expectation that anyone will provide compensation. Yet under the majority’s analysis, if a family member did not expect compensation at the time the services were provided, despite the sudden and chaotic circumstances of the situation, he or she is not entitled
II. DETERMINING WHAT IS A “REASONABLE CHARGE”
Under MCL 500.3107(1)(a), PIP benefits are payable for “allowable expenses” as long as the charge is “reasonable.”
Although the majority concludes that agency rates are both relevant and admissible in determining a “reasonable charge” under MCL 500.3107(1)(a), see ante at 276 n 79 (stating that “this case is not about the admissibility of the agency rates” because agency rates “may in fact be helpful to the fact-finder as a point of comparison in determining a reasonable charge for an individual’s provision of attendant care services”); and ante at 276 (stating that “an agency rate might bear some relation to an individual’s rate”), the majority nevertheless relies exclusively on the Court of Appeals’ opinion in Bonkowski v Allstate Ins Co, 281 Mich App 154, 165; 761 NW2d 784 (2008), which expressly stated
To begin with, Bonkowski readily admitted that its entire discussion of the rate of compensation was dictum, stating that issue was not “squarely before” the Court. Id. at 164. Moreover, without justification, Bonkowski admittedly ignored caselaw that found agency rates relevant to determining the proper rate of compensation for a family member’s provision of care. Id. (acknowledging that the Court of Appeals had “previously embraced the notion that ‘comparison to rates charged by institutions provides a valid method for determining whether the amount of an expense was reasonable and for placing a value on comparable services performed [by family members]’ ”), quoting Manley v Detroit Auto Inter-Ins Exch, 127 Mich App 444, 455; 339 NW2d 205 (1983) (alteration in original). Further, Bonkowski cited no authority in support of its preferred approach to determining the proper rate of compensation for attendant care provided by unlicensed family members.
Most importantly, however, Bonkowski is poorly reasoned and, as a result, unpersuasive. Particularly unpersuasive is the notion that only the hourly rate paid to an attendant-care-services provider by an agency is relevant. Indeed, even the majority rejects this perspective. See ante at 276 n 79 (acknowledging that agency rates “may in fact be helpful to the fact-finder”).
Hardrick, 294 Mich App at 678-679, first noted that the question whether expenses are reasonable is generally a question for the fact-finder, as this Court stated in Nasser, 435 Mich at 55. Second, Hardrick agreed with Bonkowski that “the rates charged by an agency to provide attendant-care services are not dispositive of the reasonable rate chargeable by a relative caregiver,” but the opinion also concluded that “this does not detract from the relevance of such evidence.” Hardrick, 294 Mich App at 666. Accordingly, I find persuasive Hardrick’s decision to review the issue through the lens of the admissibility of evidence. Hardrick explained that evidence is “relevant” and thus “material” when it helps prove a proposition that is a “material fact at issue.” Id. at 667-668. Because the “material fact at issue” is the reasonable rate for attendant-care services for an insured, and insurers routinely pay agency rates for attendant-care services, Hardrick concluded that agency rates are relevant to determining the proper compensation for relative caregivers. Hardrick emphasized that the issue “is not whether an agency rate is reasonable per se under the circumstances, but whether evidence of an agency rate may assist a jury in determining a reasonable charge for family-provided attendant-care services.” Id. at 669. Accordingly, because an agency rate commonly paid by insurers “ ‘throws some light, however faint,’ on the reasonableness of a charge for attendant-care services,” it is admissible. Id., citing Beaubien v Cicotte, 12 Mich 459, 484 (1864).
Indeed, by adopting Bonkowski's emphasis on an individual caregiver’s hourly rate, the majority’s approach ignores other relevant considerations. For example, the family member might be forced to abandon a more lucrative career or move a great distance in order to be able to provide long hours of care to a loved one over an extended period. Additionally, the majority’s
Furthermore, by implying that certain evidence is deserving of greater consideration when determining a “reasonable charge,” the majority risks making the possibility of family-provided attendant care unattainable for a large number of no-fault insureds because their family members simply cannot afford to suffer the financial ramifications of that decision. This result not only potentially places families in the unenviable position of being forced to institutionalize a family member in order to make a fair living, but it also runs counter to one of the goals of the no-fault act: to keep no-fault
Finally, although the majority is correct that this Court has not previously considered this exact issue, the Court of Appeals’ approach in Hardrick is more consistent with this Court’s opinion in Manley, 425 Mich at 154, which considered the “reasonable charge” aspect of MCL 500.3107(1)(a) and held that evidence of a daily charge by facilities for “room and board” is admissible to determine a parent’s costs for room and board of a disabled child in the parent-caregiver’s home. See, also, Manley, 425 Mich at 169 (BOYLE, J., concurring in part and dissenting in part) (stating that “comparison to rates charged by institutions provides a valid method for determining whether the amount of an expense was reasonable and for placing a value on comparable services performed by [a family member]”) (quotation marks and citation omitted). Thus, given this Court’s guidance on the issue in Manley, and because I believe that Hardrick’s analysis is more thorough and well reasoned than Bonkowski’s, I would adopt Hardrick’s analysis.
Applying Hardrick’s approach to this case, I would affirm the trial court’s conclusion that $40 an hour is a “reasonable charge.” The majority claims that the trial court’s finding is “unjustified on this record”; however, the majority fails to consider a variety of factors that were before the fact-finder in this case. Specifically, the trial court heard testimony from which it could conclude that
III. CONCLUSION
In summary, I dissent from the majority’s effort to extend the erroneous interpretation of MCL 500.3107 from Griffith. Specifically, I disagree with the majority’s
Additionally, I continue to believe that the interpretation of MCL 500.3105 and MCL 500.3107 from the majority opinion in Griffith v State Farm Mut Auto Ins Co, 472 Mich 521; 697 NW2d 895 (2005), which the majority applies in this case, is incorrect for the reasons provided in Justice Marilyn Kelly’s Griffith dissent. See id. at 542-554 (Marilyn Kelly, J., dissenting).
Included within the majority’s conclusion that a caregiver must expect payment is an additional preference that documentation of the charges be provided in a “memorialized statement” because the majority considers such documentation to be the “best way of proving” entitlement to PIP benefits. Ante at 269-270. For the reasons discussed in part 1(A), I disagree.
As the majority opinion states, a formal bill or memorialized statement is not the only method sufficient to show that an insured is entitled to PIP benefits. See ante at 270 (acknowledging that “a caregiver’s testimony can allow a fact-finder to conclude that expenses have been incurred”). Accordingly, despite the majority’s unsupported conclusion that documentary evidence is “best,” any form of admissible evidence could be equally sufficient to meet an insured’s burden to prove that services were actually rendered.
The majority apparently interprets my dissent as asserting that when a family member provides care, the insured need not provide any evidence that attendant care was actually provided. See ante at 269 n 60. This is not an accurate characterization of my dissent, however, because I agree that an insurer “is not obligated to pay any amount except upon submission of evidence that services were actually rendered . ...” Manley, 425 Mich at 159. Rather, as I previously stated, I disagree with the majority’s unsupported preference for specific documentary evidence
See, also, Johnson v Recca, 492 Mich 169, 196-197; 821 NW2d 520 (2012), stating that
it must be assumed that the language and organization of the statute better embody the “obvious intent” of the Legislature than does some broad characterization surmised or divined by judges.... It is not for this Court to “enhance” or to “improve upon” the work of the lawmakers where we believe this can he done, for it will always he easier for 7 judges on this Court to reach agreement on the merits of a law than 110 state representatives and 38 state senators representing highly diverse and disparate constituencies. Therefore, this Court must.. . rest its analysis on the language and organization of the statute.
The majority also expresses its belief that an insured should submit evidence “to the insurer within a reasonable amount of time after the services were rendered,” ante at 270 (emphasis added). See, also, ante at 270 (discussing the “risk” of “fail[ing] to request reimbursement for allowable expenses in a timely fashion ....”) (emphasis added). However, the majority admits that “MCL 500.3107(1)(a) does not require a claim for allowable expenses to occur within any particular time.” Ante at 270 n 64. Thus, it is unclear to me why the majority chooses to create potential confusion by injecting the statutorily unsupported phrases “within a reasonable amount of time” and “in a timely fashion” into its application of MCL 500.3107(1)(a).
The majority dismisses as unfounded my concerns regarding the practicalities of the majority’s new requirements, stating that “[cjontrary to the dissent’s suggestion, a family member’s determination to provide care even in the absence of an insurer’s payment is not inconsistent with expecting compensation from the insurer, but the expectation must nevertheless be present for a charge to be incurred within the meaning of MCL 500.3107(1)(a).” Ante at 268 n 56. However, this statement only addresses the source of the compensation, not the timing of when the caregiver developed the expectation of payment, regardless of the source. Under the circumstances that I discuss, the family caregiver does not expect compensation “at the time the services were rendered,” ante at 269-270, which is an express requirement of the majority’s erroneous interpretation of MCL 500.3107(1)(a). The majority claims that its requirement that compensation be expected at the time the services were provided “simply applies the dictionary definitions of the statutory phrase ‘charges incurred.’ ” Ante at 268 n 56. However, even accepting the dictionary definitions that the majority selects, there is clearly no time component to those definitions. See ante at 267 (defining “incur” as “[t]o become liable or subject to, [especially] because of one’s own actions,” and' “charge” as a “[pecuniary burden, cost” or “[a] price required or demanded for service rendered or goods supplied”) (quotation marks and citations omitted). Indeed, applying these definitions, it is clear that a person could “become liable” for “a price demanded for services” after the services are rendered.
The majority incorrectly states that “the fact-finder must determine what is a reasonable charge for an individual’s provision of services ....” Ante at 276. Rather, the plain language of MCL 500.3107(1)(a) simply requires that the charge be “reasonable.” Accordingly, although what an
The majority, however, also risks creating confusion when it states that the amount Mrs. Douglas was paid while employed by Dr. Rosenbaum “is highly probative of what constitutes a reasonable charge for her services” because “this figure is the rate she actually received for providing attendant care services .. ..” Ante at 277. This statement could be misinterpreted and lead lower courts to conclude that a professional caregiver’s hourly rate is the only relevant evidence. Thus, to clarify, I
I recognize that the majority briefly considers the issue of fringe benefits, see ante at 272 n 69, but the majority relegates the issue to a mere secondary consideration by repeatedly emphasizing that “Mrs. Douglas actually received $10 an hour in providing attendant care services to plaintiff,” ante at 277. See, also, ante at 277 (stating that the $10 an hour rate is “highly probative” of what is a reasonable charge under MCL 500.3107(l)(a) because it was “the rate [Mrs. Douglas] actually received for providing attendant care services”).
