MALICK GUEYE, Plaintiff-Appellant, v STATE
No. 358992
STATE OF MICHIGAN COURT OF APPEALS
September 22, 2022
FOR PUBLICATION. Oakland Circuit Court LC No. 2021-186759-NI. 9:30 a.m.
If this opinion indicates that it is “FOR PUBLICATION,” it is subject to revision until final publication in the Michigan Appeals Reports.
Before: CAVANAGH, P.J., and GARRETT and YATES, JJ.
GARRETT, J.
Plaintiff Malick Gueye appeals as of right the trial court‘s order dismissing Gueye‘s claims against defendant State Farm for both uninsured/underinsured motorist (UM/UIM) benefits and no-fault personal protection insurance (PIP) benefits. We affirm the portion of the order dismissing Gueye‘s UM/UIM claim but remand for the trial court to determine whether dismissal is with or without prejudice. We vacate the portion of the order dismissing Gueye‘s no-fault claim and remand for further proceedings.
I. FACTUAL BACKGROUND
This case arises out of an automobile accident involving Gueye and defendant, Shannon Lee Hood,1 that occurred on March 8, 2020. After the accident, Gueye filed a claim with State Farm, his automobile insurer. State Farm requested that Gueye appear for an insurance medical
Gueye filed a complaint on March 8, 2021, alleging that State Farm had unreasonably refused to pay him both UM/UIM benefits and nо-fault PIP benefits under the Michigan no-fault act,
In an order, the trial court concluded:
Defendant correctly states that the Michigan No-Fault Act does not require insurers to provide [UM or UIM] protection. When this coverаge is elected the provisions of the contract, rather than statute, govern all disputes.
The contract between the parties clearly states that Plaintiff‘s submission to both an independent medical examination (IME) and an examination under oath (EUO) are required as conditions precedent to the Plaintiff‘s ability to file suit. Plaintiff failed to submit to either an IME or an EUO prior to filing the Complaint in this matter. When Defendant learned that a Complaint was forthcoming, it stated that the examinations were unnecessary, as they would be duplicative of discovery in the matter.4 Plaintiff claims that this amounts to waiver by Defendant. This argument fails, as the lawsuit was already in motion.5 Accordingly, the Plaintiff‘s claims for UM/UIM [benefits] are denied.
Conversely, PIP benefits are statutorily required. Plaintiff‘s failure to submit to an IME or to an EUO as required by
MCL 500.3151 andMCL 500.3153 respectively,preclude Plaintiff from receiving benefits. Each section requires the Plaintiff to submit to examinations to be entitled to PIP benefits. The Plaintiff has submitted to neither the IME nor the EUO. For these reasons, Defendant‘s Motion for Summary Disposition and Dismissal of PIP and UM/UIM benefits is granted, and the case is hereby dismissed.
Gueye moved the trial court for reconsideration, arguing in part that the severe sanction of dismissal for missed IMEs was not a “just” order under
II. UM/UIM BENEFITS
Gueye argues that the trial court erred by granting summary disposition to State Farm and dismissing his claim for UM/UIM benefits.
A. STANDARD OF REVIEW
We review de novo a trial court‘s decision on a motion for summary disposition under
Under
We also review de novo the interpretation of a contract, such as an insurance policy. Webb v Progressive Marathon Ins Co, 335 Mich App 503, 507; 967 NW2d 841 (2021).
B. ANALYSIS
The no-fault act “created a compulsory motor vehicle insurance program under which insureds may recover directly from their insurers, without regard to fault, for qualifying economic losses arising from motor vehicle incidents.” McCormick v Carrier, 487 Mich 180, 189; 795 NW2d 517 (2010). The no-fault act, however, does
Insurance contracts are subjеct to the rules of contractual interpretation, and “the primary goal is to honor the intent of the parties.” Webb, 335 Mich App at 507-508 (quotation marks and citation omitted). “Where the language of an insurance policy is clear and unambiguous, it must be enforced as written.” Auto-Owners Ins Co v Harvey, 219 Mich App 466, 469; 556 NW2d 517 (1996). “An insurer is free to define or limit the scope of coverage as long as the policy language fairly leads to only one reasonable interpretation and is not in contravention of public policy.” Heniser v Frankenmuth Mut Ins Co, 449 Mich 155, 161; 534 NW2d 502 (1995). EUO provisions “require the insured to answer questions about the accident and damages claimеd,” and insurers conduct EUOs, in part, “to gather facts so as to discover and eliminate fraudulent insurance claims.” Cruz v State Farm Mut Auto Ins Co, 466 Mich 588, 597; 648 NW2d 591 (2002). An insurance policy provision requiring compliance with an EUO “before an insured has the right to bring an action against [an insurer]” is generally a valid and enforceable condition. Yeo v State Farm Ins Co, 219 Mich App 254, 257; 555 NW2d 893 (1996). Thus, “one who without cause refuses to submit to examination should be precluded from maintaining an action on the policy.” Id., quoting Gordon v St. Paul Fire & Marine Ins Co, 197 Mich 226, 230; 163 NW 956 (1917).
In this case, the insurance contract states that an insured making a claim for UM/UIM benefits “must, at [State Farm‘s] option, submit to an examination under oath . . . as reasonably often as [State Farm] require[s].” The insurance contract also states that a claimant for UM/UIM benefits must “be examined as reasonably often as [State Farm] may require by physicians, doctors, and healthcare professionals chosen and paid by [State Farm].” These two provisions establish that a claimant for UM/UIM benefits must (1) submit to an EUO as reasonably often as State Farm requires and (2) submit to an IME as reasonably often as State Farm requires. Finally, the insurance contract states that legal action may not be brought against State Farm if the claimant hаs not complied with the provisions described above. Put another way, compliance with a requested EUO or IME is a condition precedent7 to suing State Farm for UM/UIM benefits.
As discussed earlier, because UM/UIM benefits are not required by the no-fault act, the terms of the insurance contract control any potential entitlement to UM/UIM benefits. Stoddard, 249 Mich App at 460. The trial court correctly observed that the insurance contract unambiguously provided that “Plaintiff‘s submission to both an [IME] and an [EUO] are required as conditions precedent to the Plaintiff‘s ability to file suit.” This was a valid and enforceable contract рrovision, see Yeo, 219 Mich App at 257, and it is undisputed that Gueye failed to submit to both the IME and EUO that State Farm requested. Therefore, the trial court did not err in dismissing Gueye‘s claim for UM/UIM benefits because there was no genuine issue
Gueye asserts in response that State Farm “tacitly” waived the EUO requirement through its correspondence with Gueye‘s counsel and thus cannot rely on this policy provision to deny UM/UIM benefits. This argument misconstrues the facts and the law.
Gueye‘s argument rests of the following chain of events:
- On Octоber 12, 2020, State Farm followed up with Gueye‘s counsel about scheduling an EUO over Zoom.
- Gueye‘s counsel replied:
I would have as I indicated in my prior email; however, your client decided to suspend [Gueye‘s] benefits due to a single missed IME so I don‘t see the point in further cooperation. In light of that letter we are likely going to file a lawsuit shortly and will then have an obligation to sit for deposition anyway.
- On October 20, 2020, State Farm requested that Gueye appear for a November 10, 2020 EUO.
- On November 9, 2020, State Farm followed up on its request for a November 10, 2020 EUO.
- An employee of Gueye‘s counsel responded: “[Gueye‘s counsel] advised in his 10/12 email that a lawsuit would be forthcoming as benefits were previously terminated, and an EUO was duplicative of the deposition that will surely be taken during litigation.”
- State Farm responded: “Okay thanks – has suit been filed yet? Thanks and have a good one[.]”
These communications form the basis of Gueye‘s waiver argument.
A waiver is an “intentional relinquishment of a known right.” Reed Estate v Reed, 293 Mich App 168, 176; 810 NW2d 284 (2011) (quotation marks and citations omitted). Waiver “may be shown by express declarations or by declarations that manifest the parties’ intent and purpose.” Id. (quotation marks and citations оmitted). In other words, “[a] waiver may be shown by proof of express language of agreement or inferably established by such declaration, act, and conduct of the party against whom it is claimed as are inconsistent with a purpose to exact strict performance.” HJ Tucker & Assoc v Allied Chucker & Engineering Co, 234 Mich App 550, 564; 595 NW2d 176 (1999) (quotation marks and citation omitted).
Gueye failed to establish that State Farm expressly agreed to waive its contractual rights or made a declaration that inferred an intent to waive strict performance of the contract. Gueye repeatedly claims State Farm admitted the EUO was unnecessary, but a rеview of the e-mail communications above reveals no such admission. If anything, State Farm‘s communications reflect only (1) its attempts to offer Gueye a chance to submit to an EUO and (2) its unanswered inquiry into whether Gueye had filed his lawsuit yet. Neither of these communications expressly or impliedly establish an intent by State Farm to waive the EUO requirement. Indeed, State Farm‘s repeated attempts to schedule an EUO before Gueye filed suit would suggest otherwise.
Gueye attempts to characterize State Farm‘s final e-mail response as silence, arguing that such silence impliedly established assent to Gueye‘s position, but State Farm‘s response does not qualify as silence. It was merely a question about Gueye‘s potential lawsuit. Gueye also argues that State Farm‘s failure to issue another request for an IME or EUO after
Gueye also references the word “reasonably” in the EUO provision of the insurance contract, arguing that the EUO was not “reasonably” sought given the arbitrary nature of the scheduling process and State Farm‘s alleged unwillingness to accommodate his absence from the country. But the language of the insurance contract reveals that Gueye misconstrues the meaning of “reasonably.” The insurance contract states, in relevant part: “[E]ach insured, or any other person or organization making claim or seeking payment must, at our option, submit to an examination under oath, provide a statement under oath, or do both, as reasonably often as we require.” Thus, State Farm is not required to schedule the EUO “reasonably” based on Gueye‘s schedule or location; rather, the word “reasonably” refers to the frequency of State Farm‘s requests for an EUO. Gueye‘s interpretation of this language is therefore incorrect.
Finally, Gueye claims State Farm was the first to breach the insurance contract by denying his request for no-fault benefits, thereby relieving him of any obligations he might have had under the insurance contract. This argument falls short, however, for the simple reason that Gueye was the first party to breach the insurancе contract. The undisputed facts show that Gueye did not appear for the requested September 16, 2020 IME before State Farm denied his request for no-fault benefits. For all these reasons, the trial court did not err in dismissing Gueye‘s claim for UM/UIM benefits.
Although we agree that the trial court properly dismissed Gueye‘s claim for UM/UIM benefits, the trial court did not specify whether dismissal was with or without prejudice. In Thomson v State Farm Ins Co, 232 Mich App 38, 45; 592 NW2d 82 (1998), this Court addressed whether the failure to comply with an EUO policy provision should result in dismissal with or without prejudice. The Thomson Court held: “[I]f the noncompliance is wilful, the dismissal must be with prejudice; if the nоncompliance is not wilful, the dismissal must be without prejudice.” Id. at 55. This Court explained that willful noncompliance “involves something more than merely knowingly failing to appear for an EUO.” Id. at 46. Instead, willful noncompliance in this context means
. . . [A] failure or refusal to submit to an EUO or otherwise cooperate with an insurer in regard to contractual provisions allowing an insurer to investigate a claim that is part of a deliberate effort to withhold material information or a pattern of noncooperation with the insurer. [Id. at 50.]
Consistent with Thomson, we direct the trial court, on remand, to determine whether dismissal of Gueye‘s UM/UIM claim should be with or without prejudice. We otherwise affirm the trial court‘s order of dismissal as to the UM/UIM claim.
III. NO-FAULT BENEFITS
Gueye also argues that the trial court erred in dismissing his claim for no-fault benefits and contends that the trial court should have, at the very least, chosen a more “just” sanction for Gueye‘s missed IME.
A. STANDARD OF REVIEW
We review the trial court‘s decision to dismiss an action for an abuse of discretion. Maldonado v Ford Motor Co, 476 Mich 372, 388; 719 NW2d 809 (2006). The trial court abuses its discretion when it chooses an outcome outside the range of principled outcomes. Id. Any factual findings underlying the trial court‘s decision are reviewed for clear error. Hardrick v Auto Club Ins Ass‘n, 294 Mich App 651, 660; 819 NW2d 28 (2011). “A finding is cleаrly erroneous when this Court is left with a definite and firm conviction that a mistake has been made.” Id. (quotation marks and citation omitted).
B. ANALYSIS
Unlike UM/UIM benefits, no-fault benefits are statutorily required by the no-fault act.
If the mental or physical condition of a person is material to a claim that has been or may be made for past or future personal protection insurance benefits, at the request of an insurer the person shall submit to mental or physical examination by physicians. A personal protection insurer may include reasonable provisions that are in accord with this section in a personal protection insurance policy for mental and physical examination of persons claiming personal protection insurance benefits. [Emphasis added.]
Second,
A court may make such orders in regard to the refusal to comply with sections 3151 and 31528 as are just, except that an order shall not be entered directing the arrest of a person for disobeying an order to submit to a physical or mental exаmination. The orders that may be made in regard to such a refusal include, but are not limited to:
(a) An order that the mental or physical condition of the disobedient person shall be taken to be established for the purposes of the claim in accordance with the contention of the party obtaining the order.
(b) An order refusing to allow the disobedient person to support or oppose designated claims or defenses, or prohibiting him from introducing evidence of mental or physical condition.
(c) An order rendering judgment by default against the disobedient person as to his entire claim or a designated part of it.
(d) An order requiring the disobedient person to reimburse the insurer for reasonable attorneys’ fees and expenses incurred in defense against the claim.
(e) An order requiring delivery of a report, in conformity with section 3152, on such terms as are just, and if a physician fails or refuses to make the report a court may exclude his testimony if offered at trial. [Emphasis added.]
In other words, “[t]o allow for enforcement, should it be needed, the Legislature, in [
Trial courts should consider the following nonexhaustive factors before imposing the severe sanction of dismissal:
(1) whether the violation was wilful or accidental; (2) the party‘s history of refusing to comply with previous court orders; (3) the prejudice to the opposing party; (4) whether there exists a history of deliberate delay; (5) the degree of compliance with other parts of the court‘s orders; (6) attempts to cure thе defect; and (7) whether a lesser sanction would better serve the interests of justice. [Vicencio v Ramirez, 211 Mich App 501, 507; 536 NW2d 280 (1995), citing Dean v Tucker, 182 Mich App 27, 32-33; 451 NW2d 571 (1990).]
Before dismissing a case, “the trial court is required to carefully evaluate all available options on the record and conclude that the sanction of dismissal is just and proper.” Vicencio, 211 Mich App at 506. The trial court must also explain its reasons for dismissal on the record “in order to allow for meaningful appellate review.” Kalamazoo Oil Co, 242 Mich App at 88.
The trial court dismissed Gueye‘s no-fault PIP claim under
In Drew v Nationwide Mut Fire Ins Co, unpublished per curiam opinion of the Court of Appeals, issued August 18, 2022 (Docket No. 358546), pp 1-2, this Court decided the issue before us: an appeal of a trial court‘s order granting the defendant‘s motion to dismiss for the plaintiff‘s failure to attend scheduled IMEs in violation of
While defendant suggests that prior cases from this court involved discovery violations and did not exclusively involve a plaintiff‘s failure to submit for an IME, we see no reason to depart from the long line of cases holding that an abuse of discrеtion occurs when a court fails to place its reasoning and consideration of alternative sanctions on the record. [Id.]
The Drew Court was also unpersuaded by the defendant‘s argument that “because this was a statutory violation under the no-fault act, and not merely a discovery violation,” the trial court did not have to consider alternative sanctions other than dismissal. Id. at 5.10 We find Drew highly persuasive and adopt its analysis.11
Additionally, we are unconvinced that this case, which involved a pre-litigation missed IME,12 should be treated differently than Drew, which involved a failure to appear for multiple IMEs scheduled during litigation. Importantly, the application of
On the other hand,
Here, the trial court did not properly analyze whether dismissal of Gueye‘s no-fault claim for failure to attend IMEs was a just and proper sanction. The trial court simply ruled:
Plaintiff‘s failure to submit to an IME or to an EUO as required by
MCL 500.3151 andMCL 500.3153 respectively,14 preclude Plaintiff from receiving benefits. Each section requires the Plaintiff to submit to examinations to be entitled to PIP benefits. The Plaintiff has submitted to neither the IME nor the EUO.
The trial court‘s analysis implies that dismissal was mаndatory under the circumstances, but the no-fault act establishes that is not so. As noted above,
On remand, the trial court should consider the applicable factors discussed in Vicencio to determine whether the sanction of dismissal is appropriate for Gueye‘s no-fault claim. This includes “the party‘s history of refusing to comply with previous court orders.” Vicencio, 211 Mich App at 507. From our review of the rеcord, it does not appear that State Farm ever moved to compel Gueye‘s attendance at an IME once litigation began. While noncompliance with a court order compelling attendance at an IME is not required to dismiss the case, whether any court orders were violated is a proper consideration on remand. The Vicencio factors also include “whether a lesser sanction would better serve the
IV. CONCLUSION
For Gueye‘s UM/UIM claim, we affirm this portion of the trial court‘s order of dismissal because the insurance contract governs this coverage and requires compliance with a requested EUO and IME before filing suit. But we remand for the trial court to determine whether dismissal of the UM/UIM claim should be with or without prejudice. For Gueye‘s no-fault claim, we vacate this portiоn of the trial court‘s order of dismissal and remand for further proceedings under the proper analysis for dismissing a case under
We affirm in part, vacate in part, and remand for further proceedings consistent with this opinion. We do not retain jurisdiction.
/s/ Kristina Robinson Garrett
/s/ Mark J. Cavanagh
/s/ Christopher P. Yates
