SPECTRUM HEALTH HOSPITALS, Plaintiff-Appellant, v. MICHIGAN ASSIGNED CLAIMS PLAN, MICHIGAN AUTOMOBILE INSURANCE PLACEMENT FACILITY, and JOHN DOE INSURANCE COMPANY, Defendants-Appellees.
No. 343563
STATE OF MICHIGAN COURT OF APPEALS
September 24, 2019
If this opinion indicates that it is “FOR PUBLICATION,” it is subject to revision until final publication in the Michigan Appeals Reports.
S T A T E O F M I C H I G A N
C O U R T O F A P P E A L S
SPECTRUM HEALTH HOSPITALS,
Plaintiff-Appellant,
v
MICHIGAN ASSIGNED CLAIMS PLAN, MICHIGAN AUTOMOBILE INSURANCE PLACEMENT FACILITY, and JOHN DOE INSURANCE COMPANY,
Defendants-Appellees.
FOR PUBLICATION
September 24, 2019
9:05 a.m.
No. 343563
Kent Circuit Court
LC No. 17-007964-NF
Before: SWARTZLE, P.J., and GLEICHER and M. J. KELLY, JJ.
The Michigan Assigned Claims Plan (MACP)/Michigan Automobile Insurance Placement Facility (MAIPF) rejected Spectrum Health Hospital’s claim for assignment because the injured party did not sign the assignment application. The purpose of the MACP is to ensure prompt coverage for persons injured in motor vehicle accidents when coverage cannot be found or is unavailable. To achieve that end, the MACP/MAIPF has extremely limited authority to deny claims for assignment—it may only deny an “obviously ineligible” claim. The absence of a signature does not meet that threshold. We reverse the award of summary disposition in the MACP/MAIPF’s favor and remand for entry of summary disposition in favor of Spectrum.
I. BACKGROUND
Robin Benoit was seriously injured on August 30, 2016, while a passenger in a vehicle involved in a single-car motor vehicle accident. Spectrum Health provided more than $129,000 in services to Benoit from August 30 through September 19, 2016. Benoit was not covered by any no-fault insurance policy. Upon Benoit’s admission, Spectrum secured a “verbal consent” witnessed by two staff members for a general assignment of rights; however, Benoit was “unable to sign.” The hospital did not secure a more specific assignment to apply to the Michigan Assigned Claims Plan (MACP)/Michigan Automobile Insurance Placement Facility (MAIPF) on
Benoit’s behalf. Spectrum allegedly misplaced the general assignment, then searched high and low for Benoit, but to no avail.
On August 10, 2017, almost a year after the accident, Spectrum filed an “application for
personal injury protection [PIP]
Spectrum provided the MACP/MAIPF a “list of steps taken to find Auto Insurance” along with the application. It described Spectrum’s attempts to contact Benoit by phone and mail, and to uncover additional contact information for its patient by searching various databases.
On August 14, 2017, the MACP/MAIPF sent Spectrum a generic form letter denying the application, stating:
We have received the application for benefits through the [MACP], which you submitted on 08/10/2017. After careful review it has been determined that your application is ineligible for assignment under Michigan No Fault Act. If you have any questions regarding this determination please contact a representative for the [MACP], operated by the [MAIPF].
Spectrum then hired a private investigator to continue the search for Benoit. The investigator learned that the address and phone number given by Benoit at the hospital actually belonged to a personal friend who refused to speak to the investigator. The investigator uncovered another address for Benoit, which was a vacant lot. Benoit’s former landlord had no forwarding information. On August 25, 2017, at 2:25 p.m., the investigator sent Benoit a private message on Facebook and she telephoned him five minutes later. Benoit indicated that at the time of the accident, her ex-boyfriend was driving his personal vehicle, which he had neither registered nor insured. Benoit confirmed that she did not own a vehicle, have no-fault insurance, or live with anyone who carried no-fault insurance at the time of the accident.
On August 28, 2017, Benoit met with the investigator in person and signed an “assignment of rights, benefits and causes of action” to permit Spectrum to seek PIP benefits on her behalf. Spectrum forwarded the assignment to the MACP/MAIPF by fax on August 30, 2017, the final day to timely file a claim. The cover sheet informed the MACP/MAIPF that
Spectrum had provided medical treatment to Benoit following her motor vehicle accident and that Spectrum had filed an application for assignment on August 10. Spectrum requested, “Please assign the claim, and notify us as to the assigned carrier.”
The MACP/MAIPF immediately notified Spectrum that it was “unable to process the
claim you have submitted on behalf of”
That same day, Spectrum filed suit for mandamus and declaratory relief, asserting that
the MACP/MAIPF had a clear legal and ministerial duty to assign the claim to a no-fault insurer
under
A person claiming through the [MACP] shall notify the [MAIPF] of his or her claim within the time that would have been allowed for filing an action for [PIP] benefits if identifiable coverage applicable to the claim had been in effect. The [MAIPF] shall promptly assign the claim in accordance with the plan and notify the claimant of the identity and address of the insurer to which the claim is assigned. . . . [
MCL 500.3174 , as amended by 2012 PA 204 (emphasis added).]1
The MACP/MAIPF bucked discovery attempts, contending that Spectrum’s application for assignment was facially deficient as Spectrum made inadequate efforts before filing to determine whether Benoit had available insurance coverage. It announced its intent to file a motion for summary disposition “to draw a line in the sand to prevent these efforts at obtaining assignment with little more than the most bare of information.” A subsequent summary disposition motion added that Spectrum did not have an independent right to assert a claim in its own name after Covenant Med Ctr, Inc v State Farm Mut Auto Ins Co, 500 Mich 191; 895 NW2d 490 (2017).2 The MACP/MAIPF further contended that the application was invalid because although Spectrum signed it as the preparer, no one signed as the claimant or claimant’s representative as required by the plan’s internal operating procedures. Specifically, Michigan Assigned Claims Plan, § 5.1(A)(1)(a)3 provides that “[a] claim for [PIP] benefits under the Plan must be made on an application prescribed by the MAIPF” and that the application “must be complete and signed by the claimant,” i.e., by “a person suffering accidental bodily injury arising
out of the ownership, operation, maintenance or use of a motor vehicle as a motor vehicle in this state.”
Spectrum replied that it was entitled to summary disposition because the MACP/MAIPF
was only authorized to reject an application if from the outset the claim was obviously ineligible
under the no-fault act. The standard did not require the applicant to conclusively prove that no
insurance was available, only that it made a good-faith effort to determine whether insurance was
available. With its response, Spectrum included an affidavit from Benoit, avowing that she was
merely a passenger in the vehicle involved in the accident and had no ownership or
At the hearing on the counter motions for summary disposition, the MACP/MAIPF agreed that it now had sufficient information that Benoit did not have insurance available to her at the time of the accident. However, it continued to insist that the application was invalid at its inception based on the absence of Benoit’s signature as claimant.
The circuit court agreed with the MACP/MAIPF and summarily dismissed Spectrum’s action. The court acknowledged that Spectrum secured an assignment from Benoit after it filed its application. However, the court reasoned, the focus was on the application and whether it was valid when originally filed. The plan rules required that the application be signed by the claimant or her representative and Spectrum did not sign in that capacity. And Spectrum did not file a new or amended application after locating Benoit. The court concluded, “I’m constrained to agree that while it’s a technical point, the law is full of technicalities, and in this case, the statute requires a person entitled to claim because of accidental bodily injury to file the request for the [MACP] to assign a carrier, and that person did not do so.” The application was therefore fatally “defective,” the court ruled.
The circuit court denied Spectrum’s subsequent motion for reconsideration. Spectrum now appeals.
II. STANDARD OF REVIEW
We review de novo a circuit court’s resolution of a summary disposition motion. Zaher v
Miotke, 300 Mich App 132, 139; 832 NW2d 266 (2013). A motion under
We also review de novo underlying issues of statutory interpretation. Joseph v Auto Club Ins Ass’n, 491 Mich 200, 205; 815 NW2d 412 (2012). The primary goal of statutory interpretation is to discern the intent of the Legislature. Id. The best indicator of the Legislature’s intent is a plain reading of the statutory language. Id. at 205-206. “If the statutory language is unambiguous, we presume that the Legislature intended the meaning that it clearly expressed, and further construction is neither required nor permitted.” Id. at 206.
III. GUIDING LEGAL PRINCIPLES
In 1973, the Legislature enacted the no-fault insurance act,
To achieve its goals, the Legislature required the “owner or registrant of a motor vehicle
required to be registered in this state” in relevant part to purchase PIP insurance to cover injuries
to persons caused by motor vehicles.
The Legislature initially required the Secretary of State to “organize and maintain” the
MACP/MAIPF. See 1972 PA 345. It further authorized the Secretary of State to “promulgate
rules to implement the facility and plan.”
the 11 governors were to be elected as provided in the plan of operation and four were to be selected by the insurance commissioner).
Although the Legislature authorized the MAIPF to establish its own MACP,
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 [PIP] benefits through the [MACP] if no [PIP] is applicable to the injury, no [PIP] applicable to the injury can be identified, the [PIP] applicable to the injury cannot be ascertained because of a dispute between 2 or more automobile insurers concerning their obligation to provide coverage or the equitable distribution of the loss, or the only identifiable [PIP] applicable to the injury is, because of financial inability of 1 or more insurers to fulfill their obligations, inadequate to provide benefits up to the maximum prescribed. . . . [ MCL 500.3172(1) , as amended 2012 PA 204.]
The phrase a “person entitled to claim” refers to a person who is entitled to claim PIP
benefits under the no-fault act. Allstate Ins Co v State Farm Mut Auto Ins Co, 321 Mich App
543, 558-559; 909 NW2d 495 (2017). And such a person may claim against the MACP when
any of the four following conditions are true: “(1) no [PIP] is applicable to the injury, (2) no
[PIP] applicable to the injury can be identified, (3) the applicable insurance cannot be ascertained
due to a dispute among insurers, or (4) the only applicable insurance is inadequate due to
financial inability.” W A Foote Mem Hosp v Mich Assigned Claims Plan, 321 Mich App 159,
170; 909 NW2d 38 (2017). The Legislature also disqualified some persons from coverage under
the MACP. See
In addition to establishing eligibility criteria and disqualifying factors, the Legislature
provided a framework for the processing, timing, and review of claims under the MACP. The
Legislature stated that a person who claims PIP benefits through the MACP must notify the
MAIPF of his or her claim within the time limit for filing a PIP claim with an insurer: “A person
claiming through the [MACP] shall notify the [MAIPF] of his or her claim within the time that
would have been allowed for filing an action for [PIP] benefits if identifiable coverage applicable
to the claim had been in effect.”
deny an obviously ineligible claim.”
IV. NOTICE
Spectrum gave the MACP/MAIPF the notice required under
The MACP/MAIPF did not promptly assign the claim. Indeed, it did not even comply
with
By the August 30, 2017 deadline for providing notice of its claim, Spectrum definitively
learned that the claim was eligible for assignment under the first condition of
Spectrum notified the MACP/MAIPF of the grounds supporting eligibility and the right
to assignment by also filing suit on August 30. This Court implicitly held in Mendelson
Orthopedics PC v Everest Nat’l Ins Co, ___ Mich App ___; ___ NW2d ___ (Docket No.
341013, 2019), slip op at 6-8, that a claimant can provide timely notice as required by
V. SIGNATURE REQUIREMENT
The MACP/MAIPF continues to argue, however, that Spectrum’s application was “obviously ineligible” for assignment because its rules mandated that Benoit or her
representative sign the application. The MACP/MAIPF contends that the claim remained “obviously ineligible” because Spectrum never submitted an amended application with a signature for the claimant or her representative.
We start by noting that nothing in the no-fault act requires a claimant to file a claim with the MACP/MAIPF on a form application or through communication signed by the claimant. These requirements come entirely from the “Michigan Assigned Claims Plan” “adopt[ed], implement[ed] and maintain[ed]” by the MAIPF. Michigan Assigned Claims Plan, § 1. Section 5.1(A) of the Plan provides, “A claim for [PIP] benefits under the [MACP] must be made on an application prescribed by the MAIPF.” The MAIPF requires that the application “be complete and signed by the claimant.” Michigan Assigned Claims Plan, § 5.1(A)(1)(a). The application also “must be accompanied by reasonable proof of loss, and documentation supporting that due diligence was exercised to establish the claimant is entitled to claim benefits through the [MACP].” Michigan Assigned Claims Plan, § 5.1(B)(1).
Mandating strict adherence to the minutiae of these notice provisions would be
inconsistent with Michigan law. Even with the notice provisions enacted by our Legislature in
the no-fault act, substantial compliance that fulfills the purpose of the statute is sufficient to
preserve a claim. Perkovich v Zurich American Ins Co, 500 Mich 44, 52; 893 NW2d 322 (2017).
The purpose of notice under
Ultimately, the MACP/MAIPF has only those rulemaking powers conveyed to it by the
Legislature. See Consumers Power Co v Public Serv Comm, 460 Mich 148, 155-156; 596
NW2d 126 (1999). The MACP/MAIPF’s powers must derive from
Contrary to the MACP/MAIPF’s contention,
The MACP/MAIPF is tasked only with making the initial determination of eligibility of a
claim and may only deny a claim if it is “obviously ineligible.”
As the MACP/MAIPF has conceded that the documentation presented by Spectrum during this suit supports assignment of the claim to a member insurer, there is no ground to remand this matter for further consideration. Accordingly, we reverse the award of summary disposition in the MACP/MAIPF’s favor and remand for entry of summary disposition in favor of Spectrum. We do not retain jurisdiction.
/s/ Brock A. Swartzle
/s/ Elizabeth L. Gleicher
/s/ Michael J. Kelly