e-Journal Summary

e-Journal Number : 75495
Opinion Date : 05/20/2021
e-Journal Date : 06/04/2021
Court : Michigan Court of Appeals
Case Name : Ferndale Rehab. Ctr. v. Allstate Ins. Co.
Practice Area(s) : Insurance
Judge(s) : Per Curiam – K.F. Kelly, Servitto, and Letica
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Issues:

Whether medical & Social Security records were unauthenticated & comprised hearsay; MRE 803(4), (6), & (8); “Fraudulent insurance act”; MCL 500.3173a(2); Materiality; Whether the injured person’s medical & medication history had bearing on his eligibility for no-fault benefits; Social Security Administration (SSA); Ferndale Rehabilitation Center (FRC); Michigan Assigned Claims Plan (MACP); Examination under oath (EUO)

Summary

The court held that the trial court properly considered the challenged medical and Social Security records when deciding defendant-Allstate’s summary disposition motion, and did not err in finding plaintiff-Thomas made false statements on his application for no-fault benefits. It also did not err in holding that Thomas’s statements as to his medical and medication history were material to his claim. Finally, because plaintiff-FRC’s claim for no-fault benefits was derivative of his claim, a misrepresentation that barred his claim also barred FRC’s claim. FRC argued the trial court could not properly consider the medical and Social Security records provided by Allstate in support of its summary disposition motion “because they were unauthenticated and comprised hearsay.” But Thomas’s medical records largely included “statements made for purposes of medical treatment before the accident occurred, which were made at or near the time” he sought medical attention. There was “no question that a patient’s medical records are routinely made in the course of a medical provider’s business.” As a result, his medical records qualified for admission under MRE 803(4) and 803(6). His Social Security records, which were recorded by the SSA “for purposes of providing federal benefits to Thomas, also qualify for admission under a hearsay exception, MRE 803(8).” FRC also argued the trial court erred in holding that Thomas knowingly made materially false statements “in his application for no-fault benefits and request for replacement services.” But a review left “no question that Thomas was dishonest in his application for no-fault benefits, at his EUO, and in documents claiming replacement services.” Despite these false statements, FRC asserted “the statements were not material to bar FRC’s claim because defendant had the means to discover the truth, which it did obtain through Thomas’s deposition testimony and medical records, nor did defendant rely on Thomas’s false statements.” However, because the fraudulent acts occurred when he “submitted his application to MACP, the fact that defendant uncovered the truth during its investigation of Thomas’s medical and medication history is irrelevant. FRC’s distinction that the false statements were submitted to MACP, and not defendant, is similarly without merit because the false statements in Thomas’s application were submitted to obtain no-fault benefits.” Affirmed.

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