e-Journal Summary

e-Journal Number : 82752
Opinion Date : 12/03/2024
e-Journal Date : 12/13/2024
Court : Michigan Court of Appeals
Case Name : American Physio LLC v. State Farm Mut. Auto Ins. Co.
Practice Area(s) : Insurance
Judge(s) : Per Curiam – Jansen, Rick, and Patel
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Issues:

PIP benefits under the No-Fault Act (NFA); Priority; Michigan Automobile Insurance Placement Facility (MAIPF)

Summary

In this action for first-party PIP benefits under the NFA, the court affirmed summary disposition for defendant-Nationwide. Nonparty-G was injured in an auto collision. At the time of the accident, G “did not own a motor vehicle, did not maintain a no-fault insurance policy, and had healthcare coverage through” Medicaid. G lived with her grandfather, O, who owned a vehicle and had a no-fault policy with nonparty-USAA. When O renewed his policy, he “elect[ed] to not maintain coverage for [PIP] benefits.” At issue on appeal was “whether Nationwide, the assignee of the MAIPF, is required to pay PIP medical benefits to” plaintiff-American Physio for its treatment of G. The primary dispute was “whether the USAA policy maintained by [O] qualifies as ‘personal protection insurance [] applicable to the injury.’” Under MCL 500.3172(1)(a), the court held that G “was not entitled to PIP coverage from an insurer assigned by MAIPF. Because American Physio’s rights, having been assigned from [G], were entirely derivative of [G’s] rights, American Physio also was not permitted to seek benefits from Nationwide[.].” American Physio argued O’s “USAA policy is not in the order of priority under MCL 500.3114(1) because it does not qualify as ‘a personal protection insurance policy described in [MCL 500.3101(1)] . . . .’” The court disagreed. American Physio asserted G “did not have qualified health coverage as required by MCL 500.3107d(1) to allow her to be ‘opted out’ of PIP medical coverage and thus [O] failed to purchase a policy that conformed with the requirements of the no-fault law.” The court held that plainly, under MCL 500.3114(1), G “would be required to seek replacement-services and work loss benefits from USAA because the USAA policy applies to the injuries she sustained in the subject accident and the policy is in the order of priority.” The court found “the trial court did not err by concluding that the USAA policy is applicable to the injuries [G] sustained in the accident and thus [G] was not entitled to seek benefits from the MAIPF, and neither was American Physio as an assignee.” American Physio contended “that Nationwide should litigate the coverage issue with USAA after paying PIP medical benefits to American Physio.” The court again disagreed. There was “no evidence that Nationwide failed to act diligently here.” American Physio further argued “the trial court erred by relying on MCL 500.3113(e)[.]” The court agreed. “There was no allegation or proof of [G] using a ‘transportation network company’ at the time she was injured in the” auto accident. Thus, “no exclusion was authorized under MCL 500.3017, and MCL 500.3113(e) did not disqualify [G] form receiving PIP benefits.” Despite this error, “the trial court did not rely on that ground alone and it reached the right decision[.]”

Full PDF Opinion