Mendelson Orthopedics PC v Fremont Ins Co (COA – UNP 2/26/2019; RB #3857)


Michigan Court of Appeals; Docket # 340844; Unpublished
Judges Gleicher, Kelly, and Letica; per curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion 

General/Miscellaneous [§500.3143]
One-Year Back Rule Limitation [§3145(1)]

Intervention by Service Providers and Third Party Payors in PIP Claims 

In this unanimous unpublished per curiam decision, the Court of Appeals affirmed the trial court’s grant of summary disposition for defendant Fremont Insurance Company (“Fremont”), because the claims of plaintiffs Mendelson Orthopaedics and Synergy Spine and Orthopedic Surgery Center (“Mendelson and Synergy”) were barred by the one-year-back rule.  Mendelson and Synergy obtained a valid assignment of rights, but were precluded from recovering for any losses incurred between the filing date of the original complaint and the date of assignment.

Melvin Ayotte was insured by Fremont at the time he sustained injuries in a car accident.  He sought treatment from Mendelson and Synergy, who subsequently brought suit against Fremont to recover payment for no-fault PIP benefits.  The trial court granted summary disposition for Fremont, citing the Supreme Court’s holding in Covenant—that providers do not have a cause of action against insurers for recovery of PIP benefits—and finding that the anti-assignment clause in Ayotte’s policy was unambiguous and therefore enforceable.

The Court of Appeals affirmed the trial court’s grant of summary disposition, albeit for different reasons.  Mendelson and Synergy had received a proper assignment of rights from Ayotte, and anti-assignment clauses, themselves, were deemed unenforceable by the Court in Shah.  However, “the assignment of rights executed in favor of [Mendelson and Synergy] only gave them the right to seek no-fault benefits for any portion of the loss that was incurred within one year of the date of assignment.”  The assignment did not relate back to the filing date of the original complaint.  Any losses incurred between the two dates would be barred by the one-year-back rule.

Plaintiffs seek the payment of no-fault benefits for losses incurred between December 12, 2012, which was the date of the car accident, and January 26, 2016, which was the date that the original complaint was filed. Because the right to seek no-fault benefits only relates back one year from the date of assignment on June 1, 2017, plaintiffs can only recover no-fault benefits for medical services rendered between June 1, 2016, and June 1, 2017. Shah, 324 Mich App at 204- 205. However, there is no evidence in the record indicating that plaintiffs provided medical care to Ayotte between June 1, 2016 and June 1, 2017. Consequently, although the trial court erred by finding that the anti-assignment clause was enforceable, remand would be futile because the one-year-back rule, MCL 500.3145(1), prevents plaintiffs from recovering.

The Court thus affirmed the trial court’s grant.