Michigan Court of Appeals; Docket #355699, 356886; Unpublished
Judges Sawyer, Shapiro, and Redford; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
Entitlement to PIP Benefits: Arising Out of / Causation Requirement [§3105(1)]
In this unanimous, unpublished, per curiam decision, the Court of Appeals reversed the trial court’s summary disposition order dismissing Plaintiff Marian Oliver’s first-party action against Defendant Esurance Insurance Company (“Esurance”). The Court of Appeals held that because Oliver’s right to no-fault PIP benefits related to the subject accident was statutory, not contractual (she was riding as a passenger in her brother-in-law’s vehicle, which was insured by Esurance, at the time), Esurance could not invoke the policy’s antifraud provision to deny all Oliver’s claims for benefits, even those not implicated by her alleged fraud, to which she would otherwise be statutorily entitled under the no-fault act. The Court of Appeals also held that a question of fact existed as to whether Oliver’s injuries were caused by the subject accident for purposes of MCL 500.3105.
Marian Oliver was riding as a passenger in a vehicle driven by her brother-in-law when the two were involved in a series of chain-reaction rear-end collisions. After the collisions, Oliver exited the vehicle on her own power and began recording her reaction on Facebook Live, making “statements that she should claim an accident injury.” She sought treatment approximately one week after the accident, alleging pain primarily in her neck and back, which yielded a diagnosis of herniated discs in her cervical spine or neck and radiculopathy in the lumbar spine, ultimately requiring surgery. Oliver proceeded to file a claim for no-fault PIP benefits related to the accident with Esurance, the insurer of the vehicle she was traveling in, and Esurance ordered that she undergo an examination under oath (EUO), during which she “generally denied a history of prior neck or back injuries, and denied having previously received [treatment] for her neck.” This, despite the fact that she had been involved in two work related injuries in 2012 and 2013, in which she injured her neck or cervical spine, and for which she was awarded Social Security Disability benefits. Based on her statements during the Facebook Live recording and her statements in her EUO, Esurance denied her claim for PIP benefits entirely, invoking the antifraud provision in the subject policy. Esurance then moved for summary disposition in Oliver’s resultant first-party action against it, which the trial court granted.
The Court of Appeals reversed the trial court’s summary disposition order, relying on Shelton v Auto-Owners Ins Co, 318 Mich App 648 (2017) and Meemic Ins Co v Fortson, 506 Mich 287. Like the plaintiff in Shelton, Oliver’s entitlement to no-fault PIP benefits was statutory, not contractual, and thus Esurance could not invoke an exclusionary clause in an insurance contract to which Oliver was not a party in an attempt to deny her statutorily-mandated benefits. Like the plaintiff in Meemic, Oliver was alleged to have engaged only in post-procurement fraud, which the Supreme Court held will not trigger a contractual antifraud provision unless said fraud involves “a party’s failure to perform a substantial part of the contract or one of its essential terms,” which Oliver’s did not. Thus, Esurance could not disentitle Oliver from PIP benefits entirely based on the subject antifraud provision.
“There is no dispute in this case that defendants have alleged only postprocurement fraud. They do not rely on anything relating to the procurement or inception of the policy to avoid paying benefits. Indeed, plaintiff is not a party to the contract and did not procure the policy. Accordingly, under Meemic and Williams, defendants cannot rely on the policy’s antifraud provision to defeat plaintiff’s claim for mandatory PIP benefits. The trial court, therefore, erred by granting defendants’ motion for summary disposition.”
The Court of Appeals held, second, that a question of fact existed as to whether Oliver’s injuries did, in fact, arise out of the subject accident for purposes of MCL 500.3105. The Court noted that Oliver “testified at her deposition that, after the March 2018 accident, she experienced neck pain, back pain, and recurrent headaches that she did not experience before the accident,” and “presented medical evidence documenting her post-accident treatment for these conditions.”