Michigan Court of Appeals; Docket #361096; Unpublished
Judges Cavanagh, Boonstra, and Riordan; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
One-Year Back Rule Limitation – tolling under 2019 amendments [§3145(3)]
In this unanimous, unpublished, per curiam decision, the Court of Appeals reversed the trial court’s summary disposition order dismissing Plaintiff Spine Specialists of Michigan, PC’s (“Spine Specialists”) action for no-fault PIP benefits against Defendant Esurance Property and Casualty Insurance Company. The Court of Appeals held that Spine Specialists’ complaint was timely filed because it was filed within one year of the date Esurance formally denied the claims at issue.
Esurance’s insured received treatment from Spine Specialists after being injured in a motor vehicle accident. Spine Specialists billed Esurance for dates of service September 30, 2019, January 7, 2020, February 11, 2020, March 10, 2020, but Esurance refused or otherwise failed to issue payment. On March 24, 2020, Esurance issued a formal denial of Spine Specialists’ claims, and on January 8, 2021, Spine Specialists filed suit. Esurance then moved for summary disposition as to the September 30, 2019 and January 7, 2020 claims, arguing that they were barred by MCL 500.3145(2) and that MCL 500.3145(3) was inapplicable “because it was a damages-limiting provision, not a statute of limitations.” The trial court agreed and granted Esurance’s motion.
The Court of Appeals reversed the trial court’s summary disposition order, observing that this issue was squarely disposed of in Encompass Healthcare, PLLC v Citizens Ins Co, ___ Mich App ___, (2022). In Encompass, the Court held that the clock does not begin to run for purposes of the one-year-back rule “until the date an insurer formally denies the claim.” MCL 500.3145(3). Therefore in this case, Spine Specialists had one year from March 24, 2020 to file its complaint; it filed on January 8, 2021, and thus its complaint was timely.
“Simply put, Encompass Healthcare, PLLC stands for the proposition that ‘the one-year-back period is tolled until the date of the insurer’s formal denial of a claim.’ Id. In this case, while defendant submitted proof of its formal denial of the insured’s claims in its appendix on appeal, the denial was not part of the record before the trial court. ‘This Court’s review is limited to the record established by the trial court, and a party may not expand the record on appeal.’ Sherman v Sea Ray Boats, Inc, 251 Mich App 41, 56; 649 NW2d 783 (2002). Therefore, this Court may not consider the formal denial when reviewing this case. The case, as it stood before the trial court, had no evidence of a formal denial of the insured’s claims. Therefore, under Encompass Healthcare, PLLC, the one-year-back rule continued to be tolled until plaintiff filed suit on January 8, 2021, rendering all of its claims timely.”