Attard v. Citizens Insurance Co. of America

602 N.W.2d 633, 237 Mich. App. 311
CourtMichigan Court of Appeals
DecidedDecember 1, 1999
DocketDocket 203300
StatusPublished
Cited by87 cases

This text of 602 N.W.2d 633 (Attard v. Citizens Insurance Co. of America) is published on Counsel Stack Legal Research, covering Michigan Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Attard v. Citizens Insurance Co. of America, 602 N.W.2d 633, 237 Mich. App. 311 (Mich. Ct. App. 1999).

Opinion

Smolensk, P.J.

Plaintiff, Michael Joseph Attard, suffered injuries as the result of an automobile accident and subsequently filed suit against defendant Citizens Insurance Company of America for benefits under the no-fault act, MCL 500.3101 et seq.\ MSA 24.13101 et seq. After a jury trial, the court entered judgment in favor of plaintiff for $140,806.39. Plaintiff appeals as of right from the trial court’s denial of his request for attorney fees and interest pursuant to the no-fault act. Defendant cross appeals from the trial court’s denial of its motion for a partial judgment notwithstanding the verdict (JNOV) in which it requested the court to eliminate portions of the jury award and the court’s order awarding plaintiff mediation sanctions for certain work performed by plaintiff’s attorneys. We affirm in part, reverse in part, and remand for further proceedings.

Plaintiff suffered a closed-head injury as the result of an automobile accident on July 19, 1991. Following the accident, plaintiff’s wife, Alice Attard, cared for plaintiff. Defendant, in turn, paid Alice for attendant care benefits under the no-fault act. The parties stipulated in their joint final pretrial order that defendant paid plaintiff all attendant care benefits due through *315 June 24, 1993, and that the rate for attendant care benefits paid after that date was $15 an hour. On or about December 6, 1993, Alice terminated her employment to take care of plaintiff on a full-time basis, having elected to continue her health insurance coverage with her former employer for eighteen months as allowed under the insurance coverage continuation provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985 (cobra). 1 Plaintiff presented evidence at trial that defendant agreed to pay the premiums necessary to extend Alice’s health insurance coverage under the cobra (the cobra policy) as long as it was a cost-effective option in handling plaintiff’s claim-related medical bills; however, Alice’s cobra policy lapsed on March 31, 1994, because of nonpayment of the policy premiums.

Plaintiff filed his present two-count complaint in 1994. In count I, plaintiff claimed unpaid benefits, attorney fees, and interest because of defendant’s failure to comply with the provisions of the no-fault act. In count n, plaintiff claimed damages for defendant’s failure to pay the premiums on Alice’s cobra policy. After a trial lasting several days, the juiy awarded plaintiff compensation for 7,667.77 hours of attendant care that Alice had provided to plaintiff, $1,789.84 for a mattress, $9,600 for massage therapy, $2,100 for a family health-club membership, and $12,150 for defendant’s breach of the agreement to maintain health insurance for plaintiff and his family. On January 14, 1997, the trial court entered judgment against defendant in the amount of $140,806.39. 2

*316 Plaintiff filed postjudgment motions seeking costs, mediation sanctions pursuant to MCR 2.403, a no-fault attorney fee pursuant to MCL 500.3148; MSA 24.13148, no-fault interest pursuant to MCL 500.3142; MSA 24.13142, and prejudgment interest pursuant to MCL 600.6013; MSA 27A.6013. Defendant moved for a new trial and a partial JNOV. The trial court granted plaintiffs motion for mediation sanctions and costs, but denied the motion with respect to no-fault attorney fees, finding that defendant had adequate and reasonable grounds to defend the suit. The trial court also denied plaintiffs motion to collect both prejudgment interest and no-fault interest and defendant’s motions.

Plaintiff appeals as of right from the trial court’s order denying his motion for attorney fees and no-fault interest. Defendant cross appeals from the court’s order denying its motion for a partial JNOV with respect to the jury awards for massage therapy, the health-club membership, breach of the agreement to pay COBRA benefits and the court’s refusal to offset against its liability the $6,566.25 that defendant paid for plaintiff’s attendant care provided in November 1996. Defendant also cross appeals the trial court’s award of mediation sanctions to plaintiff for $14,200 of attorney fees incurred by a second attorney at trial.

First, plaintiff contends that the trial court erred in refusing to award him attorney fees pursuant to MCL 500.3148; MSA 24.13148 because defendant unreasonably refused to pay him no-fault benefits. We disagree. A trial court’s finding of an unreasonable refusal *317 to pay or delay in paying benefits will not be reversed on appeal unless the finding is clearly erroneous. McKelvie v Auto Club Ins Ass’n, 203 Mich App 331, 335; 512 NW2d 74 (1994); United Southern Assurance Co v Aetna Life & Casualty Ins Co, 189 Mich App 485, 492-493; 474 NW2d 131 (1991).

Plaintiffs claim is based on the no-fault act’s attorney fee provision, MCL 500.3148(1); MSA 24.13148(1), which provides that an attorney is entitled to a reasonable fee for representing a claimant in an action for personal protection insurance benefits that are overdue and that the fee “shall be a charge against the insurer in addition to the benefits recovered, if the court finds that the insurer unreasonably refused to pay the claim or unreasonably delayed in making proper payment.” When determining whether attorney fees are warranted for an insurer’s delay to make payments under the no-fault act, a delay is not unreasonable if it is based on a legitimate question of statutory construction, constitutional law, or factual uncertainty. Shanafelt v Allstate Ins Co, 217 Mich App 625, 635; 552 NW2d 671 (1996). When an insurer refuses to make or delays in making payment, a rebuttable presumption arises that places the burden on the insurer to justify the refusal or delay. McKelvie, supra at 335.

In the present case, plaintiff contends that defendant unreasonably refused to pay him for twenty-four-hour-a-day attendant care benefits provided by Alice. Plaintiff relies on defendant’s admissions that plaintiff’s physician expressed his opinion that plaintiff needed twenty-four-hour supervision; that as of June 24, 1993, there had been no material change in plaintiff’s medical condition or need for attendant care; *318 that defendant had not been advised by plaintiffs physician of a reduction in need for attendant care; that defendant had access to the medical opinion and records of plaintiffs physician concerning plaintiffs need for attendant care; and that defendant had not received a medical opinion since June 24, 1993, that plaintiff did not require twenty-four-hour-a-day attendant care. Furthermore, Alice submitted affidavits attesting to the fact that she provided plaintiff with twenty-four-hour-a-day attendant care. Defendant responds that it paid Alice for only eighteen hours a day because she could not provide plaintiff with attendant care for twenty-four hours each and every day.

We agree with defendant that a legitimate question of factual uncertainty existed concerning whether Alice provided twenty-four-hour-a-day attendant care for plaintiff.

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Bluebook (online)
602 N.W.2d 633, 237 Mich. App. 311, Counsel Stack Legal Research, https://law.counselstack.com/opinion/attard-v-citizens-insurance-co-of-america-michctapp-1999.