Bronson Health Care Group Inc v. Titan Insurance Company

887 N.W.2d 205, 314 Mich. App. 577
CourtMichigan Court of Appeals
DecidedMarch 15, 2016
DocketDocket 324847
StatusPublished
Cited by25 cases

This text of 887 N.W.2d 205 (Bronson Health Care Group Inc v. Titan Insurance Company) 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
Bronson Health Care Group Inc v. Titan Insurance Company, 887 N.W.2d 205, 314 Mich. App. 577 (Mich. Ct. App. 2016).

Opinion

MARKEY, J.

In this action under the no-fault act, MCL 500.3101 et seq., plaintiff Bronson Health Care Group, Inc., appeals by right the trial court’s order denying its motions for penalty interest from defendant Titan Insurance Company under MCL 500.3142 and for attorney fees and costs from Titan under MCL 600.2591. Because defendant failed to comply with MCL 500.3142, we reverse and remand to the trial court. 1

On May 9, 2013, Amber French, a passenger in a vehicle driven by John Capp, was involved in an automobile accident. French suffered multiple fractures, respiratory problems, and a dislocated left hip. Bronson provided French with medical care from May 9,2013, to May 14, 2013, and on May 16, 2013. Bronson charged $51,596.13 for French’s care.

On July 31, 2013, and August 29, 2013, Bronson submitted applications for personal protection insurance benefits to the Michigan Automobile Insurance *580 Placement Facility. Bronson sought payment under the Michigan Assigned Claims Plan (MACP) for the services it had provided to French. 2 Those applications were denied by the MACP because they did not contain information regarding whether the owner of the vehicle (neither French nor Capp owned the vehicle) had automobile insurance for the vehicle.

On September 12, 2013, Bronson submitted a third application for benefits under the MACP that indicated the owner of the vehicle did not have automobile insurance for the vehicle on the date of the accident and that French and Capp did not have automobile insurance at the time of the accident. On September 24, 2013, the MACP assigned Bronson’s claim for benefits regarding its treatment of French to Titan. After the assignment, Titan received itemized statements regarding Bronson’s charges for the medical care Bronson provided to French, a “UB04 form,” medical records, and a police report regarding the May 9, 2013 accident. Although Titan received this information on September 24, 2013, it did not issue payment to Bronson within 30 days.

On January 14, 2014, Bronson filed its complaint against Titan, alleging that it was owed (1) payment of personal protection insurance benefits from Titan, (2) penalty interest on the unpaid charges until they were paid in full, and (3) attorney fees.

French was deposed on July 10, 2014, and she testified that at the time of the accident she was not living with relatives, she did not own or use a vehicle, and she was not married. On August 4, 2014, Titan sent a letter to Bronson, indicating that it was willing *581 to pay Bronson’s charges in the amount of $51,596.13, but refused to pay penalty interest for its delay in paying the claim. Thus, Titan did not pay the claim until on or after August 4, 2014.

On September 4, 2014, Bronson filed its motion for penalty interest under MCL 500.3142 and for attorney fees and costs under MCL 600.2591. On September 19, 2014, Titan filed its response and argued that at the time it received Bronson’s claim from the MACP on September 24, 2013, contradictory information in Bronson’s three applications to the MACP created questions related to French’s eligibility to obtain personal protection insurance benefits through the MACP. Titan argued that its investigation into French’s eligibility concluded when French was deposed and her testimony provided evidence that she was eligible for insurance benefits through the MACP. Titan concluded that because it paid Bronson’s claim within 30 days of its investigation confirming French’s eligibility for benefits, it was not liable to pay penalty interest. For the same reason, Titan argued that Bronson was not entitled to attorney fees or costs.

On September 29, 2014, the trial court held a hearing on Bronson’s motions for penalty interest under MCL 500.3142 and for attorney fees and costs under MCL 600.2591. It entered an order on October 10, 2014, denying Bronson’s motions on the basis of Titan’s reasoning.

On appeal, Bronson argues that the trial court erred by denying its request for penalty interest pursuant to MCL 500.3142. MCL 500.3142(1) provides that “[personal protection insurance benefits are payable as loss accrues,” and MCL 500.3142(2) provides in relevant part that “[p]ersonal protection insurance benefits are overdue if not paid within 30 days after an insurer *582 receives reasonable proof of the fact and of the amount of loss sustained.” MCL 500.3142(3) provides that “[a]n overdue payment bears simple interest at the rate of 12% per annum.” The penalty interest provision in MCL 500.3142(2) is “intended to penalize an insurer that is dilatory in paying a claim.” Williams v AAA Mich, 250 Mich App 249, 265; 646 NW2d 476 (2002). A trial court’s finding regarding “whether a communication qualifies as reasonable proof of the fact or amount of a claim” is reviewed for clear error. Id. The proper interpretation of a statute and its application to the facts present questions of law reviewed de novo. Bronson Methodist Hosp v Mich Assigned Claims Facility, 298 Mich App 192, 196; 826 NW2d 197 (2012).

Titan argues that it had no obligation to pay personal protection insurance benefits to or on behalf of French until it was demonstrated that French was eligible to obtain those benefits through the MACP, notwithstanding that the MACP only itself assigns a claim after reviewing a claimant’s eligibilty. The trial court agreed with Titan’s argument when denying Bronson’s request for penalty interest. We disagree with both Titan’s and the trial court’s analysis. Michigan courts have repeatedly construed MCL 500.3142(2) in accordance with its plain language (requiring “reasonable proof of the fact and of the amount of loss sustained”) and have not allowed an assigned insurer additional time beyond the statutory 30 days to conduct its own investigation regarding the eligibility of the claimant to receive benefits. 3 See Cruz v State Farm Mut Auto Ins Co, 466 Mich 588, 596; 648 *583 NW2d 591 (2002) (explaining that once an insurer receives “reasonable proof of the fact and of the amount of loss sustained,” the statute clearly requires the benefits be paid within 30 days, or they are overdue); Roberts v Farmers Ins Exch, 275 Mich App 58, 67; 737 NW2d 332 (2007) (“Benefits are overdue if they are not paid within 30 days after the insurer receives reasonable proof of the fact and amount of the loss sustained.”); Univ of Mich Regents v State Farm Mut Ins Co, 250 Mich App 719, 735; 650 NW2d 129 (2002) (stating that under MCL 500.3142, a claimant is not required to prove that the insurer acted arbitrarily or unreasonably delayed in payment of benefits; an insurer is liable for penalty interest if it does not pay the claim within 30 days after receiving reasonable proof of loss). Accordingly, the trial court erred by concluding that Titan’s initial position that French might be ineligible for personal protection insurance benefits justified Titan’s failure to comply with MCL 500.3142(2) until it conducted enough discovery to satisfy itself that French was, indeed, eligible for benefits.

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Bluebook (online)
887 N.W.2d 205, 314 Mich. App. 577, Counsel Stack Legal Research, https://law.counselstack.com/opinion/bronson-health-care-group-inc-v-titan-insurance-company-michctapp-2016.