Douglas v. Allstate Insurance Company

821 N.W.2d 472, 492 Mich. 241, 2012 Mich. LEXIS 1224
CourtMichigan Supreme Court
DecidedJuly 30, 2012
DocketDocket 143503
StatusPublished
Cited by104 cases

This text of 821 N.W.2d 472 (Douglas v. Allstate Insurance Company) is published on Counsel Stack Legal Research, covering Michigan Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Douglas v. Allstate Insurance Company, 821 N.W.2d 472, 492 Mich. 241, 2012 Mich. LEXIS 1224 (Mich. 2012).

Opinions

[247]*247YOUNG, C.J.

Under the terms of the no-fault act,1 a person injured in a motor vehicle accident is entitled to recover personal protection insurance (PIP) benefits for “[allowable expenses consisting of all reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person’s care, recovery, or rehabilitation.”2 This case requires this Court to consider whether the services provided by plaintiffs wife constituted services “for an injured person’s care,” whether the Court of Appeals properly remanded this case to the circuit court for findings of fact regarding the extent to which expenses for services for plaintiffs care were actually incurred, and whether the circuit court erred by awarding an hourly rate that corporate agencies charge for rendering services, rather than an hourly rate that individual caregivers receive for those services.

We hold that “allowable expenses” must be “for an injured person’s care, recovery, or rehabilitation.”3 Accordingly, a fact-finder must examine whether attendant care services are “necessitated by the injury sustained in the motor vehicle accident” before compensating an injured person for them.4 However, the services cannot simply be “ ‘[o]rdinary household tasks,’ ” which are not for the injured person’s care.5 Moreover, because an allowable expense consists of a “chargeD”6 that “ ‘must be incurred,’ ”7 an injured [248]*248person who seeks reimbursement for any attendant care services must prove by a preponderance of the evidence not only the amount and nature of the services rendered, but also the caregiver’s expectation of compensation or reimbursement for providing the attendant care. Because the no-fault act does not create different standards depending on who provides the services, this requirement applies equally to services that a family member provides and services that an unrelated caregiver provides.

If the fact-finder concludes that a plaintiff incurred allowable expenses in receiving care from a family member, the fact-finder must also determine to what extent any claimed expense is a “reasonable charge[].”8 While it is appropriate for the fact-finder to consider hourly rates charged by individual caregivers when selling their services (whether to their employers that commercially provide those services or directly to injured persons), comparison of hourly rates charged by commercial caregiving agencies is far too attenuated from an individual’s charge for the fact-finder simply to adopt that agency charge as an individual’s reasonable charge.

In applying these principles of law to the facts of this case, we hold that the Court of Appeals correctly determined that plaintiff may recover “allowable expenses” to the extent that they encompass services that are reasonably necessary for plaintiff’s care when the care is “related to [plaintiff’s] injuries.”9 However, because the circuit court erred by awarding damages for allowable expenses without requiring proof that the underlying charges were actually incurred, we agree with the decision of the Court of Appeals to [249]*249remand this case to the circuit court for a determination whether charges for allowable expenses were actually incurred. Nevertheless, we also conclude that the Court of Appeals erred to the extent that its decision limited the scope of the determination on remand to the period after November 7, 2006. Instead, the circuit court must reexamine on remand the evidentiary proofs supporting the entire award. While we reject defendant’s request for a verdict of no cause of action because there remain unresolved questions of fact, we caution the circuit court that a fact-finder can only award benefits that are proved to have been incurred. Finally, in determining the hourly rate for attendant care services, the circuit court clearly erred by ruling that plaintiff is entitled to an hourly rate of $40 for attendant care services because that rate is entirely inconsistent with the evidence of an individual’s rate of compensation, including the compensation that Katherine Douglas, plaintiffs wife, actually received as an employee hired to care for plaintiff. We reverse the judgment of the Court of Appeals on this issue. Therefore, we affirm in part, reverse in part, vacate the award of attendant care benefits, and remand this case to the circuit court for further proceedings consistent with this opinion.

I. FACTS AND PROCEDURAL HISTORY

In 1996, plaintiff, James Douglas, sustained a severe closed-head brain injury when a hit-and-run motorist struck the bicycle he was riding. Plaintiff was hospitalized for approximately one month after the accident and received therapy and rehabilitation after his discharge. Because the driver of the motor vehicle that struck plaintiff could not be identified, plaintiff sought [250]*250assignment of a first-party insurance provider through the Michigan Assigned Claims Facility.10 The facility assigned defendant, Allstate Insurance Company, to plaintiffs claim. In the three years after the accident, defendant paid plaintiff PIP benefits for his hospitalization, medical expenses, wage loss, and attendant care, as well as for replacement services, in accordance with the no-fault act. Defendant claims that plaintiff did not seek additional PIP benefits after 1999 until he filed the instant lawsuit in 2005.

In 1999, plaintiff began the first of a series of full-time jobs. However, he was unable to hold a job for very long, and he eventually stopped working. During this time, he twice attempted suicide. After the second suicide attempt, a 2005 letter written by plaintiffs psychiatrist indicated that plaintiff “requires further treatment” because he “continues to suffer from ill-effects as a result of his closed-head injury. . . .” In particular, the psychiatrist emphasized that plaintiff suffered from short-term memory problems and impulsivity as a result of the accident and explained that plaintiff “should have the opportunity to obtain the care that will most likely restore him to a good level of functioning.” Defendant claims that it did not receive this letter before plaintiff initiated this lawsuit.

Plaintiff filed the instant lawsuit on May 31, 2005, in the Washtenaw Circuit Court seeking compensation for [251]*251unspecified PIP benefits that defendant “has refused or is expected to refuse to pay____”11 Defendant filed three successive dispositive motions, only the first of which was granted.12 Relevant here, the second motion for summary disposition claimed that attendant care was not reasonably necessary because none of plaintiffs medical providers had prescribed attendant care for plaintiff. The circuit court denied the motion without prejudice in advance of further discovery. The third motion for partial summary disposition claimed that plaintiff could not recover for attendant care services provided before November 7, 2006, because plaintiffs treating psychologist, Dr. Thomas Rosenbaum, neither authorized nor prescribed attendant care services before that date. In opposing the motion, plaintiff offered an affidavit from Dr.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

S Baxter Jones v. Esurance Insurance Company
Michigan Court of Appeals, 2025
Moore v. Auto Club Group
E.D. Michigan, 2025
Prism Lab LLC v. Allstate Insurance Company
Michigan Court of Appeals, 2025
Victoria Taylor v. Farmers Insurance Company
Michigan Court of Appeals, 2025
Nsw v. Farmers Insurance Exchange
Michigan Court of Appeals, 2025
20250221_C370136_44_370136.Opn.Pdf
Michigan Court of Appeals, 2025
Shawn Hall v. Citizens Insurance Company
Michigan Court of Appeals, 2025
20250116_C367792_48_367792.Opn.Pdf
Michigan Court of Appeals, 2025
Joseph Canty v. Michael Chester Mason
Michigan Court of Appeals, 2024
Milenium Inc v. Kml Communications Inc
Michigan Court of Appeals, 2023

Cite This Page — Counsel Stack

Bluebook (online)
821 N.W.2d 472, 492 Mich. 241, 2012 Mich. LEXIS 1224, Counsel Stack Legal Research, https://law.counselstack.com/opinion/douglas-v-allstate-insurance-company-mich-2012.