Ellen M Andary v. Usaa Casualty Insurance Company

CourtMichigan Court of Appeals
DecidedAugust 25, 2022
Docket356487
StatusPublished

This text of Ellen M Andary v. Usaa Casualty Insurance Company (Ellen M Andary v. Usaa Casualty 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
Ellen M Andary v. Usaa Casualty Insurance Company, (Mich. Ct. App. 2022).

Opinion

If this opinion indicates that it is “FOR PUBLICATION,” it is subject to revision until final publication in the Michigan Appeals Reports.

STATE OF MICHIGAN

COURT OF APPEALS

ELLEN M. ANDARY, a Legally Incapacitated FOR PUBLICATION Person, by and through her Conservator and August 25, 2022 Guardian, MICHAEL T. ANDARY, M.D., PHILIP 9:00 a.m. KRUEGER, a Legally Incapacitated Person, by and through his Guardian, RONALD KRUEGER, and MORIAH, INC., doing business as EISENHOWER CENTER,

Plaintiffs-Appellants,

v No. 356487 Ingham Circuit Court USAA CASUALTY INSURANCE COMPANY and LC No. 19-000738-CZ CITIZENS INSURANCE COMPANY OF AMERICA,

Defendants-Appellees.

Before: MARKEY, P.J., and SHAPIRO and PATEL, JJ.

SHAPIRO, J.

The question in this case is whether legislative amendments to the no-fault act, MCL 500.3101 et seq., limiting reimbursement for expenses covered by personal protection insurance apply retroactively so as to limit benefits to those injured before the effective date of the amendments. We conclude that they do not because the Legislature did not clearly demonstrate an intent for the amendments to apply retroactively to persons injured in pre-amendment accidents. We further conclude that even if retroactive intent had been demonstrated, imposing the new limits would substantially impair no-fault insurance contracts entered into before the amendments’ effective date, and therefore would violate the Contracts Clause of the Michigan Constitution.

I. BACKGROUND

Since the inception of the no-fault act in 1973, Michigan law has required that personal protection insurance (PIP) policies provide for payment of “all reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person’s care,

-1- recovery or rehabilitation.” MCL 500.3107(1)(a). Previously, the rates of reimbursement were limited only by what constituted “reasonable” and “customarily charge[d]” fees. MCL 500.3157, as enacted by 1972 PA 294. And there was no cap on the amount of attendant care that could be provided by family.

Effective June 11, 2019, the Legislature enacted 2019 PA 21 and 2019 PA 22, both of which made significant amendments to the no-fault act. Relevant to this case, 2019 PA 21 amended MCL 500.3157 to include fee schedules limiting a medical provider’s reimbursement amount.1 This case specifically concerns MCL 500.3157(7), which caps a provider’s reimbursement for services not covered by Medicare to 55 percent of the fees charged as of January 1, 2019.2 Also at issue is MCL 500.3157(10), which limited the reimbursable hours of family- provided attendant care to 56 hours per week.3

Plaintiffs Ellen Andary and Philip Krueger are individuals who suffered traumatic brain injuries in motor vehicle accidents prior to June 11, 2019. Both Andary and Krueger are permanently disabled as a result of their respective accidents. Andary requires 24-hour in-home attendant care, most of which is performed by family members. Krueger is a patient at plaintiff Eisenhower Center, which provides inpatient living accommodations and rehabilitative services to

1 The fee schedules went into effect on July 1, 2021. See MCL 500.3157(2); MCL 500.3157(7)(a)(i). 2 More specifically, MCL 500.3157(7)(a) provides that, if MCL 500.3157(2) applies, and the treatment or rehabilitative training is not compensable by Medicare, the applicable following percentage of the amount payable for the treatment or training under the person’s charge description master in effect on January 1, 2019 or, if the person did not have a charge description master on that date, the applicable following percentage of the average amount the person charged for the treatment on January 1, 2019:

(i) For treatment or training rendered after July 1, 2021 and before July 2, 2022, 55%.

(ii) For treatment or training rendered after July 1, 2022 and before July 2, 2023, 54%.

(iii) For treatment or training rendered after July 1, 2023, 52.5%. [MCL 500.3157(7)(a).] 3 MCL 500.3157(10) provides in part that “[f]or attendant care rendered in the injured person’s home, an insurer is only required to pay benefits for attendant care up to the hourly limitation in section 315 of the worker’s disability compensation act of 1969, 1969 PA 317, MCL 418.315.” In turn, MCL 418.315 provides that “[a]ttendant or nursing care shall not be ordered in excess of 56 hours per week if the care is to be provided by the employee’s spouse, brother, sister, child, parent, or any combination of these persons.”

-2- individuals with traumatic brain injuries. The vast majority of the residential patients at Eisenhower Center are victims of motor vehicle accidents, and the services Eisenhower Center provides to them are reimbursed through the no-fault system. Most of the services performed by Eisenhower Center are not compensable under Medicare, however.

The defendants in this case are the insurers responsible for providing no-fault benefits to the two injured plaintiffs, respectively. At the time of their respective accidents, Andary was covered under a PIP policy issued by defendant USAA Casualty Insurance Company; Krueger was covered under a PIP policy issued by defendant Citizens Insurance Company of America.

In this declaratory action, the injured plaintiffs assert that because they (1) were injured prior to the effective date of 2019 PA 21, and (2) have vested contractual rights under the policy in effect when they were injured, they are not subject to 2019 PA 21’s limitations on benefits and payment contained in MCL 500.3157(7) and (10). Plaintiffs further argue that the limitations on payments violate the Contracts Clause of the Michigan Constitution and their constitutional rights to equal protection and due process. In lieu of filing an answer, defendants filed a motion for summary disposition under MCR 2.116(C)(8) (failure to state a claim). They argue that regardless of when Andary’s and Krueger’s injuries occurred, they are subject to the newly enacted limitations of MCL 500.3157, and that this does not violate that Contracts Clause or any other constitutional provision. Defendants also assert that no factual development is necessary to consider plaintiffs’ constitutional challenges to the future application of the 2019 amendments. The trial court agreed with defendants and granted them summary disposition as to all counts. The court also denied plaintiffs’ motion to amend the complaint to include a breach-of-contract claim. This appeal followed.4

II. DISCUSSION

A. RETROACTIVITY

The first question presented by this appeal is whether the Legislature intended MCL 500.3157(7) and (10) to apply retroactively to those injured before 2019 PA 21’s effective date.

Statutes and amendments of statutes are presumed to operate prospectively. Davis v State Employees’ Retirement Bd, 272 Mich App 151, 155; 725 NW2d 56 (2006). To overcome this presumption, the Legislature must clearly manifest an intent for retroactive application. Johnson

4 We review de novo a trial court’s decision on a motion for summary disposition. See Spiek v Dep’t of Transp, 456 Mich 331, 337; 572 NW2d 201 (1998). A motion under MCR 2.116(C)(8) tests the legal sufficiency of a complaint by the pleadings alone. Patterson v Kleiman, 447 Mich 429, 432; 526 NW2d 879 (1994). All well-pleaded factual allegations are accepted as true, as well as any reasonable inferences or conclusions that can be drawn from the allegations. Peters v Dep’t of Corrections, 215 Mich App 485, 486; 546 NW2d 668 (1996).

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Ellen M Andary v. Usaa Casualty Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ellen-m-andary-v-usaa-casualty-insurance-company-michctapp-2022.