Ivezaj v. Auto Club Insurance

737 N.W.2d 807, 275 Mich. App. 349
CourtMichigan Court of Appeals
DecidedAugust 29, 2007
DocketDocket 265293, 266442, 268137
StatusPublished
Cited by20 cases

This text of 737 N.W.2d 807 (Ivezaj v. Auto Club Insurance) 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
Ivezaj v. Auto Club Insurance, 737 N.W.2d 807, 275 Mich. App. 349 (Mich. Ct. App. 2007).

Opinion

PER CURIAM.

Defendant Auto Club Insurance Association appeals as of right the judgments of the Macomb Circuit Court awarding plaintiff Dila Ivezaj attorney fees, denying case evaluation sanctions against her, and awarding her taxable costs. We affirm the trial court’s award of attorney fees, and we reverse the trial court’s orders denying defendant’s request for case evaluation sanctions and awarding taxable costs to plaintiff.

Plaintiff was injured in a motor vehicle accident in Pontiac, Michigan, on July 19, 2001. She was insured through a Michigan automobile insurance policy issued by defendant and in accordance with the provisions of the no-fault insurance act, MCL 500.3101 et seq. Defendant does not dispute that it is responsible for furnish *352 ing plaintiffs no-fault personal injury protection (PIP) benefits arising from the accident.

Plaintiff filed a complaint alleging that defendant failed to pay PIP benefits covered under the no-fault act. After a hearing on November 10, 2003, a case evaluation panel concluded that plaintiffs claim against defendant was worth $150,000. Plaintiff rejected and defendant accepted the award. The case proceeded to trial. After deliberation, a jury found that plaintiff sustained accidental bodily injury in the July 19, 2001, accident and awarded plaintiff $108,000 in allowable expenses and $13,000 in interest reimbursement for overdue benefits. The trial court subsequently entered judgment in this amount. The trial court also awarded plaintiff $40,333.33 in attorney fees pursuant to MCL 500.3148(1). After adjusting plaintiffs $121,000 verdict by adding the $40,333.33 award of attorney fees, as well as judgment interest and taxable costs, the trial court determined that plaintiff had improved her position at trial by more than 10 percent and, therefore, defendant was not entitled to receive MCR 2.403(0) case evaluation sanctions. The trial court also awarded plaintiff $8,996.10 in MCR 2.625 taxable costs.

I. ATTORNEY FEES

Defendant argues that the trial court should not have awarded attorney fees to plaintiff because its refusal to pay certain benefits claimed by plaintiff was reasonable. Specifically, defendant argues that plaintiff recovered only a small portion of her claimed benefits at trial, proving that its refusal to pay was reasonable. We disagree.

We will not disturb a trial court’s findings concerning a plaintiffs claim for attorney fees pursuant to MCL *353 500.3148 unless the finding is clearly erroneous. Bloemsma v Auto Club Ins Co, 174 Mich App 692, 697; 436 NW2d 442 (1989). “A decision is clearly erroneous where, although there is evidence to support it, the reviewing court is left with a definite and firm conviction that a mistake has been made.” Kitchen v Kitchen, 465 Mich 654, 661-662; 641 NW2d 245 (2002).

The trial court did not clearly err when it awarded plaintiff no-fault attorney fees. MCL 500.3148(1) states:

An attorney is entitled to a reasonable fee for advising and representing a claimant in an action for personal or property protection insurance benefits which are overdue. The attorney’s 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 an insurer refuses to make or delays in making a no-fault payment, a rebuttable presumption arises that this refusal to pay or delay in paying is unreasonable. Attard v Citizens Ins Co of America, 237 Mich App 311, 317; 602 NW2d 633 (1999). The insurer has the burden of rebutting this presumption of unreasonableness by justifying the refusal or delay. McKelvie v Auto Club Ins Ass’n, 203 Mich App 331, 335; 512 NW2d 74 (1994). A delay in making payments “is not unreasonable if it is based on a legitimate question of statutory construction, constitutional law, or factual uncertainty.” Attard, supra at 317.

However, as this Court noted in McCarthy v Auto Club Ins Ass’n, 208 Mich App 97, 105; 527 NW2d 524 (1994), “the scope of inquiry under § 3148 is not whether the insurer ultimately is held responsible for a given expense, but whether its initial refusal to pay the expense was unreasonable.” The McCarthy Court re *354 versed the trial court’s holding that the defendant insurer unreasonably failed to properly investigate the plaintiffs medical needs before refusing to pay for corrective plastic surgery. Id. at 101. In particular, the verdict did not indicate whether the defendant had a reasonable basis for refusing to pay for the plaintiffs plastic surgery at the time she initially requested the coverage. Id. at 105. The McCarthy Court noted that the trial court could not rely on the jury’s verdict that the defendant was responsible for the cost of the plastic surgery to support its conclusion that the defendant unreasonably refused to pay for the surgery at the time the claim was first submitted. Id. Instead, the McCarthy Court noted that the defendant presented evidence indicating that it relied on the opinion of the plaintiffs treating physician that this surgery was unnecessary when it decided not to reimburse the plaintiff. Id. This evidence supported the defendant’s argument that it had a reasonable basis for refusing to pay for the plastic surgery at the time the plaintiff requested this coverage, because it established that, when the defendant initially refused the plaintiffs request for the coverage, it recognized that a bona fide question of fact existed regarding whether the surgery was necessary. Id.

In this case, defendant relies exclusively on the jury verdict to support its argument that its initial decision not to pay for certain medical and replacement service expenses requested by plaintiff was reasonable. Notably, defendant argues that its initial refusal to pay these expenses was reasonable because the jury only held it liable for a small percentage of plaintiffs claims. Yet defendant did not know that a jury would only find it liable for a percentage of the disputed medical and replacement service expenses when it refused to pay these expenses. Accordingly, defendant cannot use the jury verdict as evidence to rebut the presumption that *355 its initial refusal to reimburse plaintiff for these expenses was unreasonable. See Attard, supra at 317; McCarthy, supra at 105.

Again, defendant fails to identify any evidence indicating that it recognized that plaintiffs claims were unreasonable at the time it initially refused to make the payments. Defendant fails to indicate that it was not required pursuant to statute or constitutional law to reimburse plaintiff for the disputed claims, that it contacted doctors or other experts to determine if plaintiff reasonably needed the requested medical services when it decided not to pay, or that it had another reasonable basis for disputing the legitimacy of plaintiffs claims for benefits.

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Bluebook (online)
737 N.W.2d 807, 275 Mich. App. 349, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ivezaj-v-auto-club-insurance-michctapp-2007.