McKelvie v. Auto Club Ins Ass'n

512 N.W.2d 74, 203 Mich. App. 331
CourtMichigan Court of Appeals
DecidedJanuary 19, 1994
DocketDocket 136378
StatusPublished
Cited by26 cases

This text of 512 N.W.2d 74 (McKelvie v. Auto Club Ins Ass'n) 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
McKelvie v. Auto Club Ins Ass'n, 512 N.W.2d 74, 203 Mich. App. 331 (Mich. Ct. App. 1994).

Opinion

Per Curiam.

Defendant Auto Club Insurance Association (acia) appeals as of right from a circuit court judgment awarding plaintiff Frank McKelvie attorney fees under § 3148(1) of the no-fault act, MCL 500.3148(1); MSA 24.13148(1). Mc-Kelvie cross appeals from the trial court’s ruling in a prior opinion and order that McKelvie was entitled to judgment interest, under MCL 600.6013; MSA 27A.6013, from the date the delay in payment began, rather than the date the original complaint was filed, for acia’s subsequent refusal to completely reimburse nursing and home care costs. We affirm.

McKelvie sustained injuries in a January 5, 1985, accident, which resulted in quadriplegia. He was hospitalized for approximately six months, and also required rehabilitation services, which he obtained from Professional Rehabilitation Associates (pra). He also required twenty-four-hour-a-day home care services. Although acia paid for McKelvie’s various medical, nursing, and home care costs, it did not pay for pra’s services, nor did it provide a specially equipped van recommended by pra and requested by McKelvie. On March 28, 1986, McKelvie filed a complaint against acia for these failures to pay. On February 2, 1987, McKelvie amended his complaint to include a tort claim, which was later dismissed. Various counterclaims and motions not in issue here also followed.

On August 25, 1988, acia reduced its reimbursement for McKelvie’s nursing and home care to payment for eight hours of care a day. In response, McKelvie amended his complaint again on Sep *334 tember 19, 1988, to include acia’s refusal to pay for twenty-four-hour care, as well as its failure to pay expenses incidental to so-called regys treatment [an electrical stimulation therapy program] that McKelvie obtained in Florida during 1987, and the cost of a regys home therapy (ergys) unit. Before trial, acia agreed to pay for the ergys unit. The jury found acia liable for rehabilitation costs, nursing and home care expenses, and for certain of the expenses incidental to the regys treatment.

Pursuant to MCL 600.6013; MSA 27A.6013, the trial court awarded interest on the unpaid nursing and home care expenses. However, rejecting McKelvie’s argument that the interest should be calculated from the date of McKelvie’s original complaint, the court instead ordered that it be calculated from the date of delay, August 25, 1988. Pursuant to MCL 500.3148(1); MSA 24.13148(1), and upon McKelvie’s motion, the court also awarded attorney fees on the basis of acia’s unreasonable failure to pay pra’s expenses, the incidental expenses of regys treatment, and nursing and home care after August 1988. From these two decisions, the parties appeal.

i

We find first that the trial court did not clearly err in awarding McKelvie attorney fees pursuant to § 3148(1) of the no-fault act. That section provides:

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 in *335 surer unreasonably refused to pay the claim or unreasonably delayed in making proper payment.

The purpose of this penalty provision is to ensure prompt payment to the insured. Allstate Ins Co v Citizens Ins Co, 118 Mich App 594, 607; 325 NW2d 505 (1982). A refusal or delay in payment by an insurer will not be found unreasonable under this statute where it is the product of a legitimate question of statutory construction, constitutional law, or a bona fide factual uncertainty. United Southern Assurance Co v Aetna Life & Casualty Ins Co, 189 Mich App 485, 492; 474 NW2d 131 (1991). However, where there is such a delay or refusal, a rebuttable presumption of unreasonableness arises such that the insurer has the burden to justify the refusal or delay. Bloemsma v Auto Club Ins Co, 174 Mich App 692, 696-697; 436 NW2d 442 (1989). The trial court’s finding of unreasonable refusal or delay will not be reversed unless it is clearly erroneous. United Southern Assurance Co, supra.

MCL 500.3107(1)(a); MSA 24.13107(1)(a) defines allowable expenses as "all reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person’s care, recovery, or rehabilitation.” The requirements are that (1) the charge be reasonable, (2) the expense be reasonably necessary, and (3) the expense be incurred. Davis v Citizens Ins Co, 195 Mich App 323, 326; 489 NW2d 214 (1992).

With regard to acia’s refusal to pay pra, there was evidence at the trial that pra performed services for McKelvie that were related to doctor-ordered prescriptions, yet acia made nq payment at all. From that evidence, as well as acia’s arguments during the proceedings that pra did nothing that Frank McKelvie or his wife could not do, that *336 pra’s charges of approximately $50 an hour were unreasonable, and that because McKelvie had not been billed for those charges, they had not been incurred, the trial court could reasonably have concluded that acia made a policy decision to disallow any payment to pra, without any evaluation of the reasonable necessity of any of the services. The court found that this blanket denial of all payment to pra was unreasonable.

The fact that an insurer may be liable for some expenses (i.e., those reasonably incurred) does not necessarily establish its liability for all of the expenses. Nasser v Auto Club Ins Ass’n, 435 Mich 33, 51; 457 NW2d 637 (1990). However, the fact that pra provided some services that acia may have had a bona fide reason for disputing does not justify making no payment. See Cole v DAIIE, 137 Mich App 603, 613; 357 NW2d 898 (1984) (the fact that a portion of the amount due is in dispute does not justify withholding the entire amount due).

With regard to acia’s reduction of nursing and home care reimbursement to eight hours a day as of August 25, 1988, the record evidence of the last expert opinion on which acia relied for its diminution was in 1987 and, as the trial court found, provides no basis for reducing coverage for daily care from twenty-four to eight hours. To the contrary, the evaluation indicated that at that time McKelvie apparently required someone in attendance throughout both day and night. Acia asserts that the trial court found that acia simply stopped paying for home care, and thus made a factual error. However, the trial court’s opinion clearly recognized that acia had made a decision to pay for eight hours of nursing care a day. We thus find no clear error in the trial court’s decision that acia’s refusal to continue payment for twenty-four-hour care was unreasonable.

*337 With regard to the expenses incidental to the Florida regys program, the evidence offered at trial tended to support acia’s view that there was bona fide factual uncertainty. However, despite its original hesitance to pay for what it viewed as experimental treatment, acia did ultimately pay the costs of the program itself, refusing only Mc-Kelvie’s claims for incidental expenses.

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

Related

Ameerah Matti v. Hussan Tahnun
Michigan Court of Appeals, 2024
20230209_C359690_46_359690.Opn.Pdf
Michigan Court of Appeals, 2023
Abdul Nahshal v. Fremont Insurance Company
Michigan Court of Appeals, 2018
Patrick Quick v. Thomas Ryan
Michigan Court of Appeals, 2016
Tinnin v. Farmers Insurance Exchange
791 N.W.2d 747 (Michigan Court of Appeals, 2010)
Villaflor v. State Farm Mutual Automobile Insurance
343 F. App'x 33 (Sixth Circuit, 2009)
Ivezaj v. Auto Club Insurance
737 N.W.2d 807 (Michigan Court of Appeals, 2007)
Borgess Medical Center v. Resto
730 N.W.2d 738 (Michigan Court of Appeals, 2007)
Ayar v. Foodland Distributors
687 N.W.2d 365 (Michigan Court of Appeals, 2004)
Van Buren Charter Township v. Garter Belt, Inc
673 N.W.2d 111 (Michigan Court of Appeals, 2003)
Buzzitta v. Larizza Industries, Inc.
641 N.W.2d 593 (Michigan Supreme Court, 2002)
ROSKAM BAKING CO. v. Northern Ins. Co. of NY
108 F. Supp. 2d 789 (W.D. Michigan, 2000)
Perceptron, Inc. v. Sensor Adaptive Machines, Inc.
221 F.3d 913 (Sixth Circuit, 2000)
Attard v. Citizens Insurance Co. of America
602 N.W.2d 633 (Michigan Court of Appeals, 1999)
Arco Industries Corp. v. American Motorists Insurance
594 N.W.2d 61 (Michigan Court of Appeals, 1999)
McKelvie v. Auto Club Ins. Ass'n
586 N.W.2d 395 (Michigan Supreme Court, 1998)
McKelvie v. Auto Club Insurance
566 N.W.2d 658 (Michigan Court of Appeals, 1997)
Beach v. State Farm Mutual Automobile Insurance
550 N.W.2d 580 (Michigan Court of Appeals, 1996)

Cite This Page — Counsel Stack

Bluebook (online)
512 N.W.2d 74, 203 Mich. App. 331, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mckelvie-v-auto-club-ins-assn-michctapp-1994.