Sunset Assisted Living v. Farmers Insurance Exchange

CourtMichigan Court of Appeals
DecidedApril 15, 2025
Docket370095
StatusUnpublished

This text of Sunset Assisted Living v. Farmers Insurance Exchange (Sunset Assisted Living v. Farmers Insurance Exchange) 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
Sunset Assisted Living v. Farmers Insurance Exchange, (Mich. Ct. App. 2025).

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

SUNSET ASSISTED LIVING, UNPUBLISHED April 15, 2025 Plaintiff-Appellant, 1:31 PM

v No. 370095 Wayne Circuit Court FARMERS INSURANCE EXCHANGE, LC No. 23-000504-NF

Defendant-Appellee.

Before: MARIANI, P.J., and RIORDAN and FEENEY, JJ.

PER CURIAM.

Plaintiff Sunset Assisted Living appeals as of right the trial court’s opinion and order granting summary disposition in favor of defendant Farmers Insurance Exchange pursuant to MCR 2.116(C)(10). On appeal, plaintiff argues that the trial court erred by ruling that defendant only was required to pay for 56 hours per week of attendant-care services under MCL 500.3157(10) of the no-fault act, MCL 500.3101 et seq. Plaintiff also argues that the trial court erred by ruling that defendant was not liable for penalty interest under MCL 500.3142 and attorney fees under MCL 500.3148, and by denying its motion for reconsideration on that issue. For the reasons set forth, we affirm in part, reverse in part, and remand to the trial court for further proceedings.

I. FACTS

On January 11, 2023, plaintiff filed its complaint against defendant, alleging that it had provided attendant-care services to the underlying no-fault claimant, JR, after a motor-vehicle accident, that JR assigned her right to receive personal protection insurance (PIP) benefits to plaintiff, but that defendant “has unreasonably withheld and/or delayed payment for these charges.” Documentation attached to the complaint, titled “Health Insurance Claim Form,” indicated that plaintiff provided services to JR on a daily basis between July 2021 and March 2022.

On September 19, 2023, defendant moved for summary disposition “[b]ased on MCL 500.3157.” In the accompanying brief, defendant explained that JR was injured in a June 16, 2021 motor-vehicle accident, that plaintiff “charged for care that was provided by the claimant’s mother, Tiffany Crawley . . . in excess of 56 hours per week,” and that doing so was contrary to MCL 500.3157(10), which essentially states that when a family member “directly or indirectly” provides

-1- attendant care to an injured person in the injured person’s home, the no-fault insurer only is required to pay for 56 hours of attendant care per week. Defendant asserted:

Here, there is no question of fact that Sunset Assisted Living contracted Claimant’s mother, Tiffany Crawley, to provide care for the underlying Claimant [JR]. The statute was clearly written to include family provided attendant care that was provided “directly or indirectly.” Even if Tiffany Crawley filled out forms provided by the Sunset Assisted Living agency, there is no dispute as to her relation to Claimant [JR]. As such, this family provided attendant care must abide by the statutory limits of MCL 500.3157 and be capped at 56 hours per week.

On December 16, 2023, plaintiff moved for partial summary disposition under MCR 2.116(C)(10), arguing that defendant failed to timely pay PIP benefits and, therefore, was subject to penalty interest under MCL 500.3142. Plaintiff further contended that under the circumstances of this case, it was entitled to attorney fees from defendant under MCL 500.3148 as well.1

Other than a short summation in its brief in support of its motion for summary disposition, plaintiff offered little to support its arguments. The section of the supporting brief titled “INTRODUCTION AND RELEVANT FACTS” provides, in its entirety:

As set forth in the attached motion, Plaintiff, sustained multiple injuries arising out of a motor vehicle accident. These injuries included injuries to her head for which she had surgery. As a result, Plaintiff underwent reasonably necessary treatment with medical providers. Plaintiff also received replacement services and attendant care. The bills and necessary proof were timely submitted to Defendant.

In 2023, Defendant issued payment on these claims late without the required penalty interest. (See Exhibit B).

Defendant is now precluded from arguing that the payments were not owed, not late or that Plaintiff is not entitled to Attorney’s fees.

The remainder of the brief summarizes no-fault law, specifically as it relates to a no-fault insurer’s obligation to promptly pay PIP benefits and the possible penalty interest under MCL 500.3142 and liability for attorney fees under MCL 500.3148 if it fails to do so. In addition, plaintiff attached two documents as exhibits to the brief, the complaint initiating this case, and an

1 As explained infra, whether a no-fault insurer failed to timely pay PIP benefits as required by MCL 500.3142, and thus is subject to penalty interest, generally is a question of fact for a jury— unless, of course, either the claimant or the insurer is entitled to summary disposition on this issue as a matter of law. However, whether a no-fault insurer is liable for a claimant’s attorney fees under MCL 500.3148 for unreasonably delaying payment of PIP benefits is a question of law for the court in post-judgment proceedings.

-2- October 31, 2023 check from defendant to plaintiff in the amount of $91,728.00. Plaintiff did not identify any other factual support in its motion, brief, or accompanying exhibits.2

On January 2, 2024, defendant filed its own motion for summary disposition under MCR 2.116(C)(8) and (C)(10), asserting:

During the course of discovery, Defendant attempted to determine which claims were outstanding by serving written discovery. At Case Evaluation, Plaintiff presented a demand that included medical bills in excess of the 56 hour per week limit. Defendant issued payments in compliance with the 56 hour per limit.

(Exhibit B- Correspondence with Payments). The payment log reflects that Defendant paid benefits in the total amount of $91,728.00. (Exhibit C – Payment Log). Defendant made payment in accordance with the 56 hour per week limit on family provided attendant care and no claims remain outstanding.

Substantively, defendant argued that because it paid plaintiff in an amount consistent with the “Medicare Fee Schedule,” and because plaintiff was not entitled to any payments in excess of the 56-hour weekly cap under MCL 500.3157(10), all claims to plaintiff were satisfied and the case should be dismissed.

Plaintiff responded that the 56-hour weekly cap under MCL 500.3157(10) does not apply in this case because “Sunset Assisted Living provided the services requested and billed for the attendant care services. While [JR’s] relatives are employed by Sunset Assisted Living and doing the actual work, they are not the one [sic] responsible for providing the attendant care services.” Plaintiff further argued that defendant failed to timely pay PIP benefits under MCL 500.3142, reasoning as follows:

Defendant’s Payment Log indicates that it received bills from Plaintiff periodically from December 2021 through March 2022. The Payment Log and the check attached as exhibits to Defendant’s Motion show that payment for the 56 hours per week of attendant care was not paid until October 31, 2023. (See Defendant’s Exhibits B and C) Therefore, this evidence establishes unequivocally that the bills were overdue when paid. The Payment Log further shows that no interest was paid, even though the bills were overdue when paid.

2 Thus, while the factual basis for the partial motion for summary disposition is not clearly stated, it may be inferred from the motion and accompanying brief that defendant either paid nothing to plaintiff until October 2023 or that, according to plaintiff, defendant did not pay a sufficient amount to plaintiff.

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Cite This Page — Counsel Stack

Bluebook (online)
Sunset Assisted Living v. Farmers Insurance Exchange, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sunset-assisted-living-v-farmers-insurance-exchange-michctapp-2025.