Usf Ins. & Gua. Co. v. McCa

731 N.W.2d 481, 274 Mich. App. 184
CourtMichigan Court of Appeals
DecidedMay 14, 2007
DocketDocket Nos. 260604, 271199
StatusPublished

This text of 731 N.W.2d 481 (Usf Ins. & Gua. Co. v. McCa) 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
Usf Ins. & Gua. Co. v. McCa, 731 N.W.2d 481, 274 Mich. App. 184 (Mich. Ct. App. 2007).

Opinion

731 N.W.2d 481 (2007)
274 Mich. App. 184

UNITED STATES FIDELITY INSURANCE & GUARANTY COMPANY, Plaintiff-Appellee,
v.
MICHIGAN CATASTROPHIC CLAIMS ASSOCIATION, Defendant-Appellant, and
Michael Migdal, Individually and as Conservator for the Estate of Daniel Migdal, a Protected Person, Defendant.
The Hartford Insurance Company of the Midwest, Plaintiff-Appellant,
v.
Michigan Catastrophic Claims Association, Defendant-Appellee.

Docket Nos. 260604, 271199.

Court of Appeals of Michigan.

Submitted December 6, 2006, at Detroit.
Decided February 6, 2007, at 9:00 a.m.
Released for Publication May 14, 2007.

*482 Plunkett & Cooney, P.C. (by Jeffrey C. Gerish and Gregory Gromek), Bloomfield Hills, for United States Fidelity Insurance & Guaranty Company.

Stark Reagan, P.C. (by Ava K. Ortner), Troy and Dykema Gossett, P.L.L.C. (by Joseph K. Erhardt, Jill M. Wheaton, and K.J. Miller), Detroit, for the Michigan Catastrophic Claims Association.

Secrest Wardle (by Janet Callahan Barnes and John H. Cowley, Jr.), Farmington Hills, for The Hartford Insurance Company of the Midwest.

Secrest Wardle (by Janet Callahan Barnes and John H. Cowley, Jr.), Farmington Hills, for The Hartford Insurance Company of the Midwest in Docket No. 260604, amicus curiae.

*483 John A. Lydick, Bingham Farms, for the Insurance Institute of Michigan, amicus curiae.

Gross, Nemeth & Silverman, P.L.C. (by Mary T. Nemeth), Detroit, for Auto Club Insurance Association, amicus curiae.

Before: OWENS, P.J., and WHITE and HOEKSTRA, JJ.

PER CURIAM.

These consolidated appeals concern the extent of the Michigan Catastrophic Claims Association's (MCCA) duty to indemnify its member insurance companies for losses incurred as a result of personal protection insurance (PIP) payments made to insureds who have suffered catastrophic injuries.

In Docket No. 260604, the MCCA appeals by right the Oakland Circuit Court's November 3, 2004, order granting summary disposition to plaintiff United States Fidelity Insurance & Guaranty Company (USF&G) under MCR 2.116(C)(10). The court interpreted MCL 500.3104 as requiring the MCCA to indemnify its members for the actual amount that each member paid in PIP coverage in excess of the $250,000 statutory threshold, rejecting the MCCA's argument that it is only required to indemnify its members for "reasonable" charges. We affirm.

In Docket No. 271199, plaintiff The Hartford Insurance Company of the Midwest (Hartford) appeals by leave granted the Oakland Circuit Court's June 6, 2006, order denying its motion for summary disposition under MCR 2.116(C)(9) and (C)(10). The court determined that the MCCA may challenge the reasonableness of a member's payments for PIP benefits as a defense to a claim for indemnification under MCL 500.3104. We reverse.

I. Facts and Procedural History

A. Docket No. 260604

On August 22, 1981, Daniel Migdal, aged 17, was involved in an automobile accident that left him severely and permanently injured. Since then, Daniel has required constant nursing care. In 1988, Michael Migdal, Daniel's father and the conservator of his estate, sued USF&G to recover attendant care benefits for the care that he and his wife, Betty, provided to Daniel.[1]

In early 1990, the parties stipulated the entry of a consent judgment under which USF&G agreed to pay Michael a lump sum of $35,000 for attendant care services rendered before May 10, 1989. USF&G also agreed to pay, beginning January 25, 1989, $17.50 "per hour for nursing care services," for "a single nurse," for a maximum of 24 hours a day, with yearly increases of 8.5 percent, compounded annually, "during the period Daniel Migdal is residing in the family home." The judgment also provided that if the Migdals became unable or unwilling to continue providing Daniel's home care, USF&G would reimburse Michael for the costs of Daniel's care at the rate charged by the facility providing care. All personnel decisions, including hiring, firing, scheduling, and staffing, as well as all placement decisions, were at the Migdals' sole discretion.

USF&G maintained that its stipulation for the entry of the consent judgment was the product of its best judgment, appeared reasonable, and represented a compromise of various disputed factors, including Michael's claim that more than one nurse was needed to care for Daniel and the then-high inflation rate for medical care.[2] Regardless, *484 according to USF&G, by July 2003 it had paid over $7 million in PIP benefits on Daniel's behalf. In 2003, USF&G paid $54.84 an hour for Daniel's nursing care services.[3]

Michael created a company (Migdal, doing business as Medical Management) to manage Daniel's care. He hired and paid nurses to care for Daniel through the company. In 2003, the nurses were paid, on average, $32 an hour, including benefits, and Michael kept as his compensation the approximately $200,000 difference between the costs of nursing care and the money paid by USF&G. To manage the company and Daniel's care, Michael would spend time with Daniel, nurses, and therapists; check equipment; prepare the payroll; talk to his accountant; review newspapers and magazines; interview, hire, and manage the company's nurses; and help move Daniel as needed.

After the consent judgment was entered, USF&G paid the rate stipulated therein, without continuing to review its reasonableness. USF&G submitted these claims to the MCCA for reimbursement. The MCCA reimbursed USF&G $22.05 an hour for nursing care services, which it considered a reasonable rate of reimbursement, not the hourly rate stipulated in the consent judgment.

On July 29, 2003, USF&G filed a complaint for a declaratory judgment, asking the court to declare that the MCCA was required to reimburse it for all amounts it paid under the consent judgment, without regard to the MCCA's assessment of the "reasonableness" of these payments.[4] The MCCA moved for summary disposition of this claim under MCR 2.116(C)(10), arguing that the no-fault act only required it to indemnify its members for reasonable claims paid above the statutory threshold and that there was no question of material fact that the benefits paid by USF&G were unreasonable. USF&G filed a countermotion for summary disposition under MCR 2.116(C)(9) and (C)(10), arguing that a question of material fact existed concerning the reasonableness of the payments made to Michael and that, in any event, the no-fault act required the MCCA to reimburse it for the full amount of its "ultimate losses" over the statutory threshold.[5]

On November 3, 2004, the trial court granted USF&G's MCR 2.116(C)(10) motion for summary disposition and denied the MCCA's motion. The trial court found that nothing in the no-fault act prevented an insurer from entering a long-term settlement agreement to provide nursing care services to an insured person who was catastrophically injured in a motor vehicle accident. The court found that, because the statute requires the MCCA to reimburse USF&G for the total amount of its "ultimate loss," the real issue was whether *485 the MCCA must reimburse USF&G for all its payments or merely for reasonable payments. After examining the language of the statute, the trial court found that "ultimate loss" was defined as an insurer's "actual loss," and that nothing in the statute required that amount to be reasonable.

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

Related

United States v. Turkette
452 U.S. 576 (Supreme Court, 1981)
Elezovic v. Ford Motor Co.
697 N.W.2d 851 (Michigan Supreme Court, 2005)
Mayor of Lansing v. Public Service Commission
680 N.W.2d 840 (Michigan Supreme Court, 2004)
Dessart v. Burak
678 N.W.2d 615 (Michigan Supreme Court, 2004)
Lesner v. Liquid Disposal, Inc
643 N.W.2d 553 (Michigan Supreme Court, 2002)
Dessart v. Burak
652 N.W.2d 669 (Michigan Court of Appeals, 2002)
Nasser v. Auto Club Ins. Ass'n
457 N.W.2d 637 (Michigan Supreme Court, 1990)
People v. McIntire
591 N.W.2d 231 (Michigan Court of Appeals, 1999)
In Re Wayne County Prosecutor
591 N.W.2d 359 (Michigan Court of Appeals, 1999)
Luttrell v. Department of Corrections
365 N.W.2d 74 (Michigan Supreme Court, 1985)
Tryc v Michigan Veterans’ Facility
545 N.W.2d 642 (Michigan Supreme Court, 1996)
Michigan Municipal Liability & Property Pool v. Muskegon County Board
597 N.W.2d 187 (Michigan Court of Appeals, 1999)
Maiden v. Rozwood
597 N.W.2d 817 (Michigan Supreme Court, 1999)
Oakland County Board v. Michigan Property & Casualty Guaranty Ass'n
575 N.W.2d 751 (Michigan Supreme Court, 1998)
Decker v. Flood
638 N.W.2d 163 (Michigan Court of Appeals, 2002)
Farmers Insurance Exchange v. South Lyon Community Schools
602 N.W.2d 588 (Michigan Court of Appeals, 1999)
In Re Certified Question
449 N.W.2d 660 (Michigan Supreme Court, 1989)
Robinson v. Shatterproof Glass Corp.
605 N.W.2d 677 (Michigan Court of Appeals, 2000)
Sun Valley Foods Co. v. Ward
596 N.W.2d 119 (Michigan Supreme Court, 1999)
Hoste v. Shanty Creek Management, Inc
592 N.W.2d 360 (Michigan Supreme Court, 1999)

Cite This Page — Counsel Stack

Bluebook (online)
731 N.W.2d 481, 274 Mich. App. 184, Counsel Stack Legal Research, https://law.counselstack.com/opinion/usf-ins-gua-co-v-mcca-michctapp-2007.