Whether misrepresentations triggered the policy’s fraud provisions; Bazzi v. Sentinel Ins. Co.; Cole v. Auto-Owners Ins. Co.; Replacement services; MCL 500.3107(1)(c); Hmeidan v. State Farm Mut. Auto. Ins. Co.; An insurance policy as a contract; West Am. Ins. Co. v. Meridian Mut. Ins. Co.; Waldan Gen. Contractors, Inc. v. Michigan Mut. Ins. Co.; Assertion that a contract is void or voidable as an affirmative defense; MCR 2.111(F)(3); Deciding whether an insured committed fraud; Meemic Ins. Co. v. Fortson; Shelton v. Auto-Owners Ins. Co.; Bahri v. IDS Prop. Cas. Ins. Co.; Motion for JNOV; Hecht v. National Heritage Acads., Inc.; Heaton v. Benton Constr. Co.; Dawe v. Bar-Levav & Assoc., PC (On Remand); Case evaluation sanctions; Elia v. Hazen; Allard v. State Farm Ins. Co.; Smith v. Khouri; Peterson v. Fertel; Determining a reasonable attorney fee; Wood v. v. Detroit Auto. Inter-Ins. Exch.; Pirgu v. United Servs. Auto. Ass'n
Holding that the trial court’s denial of defendant’s motions for summary disposition and JNOV were supported by the record, the court affirmed the judgment of $120,641.75 in plaintiff’s favor. It also affirmed the award of case evaluation sanctions to plaintiff. Defendant argued that surveillance video recordings and affidavits showed that “plaintiff was able to, and in fact did, perform tasks that she represented to defendant she could not do and that she asserted were performed by her husband on those dates.” It asserted that these misrepresentations triggered the policy’s fraud provisions, thereby voiding coverage. It relied primarily on Bahri. More recently, the court in Shelton affirmed the trial court’s decision “that the defendant insurer was not entitled to summary disposition of the plaintiff’s claim for medical expenses despite video evidence showing the plaintiff performing activities that the claim suggested were not possible for her to perform.” The court in Shelton distinguished Bahri in part. Here the court reviewed de novo whether the record supported “the trial court’s denial of defendant’s motion for summary disposition, which was based on the ground that plaintiff engaged in fraud or misrepresentation to obtain PIP benefits, and thereby had triggered the fraud provision of the contract, consequently voiding the contract. To establish the contract defense of fraud, defendant was required to show that plaintiff knowingly or recklessly made a material misrepresentation of a fact that she knew was false when she made it, and did so intending that defendant act upon it.” The court considered specifically “whether the video evidence and affidavits demonstrated that there was no question of fact remaining that plaintiff made material misrepresentations of a fact or facts that she knew were false when she made them, and did so intending that defendant act upon them, regarding her need for and receipt of replacement services . . . .” It concluded that the video did “not establish that the form requesting replacement services necessarily contained a false statement.” Plaintiff’s explanation about the video evidence was “not contradictory to her statements made in requesting replacement services reimbursement. Her position is that she never said she was entirely incapable of driving, walking, or running errands, only that she often needs help to do these activities.” She contended that her abilities varied from day to day, and that she was trying “to improve her condition by doing tasks to the extent that she can.”
Full PDF Opinion