e-Journal Summary

e-Journal Number : 74155
Opinion Date : 10/29/2020
e-Journal Date : 11/17/2020
Court : Michigan Court of Appeals
Case Name : Jawad Shah M.D., PC v. State Farm Mut. Auto. Ins. Co.
Practice Area(s) : Healthcare Law Insurance
Judge(s) : Per Curiam – Stephens, Sawyer, and Beckering
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Issues:

Action by healthcare providers against a no-fault insurer for payment of billed expenses; Whether defendant’s insured complied with the notice provisions of MCL 500.3145(1); Perkovic v. Zurich Am. Ins. Co.; Walden v. Auto Owners Ins. Co.; The remedial purpose of the No-Fault Act; In re Geror; Personal injury protection (PIP)

Summary

The court held that the insured (nonparty-TF) complied with the notice requirements in MCL 500.3145(1) when she contacted defendant-insurer’s claims representative (F) and timely provided “a description of the accident, the place of the accident, and the nature of her injuries.” Thus, plaintiffs-healthcare providers’ claim for payment of billed expenses was not barred by the No-Fault Act’s one-year statute of limitations. About two weeks after the accident, TF spoke with F on the phone. In a claim file opened for TF, F noted the claim was “for PIP only,” and described the injury as “neck pains.” F testified at deposition that while she did “not recall her conversation with [TF], ‘based on that entry and my note, [TF] told me she was injured.’” F also testified that TF relayed “her version of the accident. [F] confirmed that after speaking with [TF], she knew [TF’s] name, knew where she lived, and knew how and when the accident happened that led to [TF’s] alleged injuries.” F ordered and reviewed a copy of the accident police report. She routed the information to defendant’s PIP department for follow up. Employees there closed the claim file after unsuccessful attempts to contact TF. A sufficient notice under the statute “must substantively contain ‘the name and address of the claimant and indicate in ordinary language the name of the person injured and the time, place and nature of his injury.’” The record showed defendant had written notice that substantially complied with these requirements, and it did not argue “it lacked any of the statutorily required information.” Rather, it relied on Perkovic to contend that F’s written record did not fulfill the notice requirement because an oral statement written down by its employee did not constitute written notice to defendant, and F, as its claims representative, was not acting on TF’s behalf. The court rejected both arguments. The information TF directly provided to defendant sufficed for it “to open a PIP claim file and to attempt to re-contact [TF] to discuss her options. That [TF] did not elect to file a claim at that time does not render her notice somehow ineffective.” The court also declined to adopt the assumption that an insurer’s representatives “cannot simultaneously act on behalf of their employers and in the interests of their insureds, even in the absence of a dispute.” It reversed summary disposition for defendant and remanded.

Full PDF Opinion