e-Journal Summary

e-Journal Number : 77690
Opinion Date : 06/23/2022
e-Journal Date : 07/12/2022
Court : Michigan Court of Appeals
Case Name : Bronson Health Care Group, Inc. v. Falls Lake Nat'l Ins. Co.
Practice Area(s) : Healthcare Law Insurance
Judge(s) : Per Curiam – Cameron, Cavanagh, and Gadola
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Issues:

Action by a healthcare provider to recover personal protection insurance (PIP) benefits under the No-Fault Act; Cancellation of an insurance policy; MCL 500.3020; Yang v Everest Nat’l Ins Co; Effect of cashing a refund check; Mutuality requirement for a contract modification; Reasonableness of requested medical charges; MCL 500.3107(1)(a); MCL 500.3157(1); MCR 2.116(G)(4); Attorney fees; MCL 500.3148(1); Michigan Assigned Claims Plan & Michigan Automobile Insurance Placement Facility (collectively MAIPF); MCL 500.3172(1)(a)

Summary

Holding that defendant-insurer (Falls Lake) did not comply with MCL 500.3020(1)(b)’s notice requirements to effectively cancel its policy and thus, it was still in effect at the time of the accident at issue, the court affirmed summary disposition for plaintiff-healthcare provider (Bronson). Further, Falls Lake offered no evidence that a genuine issue of material fact existed as to the reasonableness of Bronson’s charges. The court also upheld the award of attorney fees to Bronson under MCL 500.3148(1). Finally, it affirmed summary disposition for defendants-MAIPF given that Falls Lake was “responsible for payment of Bronson’s medical charges” and the MAIPF did not need to be involved in the case. Bronson sought to recover PIP benefits “for medical services provided to a pedestrian who was” struck by a vehicle driven by Falls Lake’s insured (J). The court noted the facts here were similar to those in Yang. Falls Lake conceded the notice it sent to J “was not a valid cancellation notice under Yang because it was sent before the premium payment was due.” But Falls Lake asserted “the premium refund check served as proper notice of cancellation and that [J] agreed to the cancellation because he cashed the check. This argument is unavailing because MCL 500.3020(1)(b) requires that the insured be provided with 10 days’ notice of the cancellation in order to reinstate the policy or obtain different insurance.” In addition, to the extent Falls Lake contended J’s cashing the “check established his agreement or assent to the cancellation of the policy, there” was no record evidence indicating his “state of mind or understanding.” The document simply stated “the refund was for the canceled policy. There was no indication that cashing the check constituted agreement to the policy’s cancellation or waiver of the 10 days’ notice requirement in MCL 500.3020(1)(b).” As to the reasonableness of Bronson’s charges, “Falls Lake failed to specify which charges were unreasonable or explain why” they were so, and it offered no supporting documentary evidence. As to attorney fees, “even considering what was known to Falls Lake . . . when it denied Bronson’s claim for benefits, its denial was unreasonable considering the language of its own policy and longstanding caselaw.”

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