First-party action for PIP benefits; Attorney fees under MCL 500.3148(1); Moore v Secura Ins; Ross v Auto Club Group; Motion for reconsideration; MCR 2.119(F)(3)

The court held that the trial court did not err in ruling that defendant-insurer (Farm Bureau) unreasonably refused to pay plaintiff-Maurer the PIP benefits in dispute, and in awarding plaintiff her attorney fees pursuant to MCL 500.3148(1). She was in an accident in 2000 and underwent surgery in 2002 as a result. Defendant paid for that surgery. Plaintiff asserted “she improved for a time after the surgery, but then her symptoms worsened. She relied on pain medication for years. Ultimately, she underwent another surgery in 2018. Farm Bureau refused to pay the expenses that Maurer incurred for continued pain management, the 2018 surgery, and post-surgical attendant care.” Plaintiff filed this action and a jury found in her favor. The trial court then determined defendant “unreasonably withheld PIP benefits,” and ordered it to pay plaintiff $54,820 in attorney fees. Defendant argued that the trial court erred in doing so and in denying its motion for reconsideration. The court disagreed. Defendant relied on reports from two of its own doctors (O and M) to whom it sent plaintiff for exams. The court found that the failure of O and M “to offer anything more than conclusory statements and recommendations distinguishes this case from the cases” cited by defendant. The court concluded a reasonable fact-finder could determine that an insurer would not rely on O’s and M’s “reports to justify refusing all payments associated with Maurer’s care because the assessments were conclusory, ignored significant medical evidence to the contrary,” including imaging evidence, “and were contrary to the opinions of Maurer’s treating physicians.” During the litigation, defendant compelled plaintiff to undergo another medical exam by another of its own doctors, a neurosurgeon (K), and it cited K’s opinion that the 2018 surgery was unrelated to the accident. But the court noted that K “did not examine Maurer until 2019, which was after Farm Bureau had already made the decision to stop paying for Maurer’s care. So Farm Bureau could not have relied on his opinion at the time of its decision.” Thus, the court found the trial court did not clearly err in giving K’s testimony “little weight in assessing whether Farm Bureau acted reasonably at the time when it cut Maurer off from all payments for her care.” Affirmed.