Action by a medical provider seeking PIP benefits for services provided to an insured; Causation; MCL 500.3105(1); McPherson v McPherson; Effect of a failure to pursue workers’ compensation benefits; MCL 500.3109(1); Perez v State Farm Mut Auto Ins Co

The court held that the trial court erred by granting summary disposition for defendants-insurers because a genuine issue of fact remained and neither party was entitled to summary disposition. Plaintiffs sought reimbursement from defendants for services it provided for defendants’ insured (W), who was injured in an auto accident. The trial court found defendants were not liable to pay no-fault benefits because W failed to use reasonable efforts to obtain workers’ compensation benefits before pursuing no-fault benefits. On appeal, the court found neither party was entitled to summary disposition because there remained a genuine issue of material fact whether W’s injury requiring surgery arose from the accident. “[R]esolution of the parties’ dispute comes down to what caused [W’s] AC joint separation to worsen and require surgery—did it naturally worsen over time (as plaintiffs argue) or did it worsen because [W] caused greater damage by reinjuring his shoulder while at work (as defendants argue)? Both theories have evidence support, so resolution of the issue should be left to a factfinder, not resolved at the dispositive motion stage.” The court also found that the trial court erred by granting defendants’ motion for summary disposition on the basis of W’s failure to use reasonable efforts to obtain workers’ compensation benefits, and that W’s failure to pursue available workers’ compensation benefits did not entitle defendants to summary disposition. “First, as plaintiffs point out, defendants themselves could have pursued workers’ compensation benefits on behalf of” W. As such, W’s “failure to pursue workers’ compensation benefits did not preclude the practical application of MCL 500.3109(1), nor did it frustrate that statute’s purpose.” Second, defendants “are only entitled to subtract ‘[b]enefits provided or required to be provided,’ and the parties dispute whether [W’s] injuries would have qualified for workers’ compensation benefits.” Third, nothing in MCL 500.3109(1) indicated “it absolves defendants of their responsibility to pay PIP benefits.” Reversed and remanded.