Attorney fees under the No-Fault Act (NFA); MCL 500.3148; Moore v Secura Ins; Brown v Home-Owners Ins Co; Reasonableness of an insurer’s refusal to pay work loss benefits; Whether there was a bona fide factual dispute; Principle that work loss & medical expenses are distinct categories of personal protection insurance (PIP) benefits

The court held that the trial court did not clearly err in finding that defendant-insurer’s decision to refuse to pay work loss benefits was unreasonable under the circumstances and that plaintiff was entitled to attorney fees under the NFA. A jury found that he sustained an accidental bodily injury in an accident and was entitled to $149,630 in work loss benefits. It also determined that payment was overdue, and he was entitled to $17,955.60 in penalty interest. Based on the jury’s determinations, “a rebuttable presumption arose that defendant’s refusal to pay benefits was unreasonable, entitling plaintiff to attorney fees.” The court had to “determine the reasonableness of defendant’s decision based on the circumstances that existed” when it stopped payments. Defendant could not support its decision with a doctor’s opinion obtained months “after payments were discontinued.” That meant it could only rely on another doctor’s (J) report “and the surveillance of plaintiff, but neither was sufficient to overcome the presumption that defendant’s failure to pay was unreasonable.” It appeared that the video “was inconsequential. The surveillance showed plaintiff doing small everyday tasks such as leaving his home, getting into his vehicle, or vacuuming his truck for a few minutes. As there was not a claim that [he] was entirely disabled and unable to walk, this evidence proves very little.” J’s report contained “at least one inaccuracy and an assumption that should have given defendant more pause before stopping” the payment of benefits. Given another doctor’s “opinion that the multiple disc herniations were likely caused by the trauma of the accident and the inaccuracies and assumptions made in [J’s] report, the trial court did not err by finding that defendant could not reasonably rely on [J’s] report to stop payments” and avoid the attorney fee penalty under MCL 500.3148(1). Also, the jury’s decision not to award medical expense benefits did not preclude its decision to award work loss benefits and did not preclude a finding that such “benefits were overdue and unreasonably withheld.” Affirmed.