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In Candler, we held "[n]o reasonable jury could conclude plaintiff, despite the presence of any head injury, was not aware that he was submitting false information that was material to his claim for no-fault benefits."
Summary of this case from Gary v. Farmers Ins. Exch.Opinion
No. 332998
10-24-2017
Kalvin CANDLER, Plaintiff-Appellee, and Pain Center USA, PLLC, Intervening Plaintiff, v. FARM BUREAU MUTUAL INSURANCE COMPANY OF MICHIGAN, Defendant-Appellant.
Douglas S. Dovitz, PC (by Douglas S. Dovitz ) and Steven A. Hicks for plaintiff. Garan Lucow Miller, PC (by Sarah Nadeau ) for defendant
Douglas S. Dovitz, PC (by Douglas S. Dovitz ) and Steven A. Hicks for plaintiff.
Garan Lucow Miller, PC (by Sarah Nadeau ) for defendant
Before: Saad, P.J., and Cavanagh and Cameron, JJ.
Saad, P.J.In this action to recover personal injury protection insurance (PIP) benefits, defendant appeals the trial court's denial of its motion for summary disposition. In this case of first impression, we are asked to provide the proper interpretation of MCL 500.3173a(2), which imposes consequences for supplying false information "in support of a claim to the Michigan automobile insurance placement facility." Because plaintiff knowingly made false and material statements that were used to support a claim which was submitted to the Michigan automobile insurance placement facility (MAIPF), a fraudulent insurance act was committed, and plaintiff is precluded from recovering on his claim. Accordingly, we reverse the denial of defendant's motion for summary disposition.
We granted leave to appeal in Candler v. Farm Bureau Mut. Ins. Co. of Mich , unpublished order of the Court of Appeals, entered September 22, 2016 (Docket No. 332998). Intervening plaintiff, Pain Center USA, PLLC, is not a party to this appeal.
I. BASIC FACTS
On September 12, 2014, plaintiff was struck by a hit-and-run driver. Because plaintiff was uninsured at the time of the accident, and because the driver of the other vehicle could not be identified, plaintiff made a claim for PIP benefits through the Michigan Assigned Claims Plan (MACP), which is maintained by the MAIPF. The MAIPF assigned defendant to handle plaintiff's claims in accordance with the provisions of the Michigan no-fault act, MCL 500.3101 et seq .While defendant paid over $150,000 in PIP benefits to plaintiff, it refused to pay other PIP benefits, including any for attendant or replacement-care services. Among the documentation submitted to defendant in support of a claim for PIP benefits were replacement-services calendars for the months of August, September, and October 2015. The calendars purportedly were signed by Andrew Candler, plaintiff's brother, and showed that Andrew provided care to plaintiff during these three months. However, during discovery, it was learned that Andrew last provided services to plaintiff in July 2015. After this time, plaintiff moved from Rochester to Detroit to live with his girlfriend, who took over providing replacement services for plaintiff. Plaintiff's counsel at the trial court conceded that plaintiff had signed his brother's name to these calendars.
Under MCL 500.3171(2), the MAIPF has the responsibility to "adopt and maintain an assigned claims plan." See also W A Foote Mem Hosp. v. Mich. Assigned Claims Plan , 321 Mich. App. 159, 170 n. 5; 909 NW.2d 38 (2017) ; Bronson Health Care Group, Inc. v. Titan Ins. Co. , 314 Mich. App. 577, 580 n. 2, 887 N.W.2d 205 (2016).
There was another calendar from February 2015, which ostensibly showed that Andrew provided more hours of service than he actually performed. But because defendant's position is] [ that any false statement provided to it negates all of plaintiff's claims for PIP benefits, we will focus on the more blatant situation involving the forged signatures for the August, September, and October 2015 calendars.
Plaintiff filed the instant suit to recover the owed PIP benefits. Defendant moved for summary disposition and argued that MCL 500.3173a(2) precluded plaintiff from recovering any PIP benefits because of the false statements that were provided. After accepting supplemental briefs from the parties, the trial court denied defendant's motion.
II. STANDARDS OF REVIEW
Defendant moved for summary disposition pursuant to MCR 2.116(C)(8) and (10), but because the resolution of the motion required consideration of evidence outside the pleadings, we will treat the motion as having been decided under MCR 2.116(C)(10). See Travis v. Dreis & Krump Mfg. Co. , 453 Mich. 149, 183-184, 551 N.W.2d 132 (1996). We review a trial court's decision on a motion for summary disposition under MCR 2.116(C)(10) de novo. See Maiden v. Rozwood , 461 Mich. 109, 118, 597 N.W.2d 817 (1999). A motion under this court rule "tests the factual sufficiency of the complaint." Id. at 120, 597 N.W.2d 817. "In evaluating a motion for summary disposition brought under this subsection, a trial court considers affidavits, pleadings, depositions, and admissions, and other evidence submitted by the parties in the light most favorable to the party opposing the motion." Id. (citation omitted). The motion is properly granted "if there is no genuine issue concerning any material fact and the moving party is entitled to judgment as a matter of law." Hazle v. Ford Motor Co. , 464 Mich. 456, 461, 628 N.W.2d 515 (2001).
Resolution of this issue also involves questions of statutory interpretation, which are questions of law that we review de novo. Szpak v. Inyang , 290 Mich. App. 711, 713, 803 N.W.2d 904 (2010).
III. ANALYSIS
Defendant argues that the trial court erred when it denied defendant’s motion for summary disposition because MCL 500.3173a(2) dictates a different result. We agree.
The goal in interpreting statutes is to give effect to the intent of the Legislature. Titan Ins. Co. v. Farmers Ins. Exch. , 241 Mich. App. 258, 261, 615 N.W.2d 774 (2000). "In determining the intent of the Legislature, this Court must first look to the language of the statute." Bush v. Shabahang , 484 Mich. 156, 166-167, 772 N.W.2d 272 (2009). "If the language is clear and unambiguous, we assume the Legislature intended its plain meaning, and the statute is enforced as written." Wesche v. Mecosta Co. Rd. Comm. , 267 Mich. App. 274, 279, 705 N.W.2d 136 (2005).
MCL 500.3173a provides as follows:
(1) The Michigan automobile insurance placement facility shall make an initial determination of a claimant's eligibility for benefits under the assigned claims plan and shall deny an obviously ineligible claim. The claimant shall be notified promptly in writing of the denial and the reasons for the denial.
(2) A person who presents or causes to be presented an oral or written statement, including computer-generated information, as part of or in support of a claim to the Michigan automobile insurance placement facility for payment or another benefit knowing that the statement contains false information concerning a fact or thing material to the claim commits a fraudulent insurance act under [ MCL 500.4503 ] that is subject to the penalties imposed under [ MCL 500.4511 ]. A claim that contains or is supported by a fraudulent insurance act as described in this subsection is ineligible for payment or benefits under the assigned claims plan . [Emphasis added.]
Defendant asserts that the emphasized portion of the statutory language means that, because of the forged signatures on the August, September, and October 2015 calendars and the corresponding false claims that Andrew performed services during those months, plaintiff is ineligible to receive any PIP benefits. Plaintiff argues that the first sentence of Subsection (2) shows that this later-mentioned prohibition only applies when the false statement was made to the MAIPF . Consequently, plaintiff asserts that because the false statements were presented to defendant and not the MAIPF, then this statute does not act as a bar to the recovery of PIP benefits.
Defendant also argues that because the statute uses the term "claim" and does not refer to any "application," it shows that plaintiff's view is not supported because only applications are submitted to the MAIPF. Defendant avers that if the Legislature had intended to cover situations in which a claimant made false statements to the MAIPF in an application, then it would have used the term "application." Defendant refers us to MCL 500.4503, in which the Legislature used both the term "application" and the term "claims"; however, the word "application" in MCL 500.4503 is used in the context of an "application for the issuance of an insurance policy." MCL 500.4503(a) and(b). An application for an insurance policy is not the same as a claim for benefits. See Merriam-Webster's Collegiate Dictionary (11th ed) (defining "claim" as "a demand for something due or believed to be due").
Accordingly, while there is a reason to use the terms "claim" and "application" in MCL 500.4503, there is no reason to use both terms in MCL 500.3173a because the request/application to the MAIPF is nevertheless a claim for owed benefits. The MACP Plan of Operations, § 5.1.A states that "[a] claim for personal protection insurance benefits under the Plan must be made on an application prescribed by the MAIPF." MACP, Plan of Operations, available at [https://perma.cc/5EPNC7DW]. Hence, although the initial document to the MAIPF is called an application, it nevertheless is a claim for benefits, and the Legislature's failure to use the term "application" in MCL 500.3173a is neither surprising nor determinative.
We disagree with plaintiff's view. The first sentence of Subsection (2) states, "A person who presents or causes to be presented an oral or written statement ... as part of or in support of a claim to the [MAIPF ] for payment or another benefit knowing that the statement contains false information concerning a fact or thing material to the claim commits a fraudulent insurance act ...." MCL 500.3173a(2). Accordingly, in order to qualify as part of a fraudulent insurance act under this subsection, the false statement merely must have been presented "as part of or in support of a claim to the [MAIPF] for payment or another benefit." Contrary to plaintiff's suggestion, the prepositional phrase "to the [MAIPF]" modifies the antecedent noun "claim," not "statement." Therefore, a person commits a fraudulent insurance act under this statute when (1) the person presents or causes to be presented an oral or written statement, (2) the statement is part of or in support of a claim for no-fault benefits, and (3) the claim for benefits was submitted to the MAIPF. Further, (4) the person must have known that the statement contained false information, and (5) the statement concerned a fact or thing material to the claim. Importantly, MCL 500.3173a(2) does not require that any particular recipient have received the false statement in order for the act to qualify as a fraudulent insurance act, as long as the statement was used "as part of or in support of a claim to the [MAIPF]." With this understanding, we hold that there is no genuine issue regarding the fact that a fraudulent insurance act, as defined by MCL 500.3173a(2), was committed when the August, September, and October 2015 calendars were submitted in support of a claim to the MAIPF for replacement services that were never provided. There is no dispute that plaintiff submitted a claim to the MAIPF to recover no-fault benefits after being injured in a motor vehicle accident. There also is no question that a false statement was presented to defendant in support of plaintiff's claim. While the MAIPF ultimately assigned the claim to defendant, the claim itself was nonetheless being processed through the MAIPF. Indeed, the MACP's Plan of Operations provides that servicing insurers, such as defendant, "act on behalf of the MAIPF." MACP Plan of Operations, § 6.A.1. Therefore, plaintiff's claim for no-fault benefits is a claim to the MAIPF—not to defendant. Accordingly, the fact that plaintiff was dealing with defendant at the time the false statements were presented is not determinative.
The dissent insists that we are reading more into the statute than what it says when we state that a claim must have been submitted to the MAIPF. But as we have discussed, the phrase "a claim to the MAIPF" makes it clear that the claim at issue must have been submitted to the MAIPF. The dissent seems to ignore the fact that plaintiff's "claim" for replacement-care services benefits is part of—and not separate from—the claim that he submitted to the MAIPF, as evidenced by the dissent’s statement that a request for particular benefits is a "new" claim that is separate from the "prior" claim that was made to the MAIPF. The fact that the statute could have been drafted differently to achieve the same result is not a compelling reason to ignore the meaning of the, arguably, unartfully drafted language. Further, the fact that the Legislature ultimately did not pass the proposed modification to the statute in 2015 HB 4224 as passed by the Senate on June 9, 2016, could simply mean that it thought that any revision was not necessary because the existing language provided the same safeguards against the type of fraud that the proposed revision attempted to address. Of course, we are cognizant that any attempt to glean legislative intent from legislative history, let alone a proposed amendment that never was enacted, is a difficult proposition at best. See, e.g., In re Complaint of Mich. Cable Telecom. Ass'n , 241 Mich. App. 344, 371-372, 615 N.W.2d 255 (2000) ; Scalia, A Matter of Interpretation (Princeton: Princeton University Press, 1997), pp. 31-32.
We note that this Court's opinion in Bahri v. IDS Prop. Cas. Ins. Co. , 308 Mich. App. 420, 864 N.W.2d 609 (2014), is not relevant to our case. While the Court in Bahri held that a claimant's fraudulent acts can bar the recovery of all PIP benefits, id. at 426, 864 N.W.2d 609, the ruling was predicated on] [the interpretation and application of an insurance policy contract that contained a fraud exclusion, id. at 423-424, 864 N.W.2d 609. Here, Bahri does not govern because there is no policy to apply, let alone a fraud exclusion in a policy.
Further, plaintiff knew that the statement contained false information, which concerned a fact or thing material to the claim. Here, the evidence shows that plaintiff knew that the calendars he submitted for the months of August, September, and October 2015 were not correct. Plaintiff's counsel conceded at the trial court that plaintiff had signed or forged Andrew's name to the calendars. Further, during this three-month period, plaintiff knew that he moved to Detroit to be with his girlfriend, who then supplied the replacement services that Andrew previously supplied. No reasonable jury could conclude that plaintiff, despite the presence of any head injury, was not aware that he was submitting false information that was material to his claim for no-fault benefits. See Quinto v. Cross & Peters Co. , 451 Mich. 358, 367, 547 N.W.2d 314 (1996) (stating that to create a genuine issue of material fact and defeat a motion for summary disposition under MCR 2.116(C)(10), there must be sufficient evidence to permit a reasonable jury to find in the nonmoving party's favor).
Additionally, the last sentence of MCL 500.3173a(2) provides that "[a] claim that contains or is supported by a fraudulent insurance act as described in this subsection is ineligible for payment or benefits under the assigned claims plan." Because there is no genuine issue of material fact that plaintiff's claim for benefits was supported by a fraudulent insurance act, the claim is thereby ineligible for payment under the MACP. As a result, the trial court erred when it ruled that defendant was not entitled to summary disposition.
We decline to address the position that defendant advocated at the trial court that, in addition to plaintiff being ineligible to receive future PIP benefits, plaintiff must also reimburse defendant for any benefits it previously paid. On appeal, defendant does not present this argument. Indeed, in its brief on appeal, defendant asserts that it "is entitled to deny any further payment of PIP benefits to plaintiff."
Reversed and remanded for proceedings consistent with this opinion. We do not retain jurisdiction.
Cameron, J., (dissenting)Under MCL 500.3173a(2) of the Michigan no-fault act, a person who knowingly presents or causes to be presented a false statement that is part of or in support of a claim to the Michigan automobile insurance placement facility (Facility) is ineligible for payment and barred from receiving benefitsunder the assigned claims plan. This case raises the issue of whether a false statement made not to the Facility, but instead to one of its servicing insurers, similarly serves as a bar from receiving personal protection insurance (PIP) benefits. Because I disagree with the majority's construction of the statute, I respectfully dissent.
When construing a statute, we are required to "discern and give effect to the intent of the Legislature," and in determining legislative intent, we "must first look to the language of the statute." Bush v. Shabahang , 484 Mich. 156, 166-167, 772 N.W.2d 272 (2009). "Plain and unambiguous language in a statute must be enforced as written, and a forced construction or implication will not be upheld." Vulic v. Dep't of Treasury , 321 Mich. App. 471, ––––, 909 N.W.2d 487 (2017) (Docket No. 333255), slip op. at 2, 2017 WL 4272139. "As far as possible, effect should be given to every phrase, clause, and word in the statute." Shabahang , 484 Mich. at 167, 772 N.W.2d 272 (quotation marks and citations omitted). Furthermore, this Court must read the statute as a whole, and while individual words and phrases are important, they "should be read in context of the entire legislative scheme." Id .
MCL 500.3173a states:
(1) The Michigan automobile insurance placement facility shall make an initial determination of a claimant's eligibility for benefits under the assigned claims plan and shall deny an obviously ineligible claim. The claimant shall be notified promptly in writing of the denial and the reasons for the denial.
(2) A person who presents or causes to be presented an oral or written statement, including computer-generated information, as part of or in support of a claim to the Michigan automobile insurance placement facility for payment or another benefit knowing that the statement contains false information concerning a fact or thing material to the claim commits a fraudulent insurance act under [ MCL 500.4503 ] that is subject to the penalties imposed under [ MCL 500.4511 ]. A claim that contains or is supported by a fraudulent insurance act as described in this subsection is ineligible for payment or benefits under the assigned claims plan.
The dispute over legislative intent arises from whether fraudulent statements in connection with a claim for PIP benefits must be presented to the Facility for ineligibility under MCL 500.3173a(2) to apply. The majority construes the statute to require the withholding of benefits whenever a false statement is presented to a servicing insurer simply because an initial (albeit nonfraudulent) claim was presented to the Facility. Under the majority's reading of the statute, plaintiff is barred from receiving any benefits because he presented a false statement in support of a claim for no-fault benefits to Farm Bureau, a servicing insurer. The majority reaches its result by construing the phrase "to the Facility" to modify only the word "claim." Thus, through statutory interpretation, the majority concludes that false statements in support of a claim do not have to be presented to the Facility. I disagree.
The plain language of MCL 500.3173a(2) reflects the Legislature's intent that false statements made as part of or in support of a claim must be presented to the Facility before a person may be found ineligible for PIP benefits. A person is ineligible for payment or benefits under the assigned claims plan when one "presents or causes to be presented an oral or written statement ... as part of or in support of a claim to [the Facility] for payment...." Contrary to the majority opinion’s position, "as part of or in support of" is a conjunctive phrase reflecting the Legislature's intent that false statements have a specific relationship to a claim presented to the Facility before exclusion under MCL 500.3173a(2) is triggered. The Legislature could have made false statements to assigned member insurers, like Farm Bureau, a basis for denial of benefits and eligibility but has not yet done so. A statute must be enforced as written, and we should not rely on a forced construction of the statute to obtain a particular outcome. Vulic , 321 Mich. App. at ––––, 909 N.W.2d 487, slip op. at 2, 2017 WL 4272139.
See 2015 HB 4224 as passed by the Senate on June 9, 2016, in which our Legislature sought to amend MCL 500.3173a(2) to address this very issue:
A person who presents or causes to be presented an oral or written statement ... in support of a claim to the [Facility] OR TO AN INSURER ASSIGNED A CLAIM BY THE MICHIGAN AUTOMOBILE PLACEMENT FACILITY for payment or another benefit knowing that the statement contains false information concerning a fact or thing material to the claim commits a fraudulent insurance act .... A claim that contains or is supported by a fraudulent insurance act as described in this subsection is ineligible for payment or OF ANY benefits under the assigned claims plan.
In the majority's view, only a prior claim for benefits presented to the Facility is required for a subsequent false statement to qualify under MCL 500.3173a(2). In an effort to provide clarity, the majority sets forth the elements that a complaining party must show before MCL 500.3173a(2) is applicable. A person commits a fraudulent insurance act when "(1) the person presents or causes to be presented an oral or written statement, (2) the statement is part of or in support of a claim for no-fault benefits, ...(3) where the claim for benefits was submitted to the [Facility] ..., (4) the person must have known that the statement contained false information, and (5) the statement concerned a fact or thing material to the claim." (Emphasis added.) But the third requirement, that a claim for benefits "was submitted" to the Facility, is not found in the statute. The majority enhances the statutory language by adding a component: that as long as a prior claim was made to the Facility, any new claim supported by a false statement is barred regardless of where the claim is presented. However, every person who is assigned an insurer under the assigned claims plan made an initial claim to the Facility because it is the Facility that first receives a claim for eligibility and, if approved, assigns the person to a servicing insurer. Recognizing a new condition that a claim "was submitted" to the Facility, therefore, is superfluous and, more importantly, not found in the plain language of the statute.
A provision more consistent with the majority's reading of the statute would state, "A person who presents or causes to be presented an oral or written statement or a claim to the Michigan automobile insurance placement facility for payment or benefits knowing that the statement or claim contains false information is subject to the penalties imposed under section 4511." Under this provision, the recipient of a false statement is irrelevant, as argued by the majority. This is not the language the Legislature adopted, however. We simply should not read into a statute something that is not there.
I likewise disagree with the majority that a claim made to a servicing insurer is the same as a claim presented to the Facility. The no-fault act recognizes the Facility as a distinct entity from the participating insurers. Under MCL 500.3171(9)(a), the Facility is an entity created under Chapter 33, MCL 500.3301et seq ., and Chapter 33 defines the "Facility" as the "automobile insurance placement facility created pursuant to this chapter," MCL 500.3303(c). However, a "participating member" is specifically defined as "an insurer who is required by this chapter to be a member of the facility...." MCL 500.3303(d). By the language of these provisions, a participating member is a separate entity from the Facility, and to conclude that the Legislature only included the Facility in MCL 500.3173a, but nonetheless intended to mean both the Facility and its participating members, goes beyond the plain language of the statute and disregards the terms' distinctions under Chapters 31 and 33.
It is unnecessary to make a strained construction of the statute. The Legislature has already provided different language to exclude persons who make false statements made as part of or in support of a claim to a servicing insurer. MCL 500.3173a(2) denies PIP benefits to a person who "presents or causes to be presented " a false statement as part of or in support of a claim to the Facility for payment. (Emphasis added.) When a servicing insurer receives a false statement related to a claim and then seeks reimbursement for that claim from the Facility, then the person making the claim has caused to be presented a false statement in support of a claim to the Facility. If plaintiff's false statement in support of his claim had been presented to the Facility by Farm Bureau, plaintiff would be ineligible for benefits under the statute.
In other contexts, the language "caused to be presented" has been given broad application. See, e.g., the Medicaid False Claim Act under MCL 400.607(1) et seq . and (2) and the False Claims Act under31 USC 3729.
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In this case, however, the record reflects that Farm Bureau identified the falsity of the statements and did not seek reimbursement from the Facility in connection with plaintiff's claim for attendant care and replacement services. Therefore, a false statement was not presented or caused to be presented to the Facility, and I respectfully dissent.