Shelton v. Auto-Owners Ins. Co.

• Decision Date: 14 February 2017
• Docket Number: No. 328473,328473
• Citation: 318 Mich.App. 648,899 N.W.2d 744
• Parties: Tyann SHELTON, Plaintiff–Appellee, and Dwayne Williams, Plaintiff, and Michigan CRNAs Staffing, LLC, Intervening Plaintiff, v. AUTO–OWNERS INSURANCE COMPANY, Defendant–Appellant.
• Court: Court of Appeal of Michigan — District of US

318 Mich.App. 648

899 N.W.2d 744

Tyann SHELTON, Plaintiff–Appellee,andDwayne Williams, Plaintiff,andMichigan CRNAs Staffing, LLC, Intervening Plaintiff,

v.AUTO–OWNERS INSURANCE COMPANY, Defendant–Appellant.

No. 328473

Court of Appeals of Michigan.

Submitted December 13, 2016, at Detroit

February 14, 2017, 9:00 a.m.

Luxon & Zang, PC (by Timothy P. Luxon and Matthew M. Thomas ), and Speaker Law Firm, PLLC (by Steven A. Hicks ), for Tyann Shelton.

Anselmi & Mierzejewski, PC (by Christopher P. Endres ), Bloomfield, for Auto-Owners Insurance Company.

Before: K. F. Kelly, P.J., and Gleicher and Shapiro, JJ.

Shapiro, J.

In this no-fault personal protection insurance (PIP) case, defendant, Auto–Owners Insurance Company, sought summary disposition on the basis of a fraud-exclusion clause in its policy. Defendant asserted that plaintiff Tyann Shelton made fraudulent statements concerning her need for replacement services and therefore was excluded by the policy from all PIP benefits. The trial court granted summary disposition in favor of defendant as to replacement services, a ruling from which Shelton has not appealed.¹ The trial court denied the motion as to payment for medical services, and defendant appeals that ruling by leave granted.² We affirm.

Shelton alleges that she was injured in a single-car collision on January 22, 2013. The vehicle was owned and operated by Timothy Williams; Shelton was a passenger.³ She sought PIP benefits from defendant because she did not own a vehicle nor reside with a relative who did. Therefore, defendant, as Williams's insurer, was to provide her with those PIP benefits to which she was entitled under the no-fault act. MCL 500.3114(4)(a). Shelton claimed PIP benefits beginning in January 2013 that included medical expenses and replacement services for household chores.⁴ Defendant denied the claim, and Shelton brought suit.

Defendant moved for summary disposition, asserting that Shelton was not entitled to PIP benefits under an exclusionary clause in the policy that provided:

We will not cover any person seeking coverage under this policy who has made fraudulent statements or engaged in fraudulent conduct with respect to procurement of this policy or to any occurrence for which coverage is sought.

Defendant argues that this policy exclusion applies to Shelton despite the fact that she is not a policyholder, and defendant further argues that the evidence demonstrates beyond a question of fact that Shelton engaged in fraud as defined in the policy. Defendant relies largely on Bahri v. IDS Prop. Cas. Ins. Co. , 308 Mich.App. 420, 423–426, 864 N.W.2d 609 (2014), in which we held that a fraud provision in an insurance contract could bar a claim for PIP benefits when the policyholder filed a claim for replacement services on a date that preceded the date on which subject accident occurred. However, both the law and the facts of this case differ substantially from those that existed in Bahri .

The law governing application of the policy exclusion in Bahri is not applicable in this case. In Bahri , the provision applied to the plaintiff because "defendant issued [the subject] no-fault automobile policy to [the] plaintiff." Id. at 421, 864 N.W.2d 609. In this case, however, Shelton was not a party to, nor an insured under, the policy; she was injured while a passenger, and because neither she nor her spouse or resident relative had a no-fault policy, defendant was required to pay her benefits pursuant to statute, not pursuant to a contractual agreement.

The Michigan Supreme Court stated in Rohlman v. Hawkeye–Security Ins. Co. , 442 Mich. 520, 524–525, 502 N.W.2d 310 (1993), that

PIP benefits are mandated by statute under the no-fault act, MCL 500.3105 ; MSA 24.13105, and, therefore, the statute is the "rule book" for deciding the issues involved in questions regarding awarding those benefits. On the other hand, the insurance policy itself ... is the contract between the insurer and the insured....

The Supreme Court adhered to this principle in Harris v. Auto Club Ins Ass'n , 494 Mich. 462, 835 N.W.2d 356 (2013), a case involving a motorcycle-automobile collision. Harris cited MCL 500.3114(5)(a), which, using language paralleling the language used in MCL 500.3114(4)(a), provided that if the injured motorcyclist, his or her spouse, or a resident relative did not have a no-fault policy, then his no-fault benefits would be paid by the insurer of the owner or registrant of the automobile. In Harris , the Court stated that plaintiff could not take advantage of the uncoordinated medical benefit provision in the policy because his claim did not flow from the subject policy, but instead arose "solely by statute." Id. at 472, 835 N.W.2d 356 The Court held that:

[The plaintiff] is not claiming benefits under a no-fault insurance policy that he or anyone else procured. [He] is neither a third-party beneficiary nor a subrogee of the no-fault policy issued to the person that struck him and thus he [was] not eligible to receive benefits under that policy. Rather, [the plaintiff's] right to PIP benefits arises solely by statute. [ Id. at 471–472, 835 N.W.2d 356 (citations omitted).]

Defendant's argument is directly contrary to the grounds for the holdings in both Rohlman and Harris. Here, as in those cases, Shelton's no-fault benefits are governed "solely by statute." Therefore, the exclusionary provision in defendant's no-fault policy does not apply to Shelton and cannot operate to bar Shelton's claim.

This conclusion is also consistent with the text of the relevant statutes. "The primary rule of statutory construction is that, where the statutory language is clear and unambiguous, the statute must be applied as written." Cruz v. State Farm Mut. Auto. Ins. Co. , 466 Mich. 588, 594, 648 N.W.2d 591 (2002). Additionally, the "primary task in construing a statute is to discern and give effect to the intent of the Legislature."

Farmers Ins. Exch. v. Farm Bureau Gen. Ins. Co. of Mich. , 272 Mich.App. 106, 111, 724 N.W.2d 485 (2006) (citation, quotation marks, and brackets omitted). "[A] court must give effect to every word, phrase, and clause and avoid a construction that would render any part of the statute surplusage or nugatory." Id .

Under Subsection 1 of the no-fault priority statute, "a personal protection insurance policy ... applies to ... the person named in the policy, the person's spouse, and a relative of either domiciled in the same household...." MCL 500.3114(1) (emphasis added). Shelton is not an individual named in defendant's policy, a spouse of the person named in the policy, or a relative of either the person named in defendant's policy or his spouse. Therefore, pursuant to the statute, defendant's policy does not "apply" to Shelton. Rather, Shelton received no-fault benefits pursuant to Subsection 4, which reads:

Except as provided in subsections (1) to (3), a person suffering accidental bodily injury arising from a motor vehicle accident while an occupant of a motor vehicle shall claim personal protection insurance benefits from insurers in the following order of priority:

(a) The insurer of the owner or registrant of the vehicle occupied.

(b) The insurer of the operator of the vehicle occupied. [ MCL 500.3114(4).]

Subsection (4) does not state that the owner or operator's insurance policy "applies" to the passenger's claim for benefits, and its text, unlike that of Subsection (1), omits any mention of a personal protection insurance policy, instead providing that the injured person is to "claim personal protection insurance benefits from insurers," beginning with "[t]he insurer of the owner or registrant of the vehicle occupied." MCL 500.3114(4)(a).

Defendant argues that we should depart from the statute as a matter of public policy because if we do not, no-fault insurers will lose the ability to deny fraudulent no-fault claims. This argument is meritless. As always, if an insurer concludes that a claim is fraudulent, it may deny the claim.⁵ Should the claimant then file suit, the burden is on the claimant to prove that he or she is entitled to his or her claimed benefits, a burden that is highly unlikely to be met if the fact-finder concludes that the claim is fraudulent.⁶ And insurers can obtain attorney fees for having to litigate any claims that are determined to be fraudulent. MCL 500.3148.

This case also presents very different facts than did Bahri .⁷ In Bahri , the insurer presented unrebutted evidence (1) that the plaintiff claimed replacement-services benefits for services that had been performed 19 days before the auto accident had even occurred and (2) that over a period of approximately seven weeks, the plaintiff repeatedly engaged in a wide range of chores during the days on which she claimed that someone else did them for her. Bahri , 308 Mich.App. at 425–426, 864 N.W.2d 609. In this case, it is clear that a questions of fact exist as to whether Shelton made material misrepresentations, and if so, whether they were made with the intent to defraud defendant.

Reliance on an exclusionary clause in an insurance policy is an affirmative defense; therefore, defendant has the burden of proof. An "insurance company has the burden to prove that one of the policy's exclusions applies." Auto–Owners Ins. Co. v. Seils , 310 Mich.App. 132, 146, 871 N.W.2d 530 (2015). Thus, to obtain summary disposition the insurer must show that there is no question of material fact as to any of the elements of its affirmative defense. MCR 2.116(C)(10). The elements, as set forth in Bahri , are as follows:

"To void a policy because the insured has wilfully misrepresented a material fact, an insurer must show that (1) the misrepresentation was material, (2) that it was false, (3) that the insured knew that it was false at the time it was made or that it was made recklessly, without any knowledge of its truth, and (4) that the insured made the material misrepresentation with the intention that the insurer would act upon it. A

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