Moore v. Secura Insurance
Moore v. Secura Insurance
Opinion of the Court
In this no-fault insurance action, defendant appeals both the trial court’s decision to grant plaintiff attorney fees and costs and the amount of attorney fees and costs awarded to plaintiff. We affirm.
Plaintiff Hattie Moore was involved in an automobile accident on September 27, 2000. Plaintiff was driving her automobile on 1-475, when her automobile was struck on the passenger side by a pickup truck. Plaintiff lost control of her vehicle and crashed into the freeway median. Plaintiff fractured her right kneecap and impinged her right shoulder. The driver of the pickup truck fled the accident scene. Plaintiff filed an application for benefits with defendant insurer, seeking wage loss and first-party personal injury protection (PIP) benefits. Plaintiff also sought uninsured motorist benefits for pain and suffering. Defendant paid wage loss and injury benefits for approximately one year, and then stopped. Plaintiff brought suit.
We review for clear error a trial court’s finding that an insurance company unreasonably refused to pay benefits and its decision to award attorney fees under MCL 500.3148(1). Attard v Citizens Ins Co of America, 237 Mich App 311, 316-317; 602 NW2d 633 (1999); Beach v State Farm Mut Automobile Ins Co, 216 Mich App 612, 628; 550 NW2d 580 (1996). A finding is clearly erroneous when, even if there is evidence in the record to support it, this Court is left with the definite and firm conviction that a mistake has been made by the trial court. Amerisure Ins Co v Auto-Owners Ins Co, 262 Mich App 10, 24; 684 NW2d 391 (2004); Christiansen v Gerrish Twp, 239 Mich App 380, 387; 608 NW2d 83 (2000). We review for an abuse of discretion the amount of attorney fees awarded. Wood v Detroit Automobile Inter-Ins Exch, 413 Mich 573, 587-588; 321 NW2d 653 (1982). An abuse of discretion occurs when the trial court’s decision results in an outcome that falls outside the principled range of outcomes. Radeljak v Daimler-Chrysler Corp, 475 Mich 598, 603; 719 NW2d 40 (2006).
The statutory basis for the award of attorney fees in this case is MCL 500.3148(1), which provides:
An attorney is entitled to a reasonable fee for advising and representing a claimant in an action for personal or property protection insurance benefits which are overdue. The attorney’s fee shall be a charge against the insurer in addition to the benefits recovered, if the court finds that the insurer unreasonably refused to pay the claim or unreasonably delayed in making proper payment.
Defendant does not contend that it did not pay the benefits at issue. Rather, defendant contends that it did not receive reasonable proof of the fact and amount of plaintiffs loss until trial, so the benefits were not “overdue.” However, plaintiff in fact filed an “applications of benefits” form with defendant in December 2000, and plaintiffs employer provided employment information indicating plaintiffs wage history. “The statute requires only reasonable proof of the amount of loss, not exact proof. MCL 500.3142(2).” Williams v AAA Michigan, 250 Mich App 249, 267; 646 NW2d 476
This Court has recently reaffirmed that a refusal to pay benefits will not be “unreasonable” if “ ‘the refusal or delay is the product of a legitimate question of statutory construction, constitutional law, or a bona fide factual uncertainty.’ ” Roberts, supra at 67, quoting McCarthy v Auto Club Ins Ass’n, 208 Mich App 97, 103; 527 NW2d 524 (1994). We are unaware of any outstanding legal or constitutional uncertainties defendant might have had. More importantly, the genesis of the above definition of unreasonableness is in Liddell v Detroit Automobile Inter-Ins Exch, 102 Mich App 636, 650; 302 NW2d 260 (1981). In that case, this Court upheld the trial court’s award of attorney fees under MCL 500.3148 on the basis of the refusal of the defendant insurer to reconcile the opinion of one doctor that the plaintiffs injuries from an accident no longer precluded him from employment with the contradictory opinions of the plaintiffs treating physicians. Liddell, supra at 641, 650-651. Here, as in Liddell, defendant
Several unpublished opinions of this Court, although not binding pursuant to MCR 7.215(C)(1), have reached similar results. In Clack v Allstate Ins Co, unpublished opinion per curiam of the Court of Appeals, issued January 23, 1998 (Docket No. 192420), this Court affirmed a finding that an insurer’s denial of benefits was unreasonable where the insurer never attempted to resolve the conflict between the plaintiffs doctors’ recommendation for treatment and the IME doctor’s recommendation. In Hannawi v American Fellowship Mut Ins Co, unpublished opinion per curiam of the Court of Appeals, issued November 12, 1999 (Docket No. 207629), this Court upheld a finding that the insurer unreasonably denied benefits where the IME doctor failed to find evidence of a herniated disc, the plaintiffs doctors subsequently found such evidence through an MRI (magnetic resonance imaging) examination, and the insurer continued to deny benefits. In Villegas v Allstate Ins Co, unpublished opinion per curiam of the Court of Appeals, issued July 29, 2003 (Docket No. 235512), the plaintiffs doctors opined that the plaintiffs injury was caused by an automobile accident, the IME doctor opined that some of the
The next question is whether those benefits were overdue. The jury’s $98.71 penalty interest award, at the 12 percent rate specified by the trial court, is suggestive of a finding that defendant unreasonably delayed payment of only $822.52, or one week of work loss benefits. The necessary corollary to this finding is that the jury found the remainder of its $42,755 award for unpaid wage loss not to be overdue. We decline the invitations to speculate regarding why the jury so found, or to conclude that this is such a de minimis amount so as to be tantamount to a finding that no payments were overdue. The jury is the finder of fact, and we will not second-guess it. Again, it was determined below that the denial of benefits was unreasonable, and the jury found at least some of the benefit payments overdue. The conditions for an award of attorney fees were therefore satisfied. Roberts, supra at 66-67.
We first note that the attorney fee award itself was determined to be reasonable. There is no precise formula for computing the reasonableness of attorney fees, but the factors to be considered include: (1) the professional standing and experience of the plaintiff s attorney; (2) the skill, time, and labor involved in the plaintiffs no-fault claim; (3) the amount in question and the results achieved by the plaintiffs attorney; (4) the difficulty of the no-fault case; (5) the expenses incurred; and (6) the nature and length of the professional relationship between the plaintiffs attorney and the plaintiff. Wood, supra at 588. Plaintiffs attorney provided information about the skill, time, and labor involved in plaintiffs no-fault claim, the result he achieved for plaintiff, the difficulty of the case, and the expenses he incurred for plaintiff. The record created by plaintiffs attorney supports the amount of fees and costs awarded by the trial court. The mere fact that it is disproportionate to the amount of penalty interest is not relevant to the time and effort expended by plaintiffs attorney, the amount of the jury award on plaintiffs PIP claim, or the expenses incurred by plaintiffs attorney in securing that award. This is particularly true given the trial court’s correct finding that defendant’s termination of plaintiffs benefits was unreasonable. The decision by the trial court fell within the principled range of outcomes, so the trial court did not abuse its discretion when it determined the amount of awardable attorney fees.
Defendant nevertheless argues that the maximum to which plaintiff could be entitled is the portion of attor
Defendant points out that in Proudfoot, our Supreme Court permitted an attorney fee award only for an architect’s fee that the plaintiff had paid and that the defendant insurer had not repaid. The Court reversed an award of attorney fees for the cost of modifying the plaintiffs home, which the plaintiff had not yet incurred. Our Supreme Court emphasized that attorney fees were only available in an “ ‘action for personal or property protection insurance benefits which are overdue.’ ” Proudfoot, supra at 485, quoting MCL 500.3148(1) (emphasis added by the Proudfoot Court). “Thus, attorney fees are payable only on overdue ben
Affirmed.
Although the plaintiffs husband also brought a derivative claim, for ease of reference, Hattie Moore will be referred to as the plaintiff throughout this opinion.
Dissenting Opinion
(dissenting). In this action for first-party personal protection insurance benefits
i
The accident at issue occurred in September 2000. Plaintiff Hattie Moore
In January 2001, plaintiff underwent surgery to remove the bone fragment in her right knee. Following the surgery, Dr. Walter noted that plaintiffs right knee had improved. Dr. Walter was uncertain whether plaintiffs problems with her left knee were related to the accident.
Thereafter, defendant Secura Insurance appointed a nurse case manager to help determine plaintiffs ability to work. Dr. Walter twice failed to respond to the manager’s request for information regarding work restrictions. Secura then had Dr. Charles Xeller conduct an independent medical examination (IME) in September 2001. In his October 4, 2001, report, Dr. Xeller concluded: plaintiff could return to work with certain restrictions; plaintiff would require total knee replacement of the left knee, not because of the accident, but because of osteoarthritic degeneration; plaintiff had
Meanwhile, Secura had been paying wage loss and personal injury benefits for over a year following the accident. But, as a result of Dr. Xeller’s October 2001 IME reports, Secura discontinued plaintiffs first-party benefits in November 2001 on the basis that reasonable proof of the claim no longer existed. Secura contends that before plaintiff commenced this action, it paid plaintiff first-party benefits , that had become overdue when a computer glitch delayed issuance and delivery of those benefits to plaintiff.
In April 2002, plaintiff filed this action to recover additional first-party benefits (plus uninsured motorist coverage, which is not at issue here). At trial, with respect to first-party benefits, plaintiff sought (1) approximately $96,000 in wage loss, (2) approximately $21,000 for household/replacement services, and (3) penalty interest of over $11,000. The jury awarded $98.71 in penalty interest, $42,755 for unpaid wage loss benefits, and $50,000 in non-economic damages for uninsured motorist coverage:
Plaintiff brought a motion for attorney fees under MCL 500.3148, arguing that the benefits awarded by the jury had been overdue and that Secura unreasonably denied or delayed payment of her wage loss claims. The trial court agreed and awarded plaintiff attorney fees and costs of $79,415.
n
Attorney fees generally are not recoverable from the losing party in the absence of an exception set forth in
Under MCL 500.3148(1), “[a]n attorney is entitled to a reasonable fee for advising and representing a claimant in an action for personal. . . protection insurance benefits which are overdue.” (Emphasis added.) Attorney fees are awardable “if the court finds that the insurer unreasonably refused to pay the claim or unreasonably delayed in making proper payment.” Id.
“Well-established principles guide this Court’s statutory [or court rule] construction efforts. We begin our analysis by consulting the specific [statutory] language at issue.” Provider Creditors Comm v United American Health Care Corp, 275 Mich App 90, 95; 738 NW2d 770 (2007) (internal quotation marks and citations omitted). “This Court gives effect to the Legislature’s intent as expressed in the statute’s terms, giving the words of the statute their plain and ordinary meaning.” McManamon v Redford Charter Twp, 273 Mich App 131, 135; 730 NW2d 757 (2006), citing Willett v Waterford Charter Twp, 271 Mich App 38, 48; 718 NW2d 386 (2006). “When the language poses no ambiguity, this Court need not look beyond the statute or construe the statute, but need only enforce the statute as written.” McManamon, supra at 136. “This Court does not interpret a statute in a way that renders any statutory language surplusage ....” Id., citing Pohutski v City of Allen Park, 465 Mich 675, 684; 641 NW2d 219 (2002).
Under the unambiguous language of MCL 500.3148(1), there are two requirements for an award of attorney fees in a no-fault case: (1) the insurer
A
MCL 500.3142(2) provides that “[p]ersonal protection insurance benefits are overdue if not paid within 30 days after an insurer receives reasonable proof of the fact and of the amount of loss sustained.” Here, the trial court instructed the jury
Plaintiff is entitled to 12%. interest on any benefit you find overdue. Benefits are overdue if not paid within 30 days after reasonable proof of the fact and amount of the loss has been provided to the insurance company.... If reasonable proof is not supplied as to the entire claim, you shall award interest as to all benefits for which reasonable proof was supplied.” [Emphasis added.]
The jury awarded plaintiff $42,755 for wage loss. However, the jury awarded only $98.71 of penalty interest for overdue benefits. Thus, the jury necessarily concluded that Secura unreasonably delayed payment of only $822.52,
The majority characterizes as not “clearly erroneous” the trial court’s finding that Secura’s decision to terminate benefits after failing to “go beyond” the opinion of the IME doctor by consulting with the treating physicians or obtaining other information was unreasonable. I disagree, and would conclude, instead, that this finding is legally erroneous. The jury found that the $42,755 it awarded plaintiff for wage loss was not overdue, because it did not award penalty interest on that amount. Under MCL 500.3148(1), an attorney is only entitled to a fee award for advising and representing a claimant “in an action for... benefits which are overdue.” (Emphasis added.) The statute does not permit recovery of an attorney fee in an action in which the plaintiff is awarded benefits that were reasonably in dispute, i.e., were not yet overdue. Roberts, supra.
My conclusion is consistent with this Court’s holding in Beach v State Farm Mut Automobile Ins Co, 216 Mich App 612, 615; 550 NW2d 580 (1996). In that case, State Farm paid benefits for approximately three years following the accident in which Beach severely injured his face and head. Thereafter, the Department of Social Services referred Beach to a psychologist to determine his eligibility for a program to exchange volunteer work for welfare benefits. Id. The psychologist concluded that the residual effects of the accident had exacerbated Beach’s preexisting learning disabilities, and recommended vocational and other rehabilitation services. Id.
Beach sued for payment of the rehabilitation bills incurred, as first-party benefits, and for a declaratory judgment that State Farm was responsible for his future rehabilitation. Id. The jury awarded Beach $17,500, and found that Beach was entitled to future vocational counseling, psychiatric or psychological care, and therapy for traumatic brain injury, but refused to require State Farm to pay for Beach’s future physical therapy or pay a no-fault interest penalty. Id. On the basis of the jury’s refusal to award interest, the trial court denied Beach’s request for attorney fees under MCL 500.3148(1), even though the trial court concluded that the refusal to pay was unreasonable. Id.
We affirmed that decision. Beach, supra at 628. This Court honored the jury’s finding that benefits were not overdue (necessarily implicit in its failure to award penalty interest), and concluded:
[W]e find that the jury’s determination that plaintiffs benefits were not “overdue” for purposes of the no-fault penalty interest provision, MCL 500.3142 .. ., precluded the trial court from awarding plaintiff his attorney fees pursuant to MCL 500.3148(1)... because the attorney fees are only payable where personal... protection insurance benefits are “overdue.” [Id. at 630.]
The facts here parallel those in Beach. The benefits the jury awarded were not overdue. As a matter of law, under MCL 500.3148(1), plaintiff was not entitled to attorney fees, given the jury’s findings.
B
Even if the jury verdict could be construed as having awarded penalty interest on overdue benefits not already paid before this litigation commenced, plaintiff still would only be entitled to the attorney fees attributable to the recovery of overdue benefits. Proudfoot v State Farm Mut Ins Co, 469 Mich 476, 485; 673 NW2d 739 (2003).
In Proudfoot, supra at 478, the plaintiffs leg was amputated above the knee as a result of an accident. Home modifications were sought to accommodate her wheelchair. Id. State Farm refused to pay the architect’s bill ($815.10, which the plaintiff had paid) and the estimated cost of the home modifications ($250,000). Id. The jury found that the modifications were reasonably necessary and awarded $220,500, in addition to the $815.10. Id. at 479. The trial court awarded attorney fees of $69,300 and costs of $7,597.23. Id. at 480. The Supreme Court held that the attorney fee award was erroneous. Id. at 485. The Court explained: “[Attorney
In Proudfoot, the $220,500 home modification expense was not overdue (indeed it was not even incurred). Therefore, the Supreme Court found that the part of the attorney fee award attributable to the modification expense was erroneous. Id. at 485. Proud-foot makes it clear that where a jury awards first-party no-fault benefits and finds that only some were overdue, an attorney fee award may only include the fee amount attributable to recovering the overdue benefits. Id. at 485.
In my view, no part of the $79,415 in attorney fees and costs in this case was attributable to collecting the $822.52 overdue benefit, because that overdue benefit was paid long before litigation. Nevertheless, the trial court did not even attempt to determine what portion of the attorney fee was attributable to collecting the $822.52 in overdue benefits necessarily found by the jury.
Thus, under Proudfoot, the trial court clearly erred in awarding the full $79,415 in attorney fees and costs. I agree with defendant that, at the very least, plaintiff is required to identify which portion of the requested attorney fees was attributable to the recovery of either an overdue benefit or the $98.71 in interest on an overdue benefit.
I would find that the trial court erred as a matter of law in granting attorney fees, because the jury did not award overdue benefits to the plaintiff. Alternatively, even if the majority is correct that attorney fees were permissible in light of the jury’s verdict, the trial court erred in failing to determine what portion of the attorney fee was attributable to the recovery of overdue benefits. I would reverse, or at least vacate the $79,415 award, and remand for a determination of what portion of the attorney fees was attributable to securing overdue benefits.
“What are commonly called ‘PIP benefits’ are actually personal protection insurance (PPI) benefits by statute. MCL 500.3142. However, lawyers and others call these benefits PIP benefits to distinguish them from property protection insurance benefits.” Roberts v Farmers Ins Exch, 275 Mich App 58, 66 n 4; 737 NW2d 332 (2007).
Although the plaintiff’s husband also brought a derivative claim, for ease of reference, Hattie Moore will be referred to as the plaintiff throughout this opinion.
The majority does not conclude or suggest that the trial court’s instruction to the jury on the law governing this issue was erroneous. Neither do I.
$98.71 is 12 percent of $822.52.
The majority agrees that the jury award of penalty interest is for one week of delayed work loss benefits.
As noted above, the trial court instructed the jury that “[i]f reasonable proof is not supplied as to the entire claim, you shall award interest as to all benefits for which reasonable proof was supplied.” [Emphasis added.]
Plaintiffs rely on Ivezaj v Auto Club Ins Ass’n, 275 Mich App 349; 737 NW2d 807 (2007). This reliance is misplaced. Ivezaj only addressed whether the insurer’s denial of benefits was reasonable, not whether the action was for overdue benefits. Because I would conclude that the jury’s verdict necessarily indicates that there were no benefits overdue at the time litigation was commenced, Ivezaj does not apply here.
Plaintiffs again rely on Ivezaj, supra, which I believe is not applicable. Ivezaj did not cite, discuss, or distinguish Proudfoot, suggesting that because Proudfoot cannot be overruled by this Court, Ivezaj addressed an entirely different issue.
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