Jawad a Shah Md Pc v. State Farm Mutual Automobile Insurance Co
Jawad a Shah Md Pc v. State Farm Mutual Automobile Insurance Co
Opinion
*152 *186 In this suit seeking recovery of medical expenses under the no-fault act, MCL 500.3101 et seq ., plaintiffs, Jawad A. Shah, M.D., PC, Integrated Hospital Specialists, PC, Insight Anesthesia, PLLC, and Sterling Anesthesia, PLLC, appeal as of right the trial court's order granting summary disposition in favor of defendant, State Farm Mutual Automobile Insurance Company, and denying as futile plaintiffs' motion for leave to amend their complaint. For the reasons set forth in this opinion, we reverse the trial court's order and remand this matter for further proceedings consistent with this opinion.
I. BACKGROUND
This case involves various healthcare providers attempting to recover from a no-fault insurer for services rendered to the insured, George Hensley. According to plaintiffs' initial complaint filed on February 24, 2017, Hensley was injured on November 30, 2014, in a motor vehicle accident and was insured by defendant. Plaintiffs submitted claims for services rendered to Hensley, but defendant refused to pay these claims. In their complaint, plaintiffs sought a judgment of approximately $82,000, plus interest and reasonable attorney fees. Defendant answered the complaint and filed its affirmative defenses on April 21, 2017, denying liability.
On May 25, 2017, our Supreme Court issued its opinion in
Covenant Med. Ctr., Inc. v. State Farm Mut. Auto. Ins. Co.
,
On July 20, 2017, defendant moved for summary disposition pursuant to MCR 2.116(C)(8). Defendant argued that dismissal was required for failure to state a claim because plaintiffs' no-fault claim was "in direct contravention of the Michigan Supreme Court's decision in Covenant ."
Apparently anticipating defendant's motion, plaintiffs had obtained an assignment of rights from Hensley on July 11, 2017, 1 *153 to pursue payment of no-fault *188 benefits for healthcare services "already provided" by plaintiffs. 2 Plaintiffs relied on this assignment to then file a response to the summary disposition motion and a motion for leave to amend the complaint to reflect that the suit was being pursued through the assignment of rights obtained from Hensley. Plaintiffs argued that it was necessary to amend the complaint to allow the action to proceed pursuant to their respective assignments because the Covenant decision had extinguished their ability to pursue an independent, direct action against defendant under these circumstances. Again showing foresight in anticipating defendant's next tactical decision, plaintiffs also preemptively argued that if the trial court were to determine that a contractual provision within defendant's policy prevented assignments, then such a provision should not be enforced for one of two reasons. First, plaintiffs *189 argued that defendant would have to show that Hensley was a named insured under the policy (rather than, for example, a passenger entitled to benefits under someone else's policy) for the antiassignment clause to be enforced against him. Second, plaintiffs argued that the antiassignment clause was voidable as against public policy because the assignment was obtained after the loss occurred. Furthermore, in an effort to avoid problems with the one-year-back rule of MCL 500.3145(1), plaintiffs also argued that the amended complaint should relate back to the date of the original complaint because the amendment to accommodate the assignments was intended to support the previously filed no-fault claim that arose from the same transaction or occurrence, namely Hensley's injuries sustained in the November 30, 2014 accident. Plaintiffs did not contend that Covenant was inapplicable to their suit.
On September 7, 2017, defendant filed a reply in support of its summary disposition motion. As plaintiffs anticipated, defendant argued that an antiassignment clause in the policy rendered any assignment of rights from Hensley void. Accordingly, defendant argued that plaintiffs' claims should be dismissed because the antiassignment clause had to be enforced as written and was not against public policy. Defendant also argued that the one-year-back *154 rule of MCL 500.3145(1) would bar the assigned claims, or a portion of the assigned claims, even if the assignments were considered valid. Defendant explained that plaintiffs could not obtain any greater rights than those held by Hensley at the time of the assignments. Had Hensley brought suit on the date of the assignments, he could not have obtained damages for any expenses incurred more than a year before that date. Defendant argued that plaintiffs stood in the shoes of Hensley after the *190 assignments and could not obtain any greater rights than this. Defendant also asserted that Hensley had his own lawsuit that had already been resolved and was no longer pending. Defendant further argued that the relation-back doctrine would not apply because the assignment did not exist on the date plaintiffs originally filed their complaint. Defendant contended that plaintiffs were not really seeking an amendment that could relate back to the original complaint pursuant to MCR 2.118(D) but were actually attempting to supplement their complaint pursuant to MCR 2.118(E) in order to allege a subsequently acquired assignment. Defendant explained that supplemental pleadings never relate back to the date of the original pleading. Finally, defendant explained that Hensley was indeed a named insured, and it provided a copy of the declarations page as support.
On the same day, defendant also filed a response to plaintiffs' motion for leave to amend their complaint. Defendant raised the same arguments made in its reply brief and argued that for these reasons, any amendment was futile because the cause of action that plaintiff was attempting to add was legally insufficient on its face.
A hearing on the motions was held on September 11, 2017. The parties' oral arguments reiterated the arguments made in their written submissions. The trial court ruled as follows:
All right, the Court read both of the motions and the briefs, as well as the second motion, which is the motion for leave to file an amended complaint. As I said they interrelate and the circumstances are that Shah was a provider or plaintiffs were health providers-health services care providers for the insured George Hensley. And apparently only after the covenant [sic: Covenant decision] did an assignment take place and the policy language of *191 the State Farm policy, which Mr. Hensley purchased precludes the assignment without approval of State Farm, which did not occur. So actually (inaudible) did not acquire any rights by virtue of the assignment.
And in addition, as pointed out by defense counsel, if it had been granted it would have been a supplemental pleading and the date would be barred under the statute of limitations. You may submit an order if you don't have one here today.
The trial court clarified that it was granting defendant's motion for summary disposition, denying leave to file an amended complaint as futile, and dismissing the case with prejudice. The trial court entered an order 3 granting summary disposition pursuant to MCR 2.116(C)(8) and dismissing the case with prejudice ''for the reasons stated on the record."
This appeal followed.
*155 II. ANALYSIS
A. RETROACTIVITY OF THE COVENANT DECISION
Plaintiffs first argue that our Supreme Court's decision in Covenant should not apply retroactively but should instead be given prospective effect only.
Whether a judicial decision applies retroactively is a question that this Court reviews de novo.
W.A. Foote Mem. Hosp. v. Mich. Assigned Claims Plan
,
''Michigan generally follows the 'raise or waive' rule of appellate review."
Walters v. Nadell
,
The principal rationale for the rule is based in the nature of the adversarial process and judicial efficiency. By limiting appellate review to those issues raised and argued in the trial court, and holding all other issues waived, appellate courts require litigants to raise and frame their arguments at a time when their opponents may respond to them factually. This practice also avoids the untenable result of permitting an unsuccessful litigant to prevail by avoiding its tactical decisions that proved unsuccessful. Generally, a party may not remain silent in the trial court, only to prevail on an issue that was not called to the trial court's attention. Trial courts are not the research assistants of the litigants; the parties have a duty to fully present their legal arguments to the court for its resolution of their dispute. [ Walters ,481 Mich. at 388 ,751 N.W.2d 431 (citations omitted).]
"Although this Court need not review issues raised for the first time on appeal, this Court may overlook preservation requirements if the failure to consider the
*193
issue would result in manifest injustice, if consideration is necessary for a proper determination of the case, or if the issue involves a question of law and the facts necessary for its resolution have been presented."
Smith v. Foerster-Bolser Constr., Inc.
,
In this case, plaintiffs assert that this issue is preserved for appellate review
*156
without identifying a single place in the lower court record where they argued that
Covenant
should not apply retroactively to the instant case. As previously noted, plaintiffs actually treated the
Covenant
decision as the controlling law at all times following the issuance of that decision, arguing that it was necessary to amend the original complaint because the
Covenant
decision had extinguished plaintiffs' independent cause of action against defendant that was not premised on an assignment of rights from Hensley. On appeal, plaintiffs essentially argue that although they never contested the application of
Covenant
in the trial court, their appellate challenge to the propriety of that retroactive application is somehow automatically preserved because the
Covenant
decision was actually applied retroactively in the trial court and because defendant responded to plaintiffs' arguments on appeal.
*194
4
This argument ignores the fundamentals of appellate-preservation law, which require parties to first raise issues in the lower court to be addressed in that forum.
Walters
,
We further conclude that there is no apparent reason for us to exercise our discretion to review this issue. It does not present a question that must be addressed in order to properly resolve this case and no manifest injustice will result if we decline to review it; as explained in this opinion, plaintiffs' legal argument is unavailing because
Covenant
has already been determined to be retroactive in published decisions of this Court. Moreover, a litigant in a civil case must demonstrate more than a potential monetary loss to show a miscarriage of justice or manifest injustice. See
Napier
,
*157
*195
Furthermore, as we alluded to, plaintiffs' argument is without merit even if they had not waived this issue for appellate review. This Court has already held in two recent published decisions that
Covenant
applies retroactively. See
W.A. Foote
,
Therefore, even if this issue had not been waived for our review,
Covenant
is applicable to the instant case,
W.A. Foote
,
B. ENFORCEABILITY OF THE CONTRACT PROVISION PROHIBITING ASSIGNMENT
Next, plaintiffs argue that the antiassignment clause in the insurance policy is unenforceable and that it therefore cannot prevent the assignment that occurred in this case.
Insurance policies are contracts and are thus "subject to the same contract construction principles that apply to any other species of contract."
Rory v. Continental Ins. Co
,
''Under general contract law, rights can be assigned unless the assignment is clearly restricted."
Burkhardt v. Bailey
,
Resolution of this issue turns on the application of our Supreme Court's decision in
Roger Williams Ins. Co. v. Carrington
,
*199
Id
. at 253-254,
The assignment having been made after the loss, did not require consent of the company. The provision of the policy forfeiting it for an assignment without the company's consent is invalid, so far as it applies to the transfer of an accrued cause of action. It is the absolute *159 right of every person-secured in this State by statute-to assign such claims, and such a right cannot be thus prevented. It cannot concern the debtor, and it is against public policy. [ Id . at 254,5 N.W. 303 .]
In this case, the parties provide no authority, and we have found none, explicitly rejecting this analysis in
Roger Williams
. Moreover, it has been deemed controlling on this point of law in at least two relatively recent
9
opinions of the United States District Court for the Western District of Michigan,
10
Century Indemnity Co. v. Aero-Motive Co.
,
*200
Our Supreme Court in
Roger Williams
essentially held that an accrued cause of action may be freely assigned after the loss and that an antiassignment clause is not enforceable to restrict such an assignment because such a clause violates public policy in that situation.
Roger Williams
,
Therefore, we conclude that the antiassignment clause in the instant case is unenforceable to prohibit the assignment that occurred here-an assignment after the loss occurred of an accrued claim to payment-because such a prohibition of assignment violates Michigan public policy that is part of our common law as set forth by our Supreme Court.
Roger Williams
,
We note that contrary to the arguments advanced by defendant, our conclusion that a contractual provision is unenforceable because it violates public policy is not equivalent to a judicial assessment of unreasonableness, nor is it in conflict with the principle that unambiguous contracts must be enforced as written. Our Supreme Court has made clear that judicial notions of reasonableness are not proper grounds on which to hold contractual provisions unenforceable.
Rory
,
Plaintiffs also raise several additional grounds for arguing that the antiassignment clause is unenforceable to prevent the assignment at issue in this case. However, plaintiffs did not raise these additional arguments in the trial court, and they are thus waived for appellate review.
Walters
,
*202 C. EFFECT OF THE ASSIGNMENTS WITH RESPECT TO THE ONE-YEAR-BACK RULE
Next, plaintiffs argue that the trial court should have granted their motion for leave to amend the complaint to account for the assignments and that such an amendment should have related back to the date of the original complaint. In light of our conclusion that the assignments were not prohibited by the antiassignment clause, the issue to be addressed on appeal becomes determining the effect of the assignments at issue with respect to the one-year-back rule in MCL 500.3145(1). Clearly, we must address this question first before we can address the final, and interrelated, questions of whether the trial court erred by granting defendant's summary disposition motion and denying plaintiffs' motion for leave to amend the complaint.
MCL 500.3145(1) provides, in pertinent part, that ''the claimant may not recover benefits for any portion of the loss incurred more than 1 year before the date on which the action was commenced.'' The one-year-back rule in MCL 500.3145(1) ''is designed to limit the amount of benefits recoverable under the no-fault act to those losses occurring no more than one year before an action is brought.''
Joseph v. Auto Club Ins. Ass'n
,
The instant case presents an unusual situation with respect to the one-year-back rule because plaintiffs began this case on February 24, 2017, as a direct lawsuit filed against defendant under pre- Covenant caselaw and then sought to amend the complaint to bring the action based on an assignment theory after the Covenant decision was issued. Plaintiffs obtained the assignments from Hensley on July 11, 2017. Plaintiffs argue that they may amend their complaint to *203 account for the assignment-of-rights theory and that such an assignment should relate back to the date of the original complaint, which would allow them to pursue benefits incurred during the year preceding the date *161 of February 24, 2017. Defendant, on the other hand, argues that the date of the assignments-July 11, 2017-provides the pertinent reference date for purposes of the one-year-back rule because plaintiffs' motion actually sought leave to file a supplemental pleading rather than an amended pleading.
The rule regarding the relation back of amended pleadings is contained in MCR 2.118(D), which provides, in pertinent part, that an "amendment that adds a claim or defense relates back to the date of the original pleading if the claim or defense asserted in the amended pleading arose out of the conduct, transaction, or occurrence set forth, or attempted to be set forth, in the original pleading." However, while an amended pleading may relate back to the date of the original pleading, "there is no provision for relating back as to supplemental pleadings...."
Grist v. Upjohn Co.
,
On motion of a party the court may, on reasonable notice and on just terms, permit the party to serve a supplemental pleading to state transactions or events that have happened since the date of the pleading sought to be supplemented, whether or not the original pleading is defective in its statement of a claim for relief or a defense.
Further, the "relation-back doctrine does not apply to the addition of new parties."
*204
Miller v. Chapman Contracting
,
In this case, after the
Covenant
decision was issued, plaintiffs sought to amend their complaint to account for the assignments obtained from Hensley to allow plaintiffs to pursue an action against defendant insurer. ''An assignee stands in the position of the assignor, possessing the same rights and being subject to the same defenses.''
Burkhardt
,
Because plaintiffs actually sought to file a supplemental pleading, it could not relate back to the date of
*205
the original pleading.
*162
MCR 2.118(D) and (E) ;
Grist
,
The assignment created nothing. It simply passed to plaintiffs' insurer rights already in existence, if any. If plaintiffs' insured had no rights, then plaintiffs' insurer acquired none by virtue of the assignment. To rule otherwise would be to give such an assignment some strange alchemistic power to transform a dross and worthless cause of action into the pure gold from which a judgment might be wrought. [Quotation marks omitted.]
Therefore, through the assignments in this case, plaintiffs did not obtain the right to pursue no-fault benefits for any portion of the loss incurred more than one year before July 11, 2017, because that is the pertinent point of reference for purposes of the one-year-back rule. A supplemental pleading predicated on the July 11, 2017 assignments could not relate back to the date of the original pleading.
D. APPLICATION
We now turn to the trial court's final ruling granting summary disposition in favor of defendant and denying plaintiffs' motion for leave to amend.
"This Court reviews de novo the trial court's decision
*206
to grant or deny summary disposition."
Rory
,
A motion under MCR 2.116(C)(8) tests the legal sufficiency of the complaint. All well-pleaded factual allegations are accepted as true and construed in a light most favorable to the nonmovant. A motion under MCR 2.116(C)(8) may be granted only where the claims alleged are "so clearly unenforceable as a matter of law that no factual development could possibly justify recovery." When deciding a motion brought under this section, a court considers only the pleadings. [ Maiden v. Rozwood ,461 Mich. 109 , 119-120,597 N.W.2d 817 (1999) (citations omitted).]
However, we note that the trial court clearly considered material outside the pleadings, contrary to the proper procedure for considering a motion under MCR 2.116(C)(8). The insurance policy that contained the antiassignment clause was crucial to the trial court's decision that plaintiffs could not maintain any claim against defendant predicated on assignments from Hensley; this insurance policy was attached to defendant's reply brief in support of its motion for summary disposition and defendant's response to plaintiffs' motion for leave to amend the complaint. Furthermore, the assignments on which plaintiffs relied were attached to plaintiffs' brief in opposition to the motion for summary disposition, as well as plaintiffs' brief in support of their motion for leave to amend the complaint. While a written instrument that forms the basis for a claim or defense and that is attached to or referred to in a pleading may be treated as ''part of the pleading for all purposes,'' MCR 2.112(F), neither the assignments *163 nor the insurance policy were attached to or referred to in a pleading , MCR 2.110(A) (defining the term ''pleading'' to include only a complaint, cross-claim, *207 counterclaim, third-party complaint, an answer to any of the aforementioned pleadings, or a reply to an answer).
Therefore, we treat the motion as having been brought and decided under MCR 2.116(C)(10) because it necessarily involved considering material outside the pleadings.
13
Cf.
Hughes v. Region VII Area Agency on Aging
,
A motion under MCR 2.116(C)(10) tests the factual sufficiency of the complaint. In evaluating a motion for summary disposition brought under this subsection, a trial court considers affidavits, pleadings, depositions, admissions, and other evidence submitted by the parties, in the light most favorable to the party opposing the motion. Where the proffered evidence fails to establish a genuine issue regarding any material fact, the moving party is entitled to judgment as a matter of law. [ Maiden ,461 Mich. at 120 ,597 N.W.2d 817 (citations omitted).]
''The grant or denial of leave to amend pleadings is within the trial court's discretion.''
PT Today, Inc. v. Comm'r of Office of Fin. & Ins. Servs.
,
*208
In re Weber Estate
,
"This Court will not reverse a trial court's decision regarding leave to amend unless it constituted an abuse of that discretion that resulted in injustice."
Id
. at 142,
In this case, the trial court granted defendant's motion for summary disposition
*164
and denied plaintiffs' motion for leave to amend their complaint because the trial court concluded that the antiassignment clause prohibited any assignment from Hensley and that any claims based on such an assignment would be time-barred nonetheless.
*209
''If a trial court grants summary disposition pursuant to MCR 2.116(C)(8), (C)(9), or (C)(10), the court must give the parties an opportunity to amend their pleadings pursuant to MCR 2.118, unless the amendment would be futile."
Yudashkin v. Holden
,
As previously discussed, the antiassignment clause was unenforceable to the extent that it prohibited the particular assignments at issue, and the one-year-back rule did not bar
all
of plaintiffs' claims but rather those that were based on services provided more than one year before the date of the assignments. Accordingly, the trial court's decision was based on a misapplication of the law, and the trial court necessarily abused its discretion by denying plaintiffs the opportunity to serve their supplemental pleading.
Ronnisch
, 499 Mich. at 552,
*210
Defendant's remaining argument related to the jurisdictional minimum for the amount in controversy constitutes an argument that an alternate ground for affirming the trial court's ruling exists. This argument was not presented to the trial court. As an error-correcting court,
W.A. Foote
,
We reverse the order of the trial court and remand for further proceedings consistent with this opinion. We do not retain *165 jurisdiction. We decline to award taxable costs under MCR 7.219(A).
Tukel, J., concurred with Borrello, P.J.
I concur with the majority's conclusion that the antiassignment clause in defendant State Farm
*211
Mutual Automobile Insurance Company's policy is unenforceable because it conflicts with longstanding principles of contract law and the Michigan no-fault act, MCL 500.3101 et seq. I dissent from the majority's conclusion that the one-year-back provision runs from the date of the assignment rather than from the date set forth in the no-fault act, i.e. the date "the action was commenced." Lastly, I conclude that
W.A. Foote Mem. Hosp. v. Mich. Assigned Claims Plan
,
I. ANTIASSIGNMENT CLAUSE
For over 100 years, Michigan law has provided that all contracts, other than those that involve personal performance, are assignable. In
Northwestern Cooperage & Lumber Co. v. Byers
,
where an executory contract is not necessarily personal in its character, and can, consistent with the rights and interests of the adverse party, be fairly and sufficiently executed as well by an assignee as by the original contractor, and when the latter has not disqualified himself from a performance of the contract, it is assignable.
Accord
Voigt v. Murphy Heating Co.
,
This basic principle of contract law has never changed. It was recently articulated in
In re Jackson
,
*212 As a general rule, contract rights and duties are assignable.
Notwithstanding this general rule, Michigan law recognizes certain classes of contracts as inherently nonassignable in their character, such as promises to marry, or engagements for personal services, requiring skill, science, or peculiar qualifications. [Citations omitted.]
In this case, it is undisputed that the contract in question is not one for personal services, and it therefore falls within the general rule that contract rights may be assigned.
Defendant argues that despite this general rule, the insured may not assign his right to overdue benefits because its insurance policy contains an antiassignment clause. The majority properly relies on
Roger Williams Ins. Co v. Carrington
,
The case of
In re Jackson
,
cited earlier, is directly on point. The contract in that case was a settlement agreement that provided for Jackson to receive annuity payments.
In re Jackson
,
An executory contract is "a contract that remains wholly unperformed or for which there remains something *213 still to be done on both sides ." With respect to [Jackson's] contractual obligations, the Settlement Agreement is not executory. Immediately upon executing the Settlement Agreement, [Jackson] released her claims against the state court defendants and dismissed her lawsuit with prejudice. As of the date of [Jackson's] agreement with Settlement Capital, Jackson had fully performed the duties required of her.
Therefore, [Jackson], having held up her end of the bargain with Transamerica Insurance, had every right to partially assign her interest in the annuity to Settlement Capital, irrespective of the anti-assignment clause . The modern trend with respect to contractual prohibitions on assignments is to interpret them narrowly, as barring only the delegation of duties, and not necessarily as precluding the assignment of rights from assignor to assignee. Unless the circumstances indicate the contrary, a contract term prohibiting assignment of 'the contract' bars only the delegation to an assignee of the performance by the assignor of a duty or condition. [ Id . at 201 (quotation marks and citations omitted; emphasis added).]
[It is argued] that the anti-assignment clause in the Settlement Agreement renders inapplicable the general rule that contract rights and duties are assignable. We find however, that Michigan law mandates application of the general rule. This finding is based on the theory that once a party to a contract performs its obligations to the point that the contract is no longer executory, its right to enforce the other party's liability under the contract may be assigned without the other party's consent, even if the contract contains a non-assignment clause . [ Id. (quotation marks and citations omitted; emphasis added).]
This principle is broadly recognized. As described in Couch on Insurance:
[T]he great majority of courts adhere to the rule that general stipulations in policies prohibiting assignments of *214 the policy, except with the consent of the insurer, apply only to assignments before loss, and do not prevent an assignment after loss, 2 for the obvious reason that the clause by its own terms ordinarily prohibits merely the assignment of the policy, as distinguished from a claim arising under the policy, and the assignment before loss involves a transfer of a contractual relationship while the assignment after loss is the transfer of a right to a money claim. The purpose of a no assignment clause is to protect the insurer from increased liability, and after events giving rise to the insurer's liability have occurred, the insurer's risk cannot be increased by a change in the insured's identity. [ 3 Couch on Insurance 3d, § 35:8 pp. 35-15 through 35-18 (emphasis added) ].
Another learned treatise states:
Antiassignment clauses in insurance policies are strictly enforced against attempted transfers of the policy itself before a loss has occurred, because this type of assignment involves a transfer of the contractual relationship and, in most cases, would materially increase the risk to the insurer. Policy provisions that require the company's consent for an assignment of rights are generally enforceable only before a loss occurs, however. As a general principle , a clause restricting assignment does not in any *167 way limit the policyholder's power to make an assignment of the rights under the policy-consisting of the right to receive the proceeds of the policy-after a loss has occurred . The reasoning here is that once a loss occurs, an assignment of the policyholder's rights regarding that loss in no way materially increases the risk to the insurer. After a loss occurs, the indemnity policy is no longer an executory contract of insurance. It is now a vested claim against the insurer and can be freely assigned or sold like any other chose in action or piece of property. [17 Williston, Contracts (4th ed.), § 49:126, pp. 130-132 (emphasis added).]
The Restatement of Contracts 2d, § 322(1), pp. 31-32, articulates the same rule, stating, "Unless the circumstances *215 indicate the contrary, a contract term prohibiting assignment of 'the contract' bars only the delegation to an assignee of the performance by the assignor of a duty or condition." This principle is more clearly expressed in The Restatement of Contracts 2d, § 322(2), p. 32, which provides that "[a] contract term prohibiting assignment of rights under the contract ... does not forbid assignment of a right to damages for breach of the whole contract or a right arising out of the assignor's due performance of his entire obligation[.]"
Defendant State Farm makes a public-policy argument, asserting that permitting the assignment of rights after the loss has occurred will significantly complicate the claims process. This argument is both factually and legally flawed. It is
factually
flawed for two reasons. First, defendant already has a claims process that has been operational for decades that allows for assignments and payments to providers. Second, defendant's claim of increased administrative costs is not supported by any
evidence.
It should come as no surprise that a court may not base its decision on factual assertions unsupported by any evidence; such factual assertions amount to nothing more than speculation until such evidence is proffered. Defendant's public-policy argument is
legally
flawed for two reasons. First, it is inconsistent with over 100 years of law. Second, defendant's position is intrinsically contrary to the purpose of the no-fault system, which is designed to provide "
assured
, adequate, and prompt reparation for certain economic losses."
Shavers v. Attorney General
,
This view is contrary to Michigan law generally and to the no-fault act in particular. As the court explained in
Wonsey v. Life Ins. Co. of North America
,
[D]efendants strenuously argue that when a beneficiary of a structured settlement agreement decides to sell all or a number of his future payments, "it requires a complicated review process" and that "defendants [would be required] to review substantial paper work, and [to] determine if the assignment appears to be legal ... and/or whether any guarantees or releases provided by the assignor ... are satisfactory to fully and completely protect [defendants]...." The Court is not persuaded. The reasons asserted by defendants in objecting to the proposed assignment do not appear to amount to substantial harm or actual prejudice to defendants' interests, but merely center *168 upon the necessary administrative tasks associated with the assignment's implementation. As such, defendants have not submitted sufficient reasons to ... [enforce] contractual antiassignment clauses. [Second and third alteration in original; emphasis added.]
The no-fault act itself speaks to the issue of assignment. It provides, "An agreement for assignment of a right to benefits payable in the future is void." MCL 500.3143 (emphasis added). Notably, the Legislature elected not to void assignment of past-due benefits. By not including past-due benefits in this statutory prohibition, the Legislature, under the doctrine of expressio unius est exclusio alterius , made clear its intent to adhere to the fundamental principle that assignments of past-due benefits are effective and proper.
Defendant argues that its "right of contract" must supersede these longstanding principles. However, it
*217
cites nothing in the no-fault act providing that insurers may add
policy language
, ostensibly to limit administrative costs, that has the effect of denying benefits to individuals who are entitled to them under the
statutory language
. Defendant cites
Rory v. Continental Ins. Co.
,
Defendant's theory seems to be that it may include any provision in its policies so long as the provision is not explicitly barred in the no-fault act. It contends, therefore, that it has the right to add policy provisions not provided for in the act whose result, if not purpose,
*218
is to deny benefits to people who qualify under the statute. This position cannot be squared with the fundamental goal of the no-fault act to provide "
assured
, adequate, and prompt reparation for certain economic losses."
Kelley
,
Defendant's conceptual error lies in its view that the no-fault act is defined by what it does not say , i.e., because the act does not explicitly prohibit an antiassignment provision, an insurer is free to insert such a provision into the policy regardless of its effect on the functioning of the no-fault system and an insured's ability to obtain covered medical treatment. However, the no-fault act must be defined by what it does say . It defines a comprehensive statewide system designed to provide *169 "assured, prompt and adequate" coverage for medical services following an auto accident. Id . The fact that the Act does not contain an omnibus list of actions inconsistent with that comprehensive system does not mean that it intended that such actions be permitted. There is nothing in the act that indicates that the Legislature intended to allow insurers to unilaterally add limitations on benefits. Ultimately, if insurers are free to add whatever administrative conditions or hurdles their policy drafters can define, then the Legislature's comprehensive system will be sliced and diced by artfully drafted policy provisions, depriving insureds the benefits they paid for and that which the no-fault act mandates. Defendant's position is a slippery slope by which the no-fault system dies the death of a thousand cuts.
II. ONE-YEAR-BACK RULE
I dissent from the majority's conclusion that the one-year-back date should be measured from the date *219 of the assignment and not from the date that suit was filed. The statute provides that benefits may not be recovered "for any portion of the loss incurred more than 1 year before the date on which the action was commenced ." MCL 500.3145(1) (emphasis added). In this case, the action was commenced on February 24, 2017, by these plaintiffs-Jawada Shah, M.D., PC; Integrated Hospital Specialists, PC; Insight Anesthesia, PLLC; and Sterling Anesthesia, PLLC-against this defendant. Nothing has changed in the nature of the action. I respectfully suggest that the majority is mistaken in its view that the addition of an allegation to establish standing when the issue is raised "commences" a new "action."
The majority cites scant authority for this position. It cites
Burkhardt v. Bailey
,
The majority also relies on
Grist v. Upjohn Co.
,
Accordingly, I would hold that the one-year-back period runs from the date the suit was filed.
III. RETROACTIVITY OF COVENANT
In
Covenant
,
When a statute law has received a given construction by the courts of last resort and contracts have been made and rights acquired under and in accordance with such construction, such contracts may not be invalidated, nor *222 vested rights acquired under them impaired, by a change of construction made by a subsequent decision. [ Id. (quotation marks and citation omitted).]
The Court went on to note that in the case before it, the "decision today does not at all affect the parties' contractual rights" and should be retrospectively applied.
Id
. at 536-537,
There is no question that plaintiffs: (1) properly and reasonably relied on what appeared to be settled law when they filed suit, (2) provided services to defendant's insured based upon that law, and (3) have not been paid. A prospective application *171 would merely allow healthcare providers who provided services based on the law as it was universally understood to be paid for those already-provided services. A retroactive application, by contrast, creates a distorted result inconsistent with the no-fault act. The hospital, which provided a valuable service, will remain unpaid, while the insurer, which has already been paid through the insured's premiums, will not have to provide the service it was paid to perform.
With these concerns in mind, I respectfully suggest that the better course would be to follow the common-sense principles described in
Tebo v. Havlik
,
It is evident that there is no single rule of thumb which can be used to accomplish the maximum of justice in each varying set of circumstances. The involvement of vested property rights, the magnitude of the impact of decision on public bodies taken without warning or a showing of substantial reliance on the old rule may influence the result.
The benefit of flexibility in opinion application is evident. If a court were absolutely bound by the traditional rule of retroactive application, it would be severely hampered in its ability to make needed changes in the law because of the chaos that could result in regard to prior enforcement under that law. Placek v. City of Sterling Heights,405 Mich. 638 , 665,275 N.W.2d 511 (1979).
Appreciation of the effect a change in settled law can have has led this Court to favor only limited retroactivity when overruling prior law. Thus, when the doctrine of imputed negligence was overruled in Bricker v. Green,313 Mich. 218 ,21 N.W.2d 105 (1946), the decision was applied only to the case before the Court and to pending and future cases. When the doctrine of charitable immunity was overruled in Parker v. Port Huron Hospital,361 Mich. 1 ,105 N.W.2d 1 (1960), the retroactive effect of the decision was limited to the parties before the Court. Even where statutory construction has been involved, this Court has limited the retroactivity of a decision when justice so required.
The question before us is whether our interpretation of a statute should be applied retroactively to the statute's effective date. In Putney , we found the clear import *224 of the statute to be to require the plaintiff to name and retain the allegedly intoxicated person at risk. Were Putney a case of first impression in the Michigan courts, we would hold that the statutory language gave plaintiffs no reason to believe that the settlements entered into would comply with the "retain" portion of the statute. Putney , however, *172 was not a case of first impression in the Michigan courts. [ Tebo ,418 Mich. at 360-361 ,343 N.W.2d 181 (opinion by BRICKLEY , J.) (quotation marks and some citations omitted).] 4
The Tebo Court further stated:
In light of the unquestioned status of [ Buxton v. Alexander ,69 Mich.App. 507 ,245 N.W.2d 111 (1976),] at the time Putney was decided by this Court, it would be unjust to apply Putney retroactively to persons other than those before the Court in that case.
In contrast to the harsh effect which the full retroactivity of Putney would have on injured plaintiffs, prospective application will have little effect on dramshop defendants in those pending cases where settlement agreements have been made, even though the defense of Putney will be unavailable. For them, the law will simply remain as it was from 1976 to 1982. We hold that Putney v. Haskins is applicable to all cases where settlement agreements are entered into with the allegedly intoxicated person after the date of decision in Putney . [ Tebo ,418 Mich. at 363-364 ,343 N.W.2d 181 .]
For these reasons, I conclude that W A Foote Mem. Hosp. was wrongly decided and that Covenant should only be applied prospectively.
*225 IV. CONCLUSION
I join the majority in holding that the antiassignment clause in the policy is unenforceable. I dissent from the majority's conclusion as to the one-year-back rule, which I conclude should be calculated from the date plaintiffs filed suit.
We note that there are four assignments attached to plaintiffs' brief in opposition to defendant's motion for summary disposition and that two of those assignments explicitly designate plaintiffs Jawad A. Shah, M.D., PC, and Integrated Hospital Specialists, PC, as assignees. However, the names of the designated assignees in the other two assignments do not match the names of the remaining two plaintiffs. Nonetheless, in the trial court, defendant conceded in its reply brief in support of its summary-disposition motion that Hensley had executed an assignment to each plaintiff. Thus, as will be further explained later in this opinion, it appears that the parties assumed that all plaintiffs received assignments of rights from Hensley and that the parties essentially disputed only (1) whether these assignments were valid in light of the antiassignment clause in Hensley's insurance policy and (2) whether an amended complaint based on that assignment would relate back to the date of the original complaint. For purposes of this opinion, we assume, without deciding, that the assignments effectively assigned the stated rights to plaintiffs in this case as long as such assignments were not barred by the antiassignment clause. The only issue with respect to the validity of the assignments that was actually raised and decided in the trial court was the effect of the anti-assignment clause. Therefore, we limit our review to this issue. See
Allen v. Keating
,
The assignment-of-rights forms provided in pertinent part that Hensley was assigning
all rights, privileges and remedies to payment for health care services, products or accommodations ("Services") provided by Assignee to Assignor to which Assignor is or may be entitled under MCL 500.3101, et seq ., the No Fault Act. This Assignment is for the right to payment of Assignee's charges, only, and not for the right to payment of any other No Fault insurance benefits.
The Assignment as set forth above is for all services already provided to Assignor by Assignee prior to or at the time of Assignor's execution of this agreement. Specifically, this Assignment does not include an Assignment of any future No Fault benefits.
This order appears to be missing from the lower court file; however, a true copy of this order was provided to this Court on appeal.
We note that the primary thrust of defendant's appellate argument in response to plaintiffs' retroactivity argument is that plaintiffs failed to preserve this issue for appeal.
We acknowledge that decisions of our Supreme Court and this Court have applied the plain-error standard of review to certain unpreserved issues in the civil context. See, e.g.,
Wischmeyer v. Schanz
,
We also recognize the general distinction between forfeiture and waiver, but, as our Supreme Court has explained, the term ''waiver" in the civil-procedure context ''is typically used in the colloquial sense, encompassing inaction that would technically constitute forfeiture."
Walters
,
We note that this Court declined in both
W.A. Foote
and
VHS Huron Valley
to decide whether
Covenant
was to be given limited or full retroactive effect because that question was not necessary to the resolution in either of those cases. See
W.A. Foote
,
We note that an application for leave to appeal to our Supreme Court has been filed in both W.A. Foote and VHS Huron Valley .
Plaintiffs did not argue in the trial court that the antiassignment clause was ambiguous, and this argument is therefore waived for appellate review.
Walters
,
While we recognize that cases from 1993 and 2003 are not exactly recent in the ordinary sense, they certainly are recent when compared to a case from 1880.
We recognize that lower federal court decisions are not binding on state courts, but they may be considered persuasive.
Abela v. Gen. Motors Corp.
,
Although the Grist Court was discussing GCR 1963, 118.5, this former court rule was substantively the same as the current court rule addressing supplemental pleadings, which is MCR 2.118(E).
Although the language from
Jones
that we have quoted was a quotation attributed to the circuit court judge in that case, our Supreme Court explicitly adopted this reasoning.
Id.
at 682,
Moreover, neither party has argued in the trial court or on appeal that the trial court erroneously considered material outside the pleadings in treating the summary disposition as a motion under MCR 2.116(C)(8). Therefore, any potential appellate challenge on this ground is abandoned.
Houghton
,
I respectfully suggest that the Michigan Supreme Court should revisit Rory 's conclusion that there is no such thing as a "contract of adhesion." Anyone (except perhaps some lawyers and judges) who has ever purchased an automobile insurance policy-which under state law all car owners must do-knows exactly what a contract of adhesion is. One party, typically an individual, is presented with a preprinted policy and told to "take it or leave it." On the other side is typically an insurance entity with billions of dollars in assets and multiple employees dedicated to drafting contract language that will favor the entity in every way possible under the law or in what the entity hopes it can reshape the law to be. If the individual, assuming he or she is able to understand the policy language, declines to accept every word as written, they will not be permitted to purchase a policy. No revisions are even entertained. Moreover, if this individual then seeks coverage from a competitor insurer, they are all but certain to face the same or similar situation. In sum, the only "freedom of contract" that an individual purchaser has is to buy or not to buy a policy. And that freedom is illusory because by law every vehicle owner must obtain insurance. Accordingly, I respectfully suggest that the "freedom of contract" discussed in Rory is less a reality in this context than it is a phrase used to permit the judicial branch to ignore the words and the will of the Legislature as defined in the no-fault act.
Burkhardt
was not a no-fault case and the question was whether a party could assign rights it did not possess at the time of the assignment. In the instant case, by contrast, there is no dispute about the insured's possession of the right to benefits when he assigned them to the plaintiff healthcare providers. Specifically,
Burkhardt
concerned multiple parties involved in a tax foreclosure and subsequent assignments. The party foreclosed upon, Michael Bailey, did not redeem, and the plaintiff purchased the property at tax auction.
Id.
at 639-640,
MCL 436.22, as amended by
Justice Boyle concurred with Justice Brickley's opinion in full.
Tebo
,
Reference
- Full Case Name
- JAWAD A. SHAH, M.D., PC, Integrated Hospital Specialists, PC, Insight Anesthesia, PLLC, and Sterling Anesthesia, PLLC, Plaintiffs-Appellants, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant-Appellee.
- Cited By
- 182 cases
- Status
- Published