Meemic Insurance Company v. Louise M Fortson
Meemic Insurance Company v. Louise M Fortson
Opinion
*471 Defendants/counterplaintiffs, Louise Fortson and Richard Fortson, individually and as conservator for their son, Justin Fortson, appeal as of right the trial court's order granting the motion of plaintiff/counterdefendant, Meemic Insurance Company, *157 for summary disposition under MCR 2.116(C)(10) and denying the Fortsons' motion for summary disposition under MCR 2.116(I)(2). For the reasons stated in this opinion, we reverse.
I. BASIC FACTS
This case arises out of a motor-vehicle incident that occurred in September 2009. On that day, Richard and Louise's 19-year-old son, Justin, was riding on the hood of a vehicle when the driver suddenly accelerated and turned. The motion flung Justin from the vehicle, and he struck his head. Justin suffered extensive injuries, including a fractured skull, a traumatic brain injury, and shoulder bruising. He was initially hospitalized but eventually returned to his parents' home. According *472 to Louise, Justin's brain injury continued to manifest itself after he returned home.
Justin received benefits under his parents' no-fault policy with Meemic. Relevant to this appeal, Louise and Richard provided attendant care to Justin. The record reflects that from 2009 until 2015, Louise submitted payment requests to Meemic for attendant-care services. On each request, Louise simply noted "24" on each day of the calendar, indicating that she and Richard had provided Justin with constant daily supervision. Meemic routinely paid these benefits, and Meredith Valko, a claims representative employed by Meemic, testified that these payment requests were sufficient because she knew that Justin had a serious traumatic brain injury with significant residual effects requiring "24/7" supervision.
Around 2014, Meemic initiated an investigation into Louise and Richard's supervision of Justin and discovered that they had not provided him with daily direct supervision. Indeed, the investigation showed that Justin had been periodically jailed for traffic and drug offenses and had spent time at an inpatient substance-abuse rehabilitation facility. Additionally, on social media, Justin had reported spending time with his girlfriend and smoking marijuana. Based on its investigation, Meemic concluded that the Louise and Richard had fraudulently represented the attendant-care services they claimed to have provided. Meemic terminated Justin's no-fault benefits and filed suit against Louise and Richard, alleging that they had fraudulently obtained payment for attendant-care services that they had not provided. Louise and Richard filed a counterclaim, arguing that Meemic breached the insurance contract by terminating Justin's benefits and refusing to pay for attendant-care services. The parties
*473
filed cross-motions for summary disposition. Relying on this Court's decision in
Bazzi v. Sentinel Ins. Co.
,
II. SUMMARY DISPOSITION
A. STANDARD OF REVIEW
Louise and Richard argue that the trial court erred by granting summary disposition in Meemic's favor. We review de novo a trial court's decision on a motion for summary disposition.
Barnard Mfg. Co., Inc. v. Gates Performance Engineering, Inc.
,
B. ANALYSIS
1. FRAUD
Louise and Richard first argue that the trial court erred by finding that there was no genuine question of material fact with regard to whether they committed fraud. We disagree.
*158
Generally, whether an insured has committed fraud is a question of fact for a jury to determine. See
Shelton v. Auto-Owners Ins. Co.
,
Louise and Richard next argue that the trial court erred by determining that Justin's argument-i.e., that Meemic could not deny him coverage on the basis of fraud committed by other individuals-was, essentially, barred by
Bazzi
. In
Bazzi
, this Court concluded that the "innocent third party rule," also known as the "easily ascertainable rule," from
State Farm Mut. Auto. Ins. Co. v. Kurylowicz
,
Nevertheless,
Bazzi
and
Titan
addressed fraud in the
procurement
of an
*159
insurance policy, not fraud arising after the policy was issued.
Titan
,
This is because there is a meaningful distinction between fraud in the procurement of a no-fault policy and fraud arising
after
a claim was made under a properly procured policy. For instance, when a policy is rescinded on the basis of fraud in the procurement of the policy, it is as if no valid policy ever existed. As this Court explained in
Bazzi
, mandating no-fault benefits when an insurer can declare a policy void
ab initio
on the basis of fraud in the procurement would be akin to requiring the insurer to provide benefits in a case in which the automobile owner had never obtained an insurance policy in the first place.
Id
. at 774,
*160 *477 3. VALIDITY OF THE FRAUD-EXCLUSION CLAUSE
We next address whether the fraud-exclusion clause-as applied to Justin's claim-is a valid contractual provision. MCL 500.3114(1) provides that a person sustaining an accidental bodily injury arising out of the ownership, operation, maintenance, or use of
*478
a motor vehicle as a motor vehicle must first look to his or her own no-fault policy, to his or her spouse's policy, or to a no-fault policy issued to a relative with whom he or she is domiciled. Therefore, if Justin were not an "insured person" as defined by the policy,
2
he would be statutorily entitled to benefits under his parents' no-fault policy by virtue of the fact that he is a relative of his parents and was domiciled with them. In other words, if the policy did not define a resident relative as an "insured person," then Meemic would be required
by statute
to pay Justin benefits and would be unable to terminate his coverage because of fraud committed by a policyholder with regard to his claim. See
Shelton
,
Under Meemic's logic, by duplicating statutory benefits in a no-fault policy, an insurer can avoid paying no-fault benefits to an injured claimant if someone other than the claimant commits fraud and triggers a fraud-exclusion clause that allows the policy to be voided. We do not agree that the statutory provisions can be so easily avoided. "An insurer who elects to provide automobile insurance is liable to pay no-fault benefits subject to the provisions of the [no-fault] act."
Lewis v. Farmers Ins. Exch.
,
4. CONTRACT INTERPRETATION
Finally, even if the fraud-exclusion clause were valid, Louise and Richard's fraud is insufficient to trigger it because, *161 at the time they committed fraud, they were no longer "insured persons" under the policy. The fraud-exclusion clause in the no-fault policy provides:
This entire Policy is void if any insured person has intentionally concealed or misrepresented any material fact or circumstance relating to:
A. This insurance;
B. The Application for it;
C. Or any claim made under it.
The policy defines the term "insured person" as a named insured or the "resident relative" of a named insured. Because Louise and Richard were named insureds under the policy, they are "insured persons" as defined by the policy so long as that policy remains in effect .
The policy, however, was cancelled by Meemic. Specifically, on June 14, 2010, Meemic sent a notice of cancellation to Louise and Richard. The notice stated that as of July 29, 2010, at 12:01 a.m., the policy would no longer be in effect. Generally, once a contract of insurance is cancelled, neither the insured nor the
*480
insurer retains any rights or obligations pursuant to the cancelled agreement. See 2 Couch, Insurance, 3d, § 30:22, pp. 30-49 through 30-50 ("Cancellation of a policy at a time and in the manner specified therein cuts off all rights of the insured and bars recovery on the policy for any subsequent accident.... By definition, there can be no breach of a contract with respect to transactions arising after the contract of insurance has been effectively cancelled."). See also
Titan
,
The cancellation of the policy did not have any effect on Justin's claim because his claim was made before the policy was cancelled. Automobile no-fault insurance policies are "occurrence" policies as opposed to "claims made" or "discovery" policies.
Stine v. Continental Cas. Co.
,
When interpreting a contract, such as an insurance policy, the primary goal "is to honor the intent of the parties."
Tenneco Inc. v. Amerisure Mut Ins. Co.
,
Under the heading of "What Must Be Done in Case of Car Accident or Loss," the Meemic policy mandates that:
In the event of an accident, occurrence or loss , you (or someone acting for you ) must inform us or our authorized agent promptly. The time, place and other facts must be given, to include the names and addresses of all involved persons and witnesses. [Capitalization altered.]
It then sets forth a list of "other duties" that "[a] person claiming any coverage under this Policy must" perform, which includes cooperating with Meemic, promptly sending copies of notice or legal papers
*482
received in connection with the accident, providing written proofs of loss upon request, and submitting to examinations under oath for matters related to the claim. The policy provides a list of additional requirements for a person claiming personal injury protection insurance, underinsured motorist coverage, uninsured motorist coverage, or "car damage insurance" coverage. The common element is that
the person seeking coverage
is required to take actions or provide assistance to Meemic. There is no language mandating that
other individuals covered by the policy
have any rights or obligations with respect to that claim. The only individual who has obligations with respect to making a claim is the insured person who is claiming benefits under the policy, i.e., the claimant. Given the complete absence of language extending the obligations on the claim to all insured persons under the policy, there is no basis to extend Louise and Richard's status as insured persons beyond the date the policy was cancelled. "Just as courts are not to rewrite the express language of statutes, it has long been the law in this state that courts are not to rewrite the express terms of contracts."
McDonald v. Farm Bureau Ins. Co.
,
Here, the only person with "a claim" is Justin. He is the person who sustained an injury arising out of the ownership, operation, maintenance, or use of a motor vehicle, MCL 500.3105(1), and it is he who had an application for benefits submitted to Meemic on his behalf. 3 Therefore, as set forth in the policy, his claim *483 continues to be covered and was "locked in" as of the date of the injury, irrespective of whether the policy was cancelled at a later date. Louise and Richard, however, did not sustain an injury arising out of a motor-vehicle incident. They do not have a "claim" with Meemic, nor do they have any obligations with respect to Justin's claim. Instead, *163 Louise and Richard were merely attendant-care providers for Justin when they committed fraud. 4
Meemic asserts that it would be illogical to allow Louise and Richard to escape their obligations under the policy-in this case an obligation not to commit fraud-while simultaneously mandating that Meemic continue to provide benefits under the policy. We disagree. If Louise and Richard had made a claim under the policy before it was terminated, then their obligations under the policy would continue
with respect to their claim
, and Meemic's obligations with respect to that claim would also continue. Because Louise and Richard's obligations would continue under that scenario, if they committed fraud, then policy's fraud-exclusion clause would apply. See
Bahri
,
III. CONCLUSION
In sum, we reverse the trial court's order granting summary disposition in favor of Meemic. We do not read Bazzi as dispositive or applicable because there was no fraud in the procurement of the Fortsons' no-fault policy with Meemic. Further, the fraud-exclusion clause in the policy is invalid to the extent that it conflicts with MCL 500.3114(1), which entitled Justin to claim statutory benefits under his parents' properly procured no-fault policy. Finally, under the plain language of the policy, Louise and Richard were not insured persons under the policy when they committed fraud, so the fraud-exclusion clause is inapplicable and cannot be used to void the policy and deny Justin's claim.
Reversed and remanded for further proceedings. We do not retain jurisdiction.
Markey, P.J., concurred with M. J. Kelly, J.
Cameron, J. (dissenting ).
The majority resurrects, albeit in a new form, the abolished innocent-third-party *485 rule. 1 It also concludes that an insurance policy's fraud provision contravenes the no-fault act when applied to resident relatives. Finally, it concludes that, after cancellation, the policy's provisions will no longer apply to the policyholder who committed the fraud when the claimant is a third party. Because I disagree with all three holdings, I respectfully dissent. *164 Defendants, Louise Fortson and Richard Fortson, submitted false requests for attendant-care benefits to plaintiff, Meemic Insurance Company, from 2009 to 2015. Defendants provided care for their son, Justin Fortson, who was injured while riding on the hood of a car. Because Justin was a "resident relative" under defendants' policy, plaintiff provided personal injury protection (PIP) benefits under MCL 500.3114(1). In 2014, plaintiff discovered that defendants were fraudulently claiming 24/7 attendant-care services even when Justin was incarcerated, in drug rehabilitation programs, or staying with his girlfriend. Defendants collected over $100,000 in payments over six years.
I. INNOCENT-THIRD-PARTY RULE
The majority first concludes that Justin, as an innocent third party, can continue to collect PIP benefits because there was no fraud in the procurement of the policy. While I agree that the fraud did not occur in the procurement of the policy, there is no basis to apply the now-abolished innocent-third-party rule to the circumstances in this case.
As the majority correctly states, the innocent-third-party rule prevented insurers from voiding a policy
*486
using fraud as a defense to paying no-fault benefits, but the rule only applied when (1) there was fraud in the procurement of the policy that was easily ascertainable and (2) an innocent third-party claimant was involved.
Bazzi v. Sentinel Ins. Co.
,
Furthermore, we should not adopt the rule in a new form in order to allow a third-party claimant to collect PIP benefits when an insurer is entitled to void the policy for fraudulent conduct on the part of the policyholder. This Court clearly held in
Bazzi
that "if an insurer is entitled to rescind a no-fault insurance policy because of fraud, it is not obligated to pay any benefits under that policy,
including PIP benefits to a third party innocent of the fraud
."
Id
. at 770,
II. FRAUD PROVISION
A. VALIDITY
The majority's application of the innocent-third-party rule is premised on the *165 conclusion that the fraud provision does not void the insurance policy governing Justin's claim. To reach this conclusion, the majority determines that the fraud provision contravenes MCL 500.3114(1), and, therefore, cannot apply to Justin's claim. I disagree.
According to the majority, "[b]ecause MCL 500.3114(1) mandates coverage for a resident relative domiciled with a policyholder, the fraud-exclusion provision, as applied to Justin's claim, is invalid because it conflicts with Justin's statutory right to receive benefits under MCL 500.3114(1)." This reasoning is flawed, and the majority's holding carves out an unprecedented exception to the general rule that a fraud provision in an insurance policy is valid. First, in
Bahri v. IDS Prop. Cas. Ins. Co.
,
Unlike the plaintiff in Shelton , Justin is an insured under the policy because he is a resident relative. There is no question that the relevant insurance policy applies to his claim for PIP benefits under MCL 500.3114(1). Therefore, Justin's claim is not governed "solely by statute," and just as the fraud provision was valid in Bahri , the fraud provision in defendants' policy should also be deemed valid.
B. APPLICABILITY OF THE FRAUD PROVISION
Finally, the majority concludes that the fraud provision, even if it is valid, would not apply to Justin's claim and cannot void the insurance policy. I disagree.
*490
Insurance policies are agreements between parties, and "[t]he primary goal in the interpretation of an insurance policy is to honor the intent of the parties."
Tenneco Inc. v. Amerisure Mut. Ins. Co.
,
This case concerns the fraudulent acquisition of payments for allowable expenses. The insurance policy issued to defendants contained the following fraud provision:
22. CONCEALMENT OR FRAUD
This entire Policy is void if any insured person [ 3 ] has intentionally concealed or misrepresented any material fact or circumstance relating to:
*491 A. This insurance;
B. The Application for it;
C. Or any claim made under it.
To prove fraud and void a policy, the insurer must demonstrate 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 *167 that the insurer would act upon it. [ Bahri ,308 Mich. App. at 424-425 ,864 N.W.2d 609 (quotation marks and citation omitted).]
In
Bahri
, we concluded that clear evidence of fraud would operate to void a policy under that policy's fraud provision.
Id
. at 425,
I agree with the majority that the evidence clearly demonstrates that defendants defrauded plaintiff. However, according to the plain terms of the policy, plaintiff was entitled to void the policy if an insured person made a material misrepresentation in a claim made under the policy. See
Upjohn Co.
,
Finally, the majority concludes that defendants were only attendant-care providers for Justin and were no *492 longer the named insureds because of plaintiff's cancellation of the insurance policy in 2010. The majority maintains that "there is no basis to extend [defendants'] status as insured persons beyond the date the policy was cancelled." I disagree.
Plaintiff provided Justin coverage by virtue of his status as a "resident relative" of the named insureds, i.e., defendants. Justin's claim is subject to the terms of the policy even if it was subsequently cancelled, and defendants remain the named insureds under the policy. The policy at issue is an "occurrence" policy, which provides coverage "no matter when the claim is made, subject, of course, to contractual and statutory notice and limitations of actions provisions, providing the act complained of occurred during the policy period."
Stine v. Continental Cas. Co.
,
As a final point, the majority relies on the language of the cancellation clause, which states, "Cancellation will not affect any claim that originated prior to the date of cancellation." The claims for attendant-care benefits-even if sought after the *168 cancellation of the contract-still originate from the initial claim for no-fault benefits. Defendants cannot avoid the consequences of committing fraud simply because the policy is no longer in effect. Any such outcome contravenes the purpose of an occurrence-based policy.
III. CONCLUSION
I would conclude that the trial court did not err by granting summary disposition to plaintiff because there is no genuine issue of material fact and plaintiff is entitled to relief. Defendants submitted fraudulent claims in contravention to the policy's fraud provision, and the innocent-third-party rule should not allow Justin to continue collecting PIP benefits.
It is worth noting that the remedy sought by Meemic is to void or rescind the policy on the basis of fraud. Generally, "[i]n order to warrant recision [sic], there must be a
material
breach affecting a substantial or essential part of the contract."
Holtzlander v. Brownell
,
To rescind a contract is not merely to terminate it, but to abrogate and undo it from the beginning; that is, not merely to release the parties from further obligation to each other in respect to the subject of the contract, but to annul the contract and restore the parties to the relative positions which they would have occupied if no such contract had ever been made. Rescission necessarily involves a repudiation of the contract and a refusal of the moving party to be further bound by it. But this by itself would constitute no more than a breach of the contract or a refusal of performance, while the idea of rescission involves the additional and distinguishing element of a restoration of the status quo . [ Lash v. Allstate Ins. Co. ,210 Mich. App. 98 , 102,532 N.W.2d 869 (1995) (quotation marks and citation omitted).]
"[A] material misrepresentation
made in an application for no-fault insurance
entitles the insurer to rescind the policy."
Id
. at 103,
Here, regardless of Louise and Richard's fraudulent attendant-care payment requests, the policy still would have been issued. Therefore, there are no grounds for
automatic
rescission of the policy on the basis of fraud arising after the policy was issued, i.e., fraud that does not affect whether the policy would have been issued in the first place. Instead, at a minimum, Meemic must establish that Louise and Richard's misrepresentation affected "a substantial or essential part of the contract."
Holtzlander
,
As explained later, Justin is an "insured person" as that term is defined in Louise and Richard's no-fault policy with Meemic.
An application-for-benefits form is required to be completed by a claimant. In this case, a review of Justin's application is consistent with the language in the policy. The application-for-benefits form submitted to Meemic states that the applicant is Justin, and no other applicant is listed. It provides Justin's name and contact information in the blanks left for information about the "applicant." It provides details about when, where, and how Justin was injured, as well as the type of injuries he sustained. Further, the signature line requests the signature of the "applicant or parent/guardian." Absent from the application is any language even hinting that other individuals insured under the policy but not making a claim have any rights or obligations with respect to the claim.
Being a named insured is not a prerequisite to providing attendant-care services under a no-fault policy. Rather, any person approved by the insurance company can provide attendant-care services. The particular responsibilities of the provider are typically based on the need of the injured person and the skill and training of the provider.
This is not to say that a defrauded insurer does not have a remedy against the person who committed the fraud. See
Titan
,
See
Bazzi v. Sentinel Ins. Co.
,
The majority holds that the fraud provision conflicts with the no-fault act, but there is no provision in the no-fault act that prevents the use of a fraud exclusion in a policy. Instead, the majority concludes that because a resident relative is entitled to PIP benefits by operation of the statute, no policy provision can prevent the resident relative, or for that matter anyone entitled to claim benefits under another's policy, from his or her "statutory right to receive benefits under MCL 500.3114(1)." Of course, insurers are allowed to include various exclusions to manage their risk when insuring drivers so long as those exclusions do not conflict with the no-fault act. "It is a bedrock principle of American contract law that parties are free to contract as they see fit, and the courts are to enforce the agreement as written absent ... a contract in violation of law or public policy."
Corwin v. DaimlerChrysler Ins. Co.
,
The policy defines an "insured person," in part, as "You, if an individual[.]" The policy further defines "you" as "any person or organization listed as a Named Insured on the Declarations Page" as an assigned driver or another named insured. Louise and Richard were the named insureds on the declarations page.
Case-law data current through December 31, 2025. Source: CourtListener bulk data.