Harris v. Auto Club Insurance Association
Harris v. Auto Club Insurance Association
Opinion of the Court
The significant question in this case is whether a person claiming personal protection insurance (PIP) benefits under MCL 500.3114(5)(a) for injuries arising from a motor vehicle accident may also recover an award for those same injuries under a health insurance policy that contains a provision titled, “Care and Services That Are Not Payable,” which provides, “[w]e do not pay for the following care and services: Those for which you legally do not have to pay or for which you would not have been charged if you did not have coverage under this certificate.” The Court of Appeals majority in this case held that because plaintiff Brent Harris, for purposes of the no-fault act, incurred expenses on receiving treatment,
I. FACTS AND PROCEEDINGS
On July 11, 2008, Harris was injured when he was struck by a motor vehicle while operating a motorcycle. Harris had a health insurance policy, referred to as a Professional Services Group Benefit Certificate (the policy or the certificate), with BCBSM. The owner of the motor vehicle that struck Harris was insured under a no-fault insurance policy issued by ACIA. Under the no-fault act, MCL 500.3101 et seq., the statutory definition of motor vehicle expressly “does not include a motorcycle.”
(5) A person suffering accidental bodily injury arising from a motor vehicle accident which shows evidence of the*466 involvement of a motor vehicle while an operator or passenger of a motorcycle shall claim personal protection insurance benefits from insurers in the following order of priority:
(a) The insurer of the owner or registrant of the motor vehicle involved in the accident.
Accordingly, if Harris claimed PIP benefits, ACIA would be responsible for paying those benefits, despite the fact Harris did not purchase a no-fault insurance policy from ACIA.
Following his accident, Harris sought insurance coverage for his medical bills from both ACIA and BCBSM. Harris expected BCBSM to pay the bills submitted by his medical care providers and expected ACIA to send a check directly to him in the same amount as the BCBSM payments. BCBSM initially paid $19,801.75 in benefits, but then retracted those payments and denied coverage, relying on provisions in its policy that stated BCBSM would not pay for medical care and services for which benefits are paid by another plan. In light of BCBSM’s denial of coverage, ACIA paid all Harris’s medical bills, including those bill payments retracted by BCBSM. ACIA has paid in excess of $85,000.
Harris then filed this lawsuit naming ACIA as the only defendant. Harris alleged that ACIA was required to pay him directly the same amounts paid by BCBSM to any healthcare provider for medical expenses arising from the motor vehicle accident. ACIA subsequently filed a third-party complaint against BCBSM. Harris then filed an amended complaint naming BCBSM as a defendant.
BCBSM and Harris filed motions for summary disposition. ACIA opposed the motions. The circuit court determined that because ACIA’s policy was uncoordi
Harris appealed, challenging only the circuit court’s order dismissing his claims against BCBSM. ACIA did not appeal the circuit court’s order dismissing its third-party claims against BCBSM. A split panel of the Court of Appeals reversed the circuit court’s order to the extent that it granted summary disposition to BCBSM.
[o]bviously, [the] plaintiff became liable for her medical expenses when she accepted medical treatment. The fact that plaintiff had contracted with a health insurance company to compensate her for her medical expenses, or to pay directly the health care provider on her behalf, does not alter the fact that she was obligated to pay those expenses.[12 ]
Relying on this reasoning, the majority concluded that Harris had incurred expenses when he sought treatment for his injuries that arose from the motor vehicle
The majority also addressed BCBSM’s contention that Shanafelt and Bombalski were inapposite because they addressed the no-fault act while the instant case turns on the language of BCBSM’s certificate.
Judge MURRAY partially dissented.
We granted BCBSM’s application for leave to appeal, instructing that “[t]he parties shall include among the issues to be briefed whether [Harris] is entitled to a double recovery from both [ACIA] and [BCBSM] of medical expenses arising from a motorcycle accident involving a motor vehicle.”
II. STANDARD OF REVIEW
This Court reviews a circuit court’s decision on a motion for summary judgment de novo.
III. ANALYSIS
In Smith v Physicians Health Plan, Inc,
However, in this case, Harris’s claim is fundamentally at odds with those cases. Unlike the claimant in Shanafelt, and other cases in which a double recovery of insurance benefits was awarded, Harris is not claiming benefits under a no-fault insurance policy that he or anyone else procured. Harris is neither a third-party beneficiary
(5) A person suffering accidental bodily injury arising from a motor vehicle accident which shows evidence of the involvement of a motor vehicle while an operator or passenger of a motorcycle shall claim personal protection insurance benefits from insurers in the following order of priority:
(a) The insurer of the owner or registrant of the motor vehicle involved in the accident.
The Court of Appeals majority erred when it concluded that Harris was covered by the uncoordinated no-fault insurance policy held by the motor vehicle driver involved in the accident. Harris is entitled to PIP coverage because MCL 500.3114(5)(a) designates ACIA as the responsible insurer. This conclusion is consistent with our holding in Smith, where we concluded that an insured must pay a premium to obtain insurance policies that provide for double recovery.
Under MCL 500.3114(5)(a), Harris was not obligated to pay his medical expenses because, as a matter of law, ACIA was liable for Harris’s PIP expenses. This dispo
MCL 500.3107(1)(a) provides that “personal protection insurance benefits are payable for . . . [allowable expenses consisting of all reasonable charges incurred for reasonably necessary products, services and
Harris v Auto Club Ins Ass’n, unpublished opinion per curiam of the Court of Appeals, issued December 27, 2011 (Docket No. 300256), p 4.
MCL 500.3101(2)(e).
An uncoordinated policy means that an insurer pays benefits regardless of other insurance the insured may have. Smith v Physicians Health Plan, Inc, 444 Mich 743, 747; 514 NW2d 150 (1994).
Harris, unpub op at 2.
Id. at 1.
Id. at 2-4.
Id. at 3-4.
Id. at 2-3, citing Shanafelt v Allstate Ins Co, 217 Mich App 625; 552 NW2d 671 (1996) and Bombalski v Auto Club Ins Ass’n, 247 Mich App 536; 637 NW2d 251 (2001).
Harris, unpub op at 3.
Id. at 3-4, quoting Shanafelt, 217 Mich App at 638.
Shanafelt, 217 Mich App at 542-543.
Harris, unpub op at 4.
Id. at 6.
Id. at 4.
Id.
Id.
Id.
Judge Murray concurred in the majority’s decision to affirm the circuit court’s order denying Harris’s motion for summary disposition, as well as the dismissal of ACIA, but dissented from the majority’s decision to reverse the order granting BCBSM’s motion for summary disposition. Harris, unpublished opinion per curiam of the Court of Appeals, issued December 27, 2012 (Docket No. 300256), p 1 (Murray, J., concurring in part and dissenting in part).
Id. (Murray, J., concurring in part and dissenting in part).
Harris v Auto Club Ins Ass’n, 491 Mich 933 (2012).
Maiden v Rozwood, 461 Mich 109, 118; 597 NW2d 817 (1999).
Rory v Continental Ins Co, 473 Mich 457, 464; 703 NW2d 23 (2005).
Smith v Physicians Plan, Inc, 444 Mich 743, 752; 747; 514 NW2d 150 (1994).
Id. at 752, citing Haefele v Meijer, Inc, 165 Mich App 485; 418 NW2d 900 (1987).
Shanafelt, 217 Mich App 625.
Harris also relies on Bombalski, hut this reliance is misplaced. Admittedly, the facts of Bombalski are very similar to the instant case. However, the court in Bombalski did not address whether the insured was entitled to a double recovery because the parties agreed that he was. Indeed, “the parties did not dispute [the] plaintiff[-insured]’s entitlement to uncoordinated personal protection benefits from defendant in addition to the coverage provided by BCBSM.” Id. at 539. Rather, “the only issue in [Bombalski] involved [the] [p]laintiff[-insured]’s claim for reimbursement of medical benefits and the rate of that reimbursement.” Id. That is not the case here.
MCL 600.1405, “Rights of third party beneficiaries,” provides in part that:
[a]ny person for whose benefit a promise is made by way of contract, as hereinafter defined, has the same right to enforce said promise that he would have had if the said promise had been made directly to him as the promisee.
(1) A promise shall be construed to have been made for the benefit of a person whenever the promisor of said promise had undertaken to give or to do or refrain from doing something directly to or for said person.
There is no allegation in this case that the no-fault insurance policy contained any promise to benefit Harris.
A subrogee is defined as “[o]ne who is substituted for another in having a right, duty, or claim.” Black’s Law Dictionary (9th ed). However,
Smith, 444 Mich at 760. We also note that denying Harris double recovery is in accord with the no-fault act’s stated objectives to maintain availability of insurance at affordable rates and cost-effective health care, neither of which are promoted when decisions about health care are influenced by the potential of a matching cash grant. Id. at 757.
Harris, unpub op at 1 (Murray, J. concurring in part and dissenting in part).
Dissenting Opinion
(dissenting). I do not join the majority opinion because, in my view, the Court of Appeals did not err by concluding that the applicable language of Blue Cross Blue Shield of Michigan’s (BCBSM) certificate at issue in this case does not exclude coverage from BCBSM. Specifically, I do not believe that the Court of Appeals majority erred by reasoning that Harris legally had to pay his medical expenses at the time he received
Case-law data current through December 31, 2025. Source: CourtListener bulk data.