No-Fault Insurer Entitled to Judgment on Hospital’s Claim for Reimbursement of Medical Expenses for Motorcyclist’s Injuries for Accident Caused in Avoiding Collision with Motor Vehicle

In DMC v. Progressive, The Court of Appeals reversed a trial court judgment for the plaintiff hospital which sought reimbursement from defendant no-fault insurer of medical expenses for care to an injured motorcyclist.

The motorcyclist suffered serious injuries after he ditched his bike to avoid a collision with an automobile about to cross into his path.  The motorcycle never came into contact with the vehicle.

The hospital rendered medical services to the motorcyclist in the amount of approximately $112,000 and then sought reimbursement from the motorcyclist’s household automobile no-fault insurer.  The insurer objected on grounds the No-Fault Act, MCL 500.3101, et seq., excludes motorcycles from the definition of motor vehicle.  See MCL  500.3101(2)(e).  While motorcycles are excluded from the definition of motor vehicles, a sufficient causal connection between a motorcyclist’s accident causing injury and a motor vehicle will allow recovery by the motorcyclist of personal insurance protection benefits under the No-Fault Act. The No-Fault Act provides coverage for accidental bodily injury arising out of the ownership, operation, maintenance or use of a motor vehicle as a motor vehicle.  MCL 500.3105(1).  

Based on the evidence before it (and, apparently without a jury impaneled), the trial court ruled the hospital was entitled to recovery for the care and treatment of the injured motorcyclist.  The insurance company appealed and the Court of Appeals reversed.  

Characterizing the question as one of law, to wit, the extent of the motor vehicle’s involvement in the motorcyclist’s decision to ditch his bike, the Court of Appeals engages in a causal relationship test.  The Court concludes the nexus between the motorcyclist’s actions and conduct and the alleged fear of collision with the approaching motor vehicle was not sufficient to conclude that his injuries arose out of the use, operation or maintenance of a motor vehicle as a motor vehicle.  The Court analogizes the case to the recent McPherson decision, which I previously wrote about here (McPherson v. McPherson), to the causal tenuousness in this case.  McPherson however, involved a claim for injuries suffered in a motor vehicle accident when the injured plaintiff suffered a seizure while riding a motorcycle.  His injuries were significant in the second accident as he was rendered a paraplegic.  However, since he could not recover no-fault benefits for the second accident because he was riding a motorcycle, which is excluded, he sought to have benefits extended by alleging that the earlier motor vehicle accident was the true cause of his seizure, which caused the accident resulting in his injuries.  The Supreme Court disagreed.

Here, the Court holds that the perceived, but subjective and unfounded fear of collision with an approaching motor vehicle is not a sufficient nexus of involvement by a motor vehicle to allow recovery of no-fault benefits.  Hence, the hospital was not entitled to reimbursement from the no-fault insurer.

In my judgment, the Court of Appeals overstepped its boundaries here by concluding it is a question of law whether the approaching motor vehicle was involved in the accident.  After noting the question of such involvement is to be taken on a case-by-case basis, it appears to remove from the province of the trial court that part of the fact-finding function entitled to deference.  Having concluded the question is one of pure law, it was free to review the case de novo.  Then, it is free to conclude the motorcyclist’s fear of a collision with the vehicle was subjective and unfounded, and that the mere perception of an inevitable collision is insufficient to give rise to the causal connection required to recover no-fault benefits.

These appear to be the types of cases where it would be wise to develop a factual scenario that requires significant factual conclusions on the part of the trial court and / or a jury.  Was the testimony of the driver of the motor vehicle offered?  Was he or she even identified?  Was there any other factual information that could have led the trier of fact to conclude that a pending collision with the motor vehicle was more than an unfounded and subjective perception?  Although, the Court of Appeals concludes the facts were insufficient to establish the requisite causal connection, i.e., the proximate cause (a fundamentally mixed question of law and fact ordinarily reserved to the province of the finder of fact in the given case), to sustain the hospital’s claim against the no-fault insurer, this does appear to be a judicial choice made by a higher tribunal, rather than an unequivocal application of the rule of law.

In any event, the case provides an interesting explanation of this panel’s view of the causal relationship test to prove an entitlement to no-fault benefits.  I believe the Supreme Court might take a closer look at this case if the hospital were to challenge the ruling.

About cjtucker06

Owner of law firm since July 2014; Handles all types of appellate matters and assists other lawyers with complex litigation and insurance coverage issues; Admitted to the Supreme Court of the United States, the Sixth Circuit Court of Appeals and the State Bar of Michigan; Expertise in prosecuting and defending appeals with several significant successes in the Sixth Circuit Court of Appeals, the Michigan Supreme Court and the Michigan Court of Appeals; Author of briefs amicus curiae in the Michigan Supreme Court for the Michigan Defense Trial Counsel and the Insurance Institute of Michigan; Represents Insurance Companies, Major International Business, Governmental Entities, Law Enforcement Officers and County Sheriffs. Board of Directors, Michigan Defense Trial Counsel Amicus Committee Co-Chair, Michigan Defense Trial Counsel Military - Retired Major in the Judge Advocate General (JAG) Corps of the United States Army, Brigade Judge Advocate and Staff JAG officer for the Maneuver Training Center, Camp Grayling, Michigan; Recipient of the Army's Meritorious Service Medal (the highest medal of honor available to Soldiers serving in non-combat roles); 2012 Graduate of the Judge Advocate Officer Advanced Course, at The Judge Advocate Legal Center and School, Charlottesville, Virginia. United States Navy Reserves, Combat Warfare Qualification, January 1989 to July 2003 Former law clerk to Justice Stephen J. Markman, Michigan Supreme Court, Research Attorney, Michigan Court of Appeals. Insurance Coverage Associate Plunkett Cooney; Environmental Law Attorney at Squire Sanders, now Squire Patton Boggs; Master's Degree in Environmental Law; Environmental Law Scholar, ALI/ABA Washington, D.C., Juris Doctorate, Vermont Law School, Environmental Editor, Vermont Law Review; Treasurer and Finalist, Moot Court Advisory Board.
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