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A Better Partnership
December 01, 2015

MOA to review MACP denial of claim as obviously ineligible

In Bronson Methodist Hospital v. Michigan Assigned Claims Facility, No. 151343-4, the Michigan Supreme Court will hear oral argument on whether to grant the application in a case involving whether a hospital that fails to obtain information about an emergency-room patient’s no-fault insurance (or lack thereof) can obtain reimbursement from the Michigan Assigned Claims Plan (MACP) (successor to the Michigan Assigned Claims Facility).  The MACP denied the claim “an obviously ineligible claim” under MCL 500.3173a.  The Court of Appeals ruled in favor of the hospital.
 
On July 6, 2012, Cody Esquivel was driving while intoxicated and caused a single vehicle accident that required him to be airlifted to Bronson.  No one from Bronson collected information regarding Esquivel’s no-fault insurance coverage and the hospital was unable to locate him once he was discharged.  The final bill from Bronson for Esquivel’s treatment was $21,914.22.  Bronson filed an application for benefits with MACP, and it denied the application asserting, “The owner or co-owner of an uninsured motor vehicle . . . in an accident is not eligible for benefits.”
 
Bronson filed a complaint for declaratory judgment and mandamus requiring that MACP approve the application and assign the claim to a servicing insurer.  MACP filed a motion for summary disposition, alleging that Esquivel either maintained no-fault insurance or illegally failed to maintain insurance, making Esquivel and Bronson ineligible for claim assignment pursuant to MCL 500.3113 and MCL 500.3173.  The circuit court granted summary disposition, determining that Esquivel owned the vehicle and therefore was clearly ineligible for assigned benefits.  The circuit court denied Bronson’s motion for reconsideration and it appealed.
 
The Court of Appeals reasoned that nothing in the record established that Esquivel was actually uninsured, allowing Bronson’s claims to fall under the portion of MCL 500.3172(1) that addresses claims for which “no personal protection insurance applicable to the injury can be identified.”  Therefore, whether Esquivel failed to maintain statutorily required insurance for his vehicle is an unresolved question of fact which precludes summary disposition.  The Court of Appeals vacated and remanded the circuit court’s decision.  
 
The Michigan Supreme Court granted mini-oral argument on the application for leave to appeal and ordered the parties to address whether the Court of Appeals erred.

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