A Wayne County jury returned a no-cause-of-action verdict in favor of a no-fault insurer on January 19, 2017.  Plaintiff was an occupant of an automobile insured by defendant that was involved in an accident on May 14, 2014.  In the instant litigation, plaintiff claimed to be entitled to $567,027.04 in medical expenses, $40,800 in lost wages, and $18,060 in household replacement services.  Plaintiff claimed to be entitled to a total of $625,887.04 in first-party no-fault benefits.  In related suits pending in various circuit and district courts, numerous medical providers claimed to be entitled to an additional $775,997.81 in medical expenses for services provided to plaintiff allegedly arising out of the accident, bringing the total medical expenses incurred by plaintiff to $1,343,024.85.

Defendant, represented by Collins Einhorn Farrell PC attorney Kyle N. Smith, argued that the expenses and benefits claimed by plaintiff were not related to the automobile accident.  Plaintiff claimed to have sustained injuries to his neck, lower back, and left shoulder as a result of the accident, and ultimately underwent left shoulder surgery.  Additionally, he underwent numerous injections in his left shoulder and lumbar spine.  However, defendant argued that these injuries were not caused by the May 14, 2014 automobile accident, but instead, were caused by a subsequent bicycle accident plaintiff was involved in on June 20, 2014.

The policy of insurance issued by defendant under which plaintiff claimed benefits contained a fraud provision that provided, in pertinent part, that defendant would not provide coverage for any insured who made fraudulent statements or engaged in fraudulent conduct in connection with any accident or loss for which coverage was sought under the policy.  Defendant introduced evidence and testimony that plaintiff worked after the accident and was able to perform household replacement services during the period of time he claimed such benefits.  Regarding plaintiff’s claimed injuries, defendant introduced evidence and testimony demonstrating that the injuries plaintiff claimed to have incurred as a result of the automobile accident were instead caused by the subsequent bicycle accident.

After almost two hours of deliberation, the jury returned its verdict.  The jury found that plaintiff (1) made a false statement about a material fact, (2) knew that the statement was false at the time it was made or made it recklessly without any knowledge of the truth, and (3) made the material misrepresentation with the intention that defendant would act upon it.  Accordingly, defendant’s policy did not provide coverage for any first-party no-fault benefits claimed by plaintiff or any of his privies or providers and a no-cause-of-action verdict was rendered in favor of defendant.

 

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