Disputes over whether treatments and services are reasonably necessary for an injured person’s care, recovery, or rehabilitation—and are therefore compensable under MCL 500.3107(1)(a)—are plentiful in the Michigan no-fault world. An unpublished opinion issued by the Michigan Court of Appeals, Integrated Cognitive Rehab, LLC v Zurich American Ins Co (Docket No. 353114), provides additional guidance concerning a plaintiff’s burden in establishing an entitlement to personal protection insurance (PIP) benefits under § 3107(1)(a). The Court of Appeals held that the defendant insurer was entitled to summary disposition because the plaintiff service provider failed to present evidence showing that its recreational therapy services were reasonably necessary for the insured’s care, recovery, or rehabilitation.
Background on Integrated Cognitive Rehab
This case arose from an automobile accident in which Denzel Harris (Defendant Zurich American Insurance Company’s insured) suffered injuries. After the accident, Plaintiff Integrated Cognitive Rehabilitation, LLC (“ICR”), provided recreational therapy to Harris for several years. The therapy objectives “included ‘demonstrat[ing] leisure independence’ and ‘correct social etiquette,’ and ‘improving leisure awareness and social skills.’” Integrated Cognitive Rehab, unpub op at 2 (alteration in original). Specifically, the therapy entailed weekly visits with a therapist who took Harris to participate in recreational activities such as bowling and going out to dinner. ICR sought no-fault benefits from Zurich for these services under MCL 500.3107(1)(a). Zurich denied the claims, and ICR sued.
After the close of discovery, Zurich filed a motion for summary disposition, seeking dismissal under MCR 2.116(C)(10). Under that court rule, “[t]he moving party must present evidence to support its motion, and the court must consider that evidence in the light most favorable to the nonmoving party to determine whether any genuine issue of material fact exists to warrant a trial.” Integrated Cognitive Rehab, unpub op at 1-2 (quotation marks and citation omitted). The circuit court denied Zurich’s motion, reasoning that there was a question of fact about whether ICR’s services were reasonably necessary for Harris’s care, recovery, or rehabilitation.
The Court of Appeals’ Ruling
On appeal, the Court unanimously reversed the trial court’s order.
In reaching its decision, the Court of Appeals first considered the evidence presented by Zurich showing that Harris met his therapy goals a long time before ICR provided the services. The evidence revealed that Harris had maintained steady employment for years, lived successfully with roommates, frequently socialized with friends, and regularly participated in a number of hobbies and social activities. Harris himself admitted that while the therapy was enjoyable, it hadn’t helped him perform any activity that he couldn’t have done on his own. Zurich also submitted six independent medical examinations conducted between 2014 and 2019, all of which declared ICR’s services unnecessary.
The Court of Appeals then considered whether ICR satisfied its burden of presenting evidence establishing a genuine issue of material fact. It didn’t. ICR only proffered prescriptions for recreational therapy, which didn’t explain why the therapy was necessary for Harris’s care, recovery, or rehabilitation. ICR also noted that Harris was deemed incapacitated and had been appointed a guardian after the accident. But ICR didn’t explain how these circumstances required recreational therapy or rebutted Zurich’s evidence. Because ICR “neither supported its claim nor presented evidence to overcome summary disposition,” the Court of Appeals reversed the trial court’s ruling and remanded for entry of judgment in Zurich’s favor. Integrated Cognitive Rehab, unpub op at 1, 3.
Significance of Integrated Cognitive Rehab
The Court of Appeals’ analysis underscores a no-fault plaintiff’s burden to survive summary disposition. MCL 500.3107(1)(a) provides for the payment of PIP benefits for “[a]lowable expenses consisting of reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person’s care, recovery, or rehabilitation.” When faced with a motion for summary disposition under MCR 2.116(C)(10), the plaintiff cannot simply rely on the allegations in their complaint. They must respond with documentary evidence demonstrating that their claim is compensable under § 3107(1)(a) and refuting the opposing party’s evidence. This means that they must present, among other things, evidence establishing that the products, services, or accommodations at issue were reasonable and necessary. Otherwise, summary disposition is warranted.
If you have questions about the nuances of summary disposition in no-fault cases, please feel free to contact the author, Gina M. Derderian. More information about Collins Einhorn’s General and Automotive Liability Practice Group is available here.