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Where a plaintiff submitted claims to a defendant insurance company for medical services provided to a policyholder, it was error to grant summary disposition to the insurer, as its argument that the policyholder participated in facilitation in a separate lawsuit that completely discharged the insurer from further liability lacked evidentiary support in the record.
“The no-fault act, MCL 500.3101 et seq., authorizes certain healthcare providers to bring a direct cause of action against an insurer to recover first-party personal protection insurance (PIP) benefits payable to an injured person for qualifying medical services provided. MCL 500.3112 discharges an insurer’s liability to the extent that payments have been made, unless the insurer has been notified in writing of pending claims. In this case, Phase One Rehab, LLC submitted claims to Allstate Property & Casualty Company for medical services provided to Ciera Riley. Allstate denied the claims, and in its motion for summary disposition, asserted that it had already paid Riley the maximum benefits under the policy. Phase One argued that Allstate’s payment log demonstrated that benefits had not been exhausted at the time that it received Phase One’s claims. In its reply, and without proper evidentiary support, Allstate for the first time argued that Riley participated in facilitation in a separate lawsuit that completely discharged Allstate from further liability.
“Because Allstate’s argument lacked evidentiary support in the record, the trial court erred by granting summary disposition to Allstate under MCR 2.116(C)(10) and we reverse. We disagree with Phase One, however, that Allstate was required to seek a court order under MCL 500.3112 before paying other entities and affirm the trial court on this issue. We affirm in part, reverse in part, and remand to the trial court for further proceedings.
“Phase One argues that defendant presented insufficient evidence to establish an exhaustion of allowable expense benefits and thus the trial court erred by granting summary disposition to defendant. Phase One further asserts that Allstate could not discharge its liability because it failed to seek circuit court approval under MCL 500.3112 before issuing payment to other entities. We agree, in part.
“Affirmed in part, reversed in part, and remanded to the trial court for further proceedings.”
