WEAVER, J.
This Court originally granted leave to appeal to consider whether MCL 500.3104(2) obligates the Michigan Catastrophic Claims Association (MCCA) to reimburse a member insurer for personal protection insurance (PIP) benefits paid to a claimant without regard to the reasonableness of the member insurer's payments of PIP benefits. This Court issued an opinion reversing the Court of Appeals and remanding for further proceedings, while holding that "when a member insurer's policy only provides coverage for `reasonable charges,' the MCCA has authority to refuse to indemnify unreasonable charges."
We now hold that the indemnification obligation set forth in MCL 500.3104(2) does not incorporate the reasonableness standard that MCL 500.3107 requires between claimants and member insurers. Furthermore, the powers granted to the MCCA in § 3104(7) are limited to adjusting the "practices and procedures" of the member insurers and do not encompass adjustment to the payment amount agreed to between claimants and member insurers. Moreover, we hold that the power granted to the MCCA under MCL 500.3104(8)(g) is limited to furthering the purposes of the MCCA and that determining reasonableness is not one of its purposes. Finally, although the MCCA has no right to directly challenge the reasonableness of a claim, the no-fault statute does provide the MCCA with safeguards against negligent actions of member insurers. Accordingly, we affirm the judgment of the Court of Appeals.
In the first case in these consolidated appeals, Daniel Migdal was injured in a 1981 car accident in which he sustained catastrophic injuries. His injuries included a traumatic brain injury with cerebral spastic quadriplegia, severe oral motor apraxia, and dysphasia. Because of the extent of the injuries, Daniel was prescribed, and received, 24-hour-a-day nursing care. In 1988, Michael Migdal (Mr. Migdal), Daniel's father and the conservator of Daniel's estate, sued the no-fault insurance provider, United States Fidelity Insurance & Guaranty Company (USF & G), to recover expenses paid for Daniel's care. In 1990, the parties entered into a consent judgment. Pursuant to the judgment, USF & G paid Mr. Migdal $35,000 in exchange for a release from all contractual liability for nursing care provided before May 10, 1989. Additionally, USF & G agreed to pay $17.50 an hour for Daniel's home nursing care for the following year.
Pursuant to the consent judgment, USF & G paid Mr. Migdal the consented-to hourly wage.
Likewise, the MCCA moved for summary disposition. It contended that there was no question of material fact that the payments made by USF & G to Mr. Migdal were unreasonable. Moreover, the MCCA argued that the no-fault act only required reimbursement of payments that are reasonable. In a countermotion for summary disposition, USF & G argued that the no-fault act required the MCCA to reimburse it for the full amount paid to Mr. Migdal, despite any unreasonableness regarding the amount paid. Alternatively, USF & G argued that there was a question of material fact concerning the "unreasonableness" of the consent judgment.
The trial court granted USF & G's motion for summary disposition, ruling that the MCCA must reimburse USF & G for its "ultimate loss,"
In the second case of these consolidated appeals, Robert Allen was injured in a 2001 car accident in which he sustained catastrophic injuries. His injuries included right-sided pleuritic effusion, brain injuries, quadriparesis, bilateral frozen shoulder, and cardiopathy. Because of the extent of the injuries, Allen was prescribed, and received, 24-hour-a-day care by a licensed nurse. Hartford Insurance
The MCCA refused to reimburse Hartford for any payments above $20 an hour for the services rendered. Hartford filed a complaint for a declaratory judgment that would require the MCCA to pay Hartford $571,847.21 as reimbursement for payments exceeding the no-fault threshold. Additionally, Hartford sought a declaration that the MCCA must reimburse Hartford for the total payments above the $250,000 threshold, regardless of the reasonableness of the payments. After the initial filing, Hartford moved for summary disposition, arguing that the no-fault act required the MCCA to reimburse Hartford for the entire amount paid to Allen that exceeded the threshold, regardless of the reasonableness of that amount. The MCCA argued that it only had to reimburse Hartford for reasonable payments and that there was insufficient discovery concerning the reasonableness of the amount of the payments. The circuit court ruled that reasonableness was an element in determining how much the MCCA must reimburse Hartford and that there was insufficient discovery to determine if the payments were reasonable. Hartford immediately appealed the trial court's holding requiring the element of reasonableness to be considered.
The Court of Appeals consolidated the USF & G and Hartford cases and held that "MCL 500.3104 does not incorporate a `reasonableness' requirement and requires the MCCA to reimburse insurers for the actual amount of PIP benefits paid in excess of the statutory threshold."
Statutory interpretation is a question of law, which this Court reviews de novo. In re Investigation of March 1999 Riots in East Lansing (People v. Pastor),
The issue before this Court involves how much of a member insurer's coverages the MCCA must indemnify in the event of a catastrophic injury. Specifically, is the MCCA liable for reimbursement of PIP payments based on potentially unreasonable claims?
The outcome of these cases depends on this Court's interpretation of the language in MCL 500.3104. An overarching rule of statutory construction is "that this Court must enforce clear and unambiguous statutory provisions as written." In re Certified Question (Preferred Risk Mut. Ins. Co. v. Michigan Catastrophic Claims Ass'n),
Additionally, the frame of reference shares a deep nexus with the intent of the Legislature. "The primary goal of statutory interpretation is to give effect to the intent of the Legislature." Title Office, Inc. v. Van Buren Co. Treasurer, 469 Mich. 516, 519,
In interpreting § 3104, this Court first must determine how § 3104(2) corresponds with § 3107 and how these two provisions correspond within the entire statutory scheme. Section 3104(2) requires that the MCCA "shall provide and each member shall accept indemnification for 100% of the amount of ultimate loss sustained under personal protection insurance coverages in excess of the following amounts in each loss occurrence . . . ."
When the Legislature uses different words, the words are generally intended to connote different meanings. Simply put, "the use of different terms within similar statutes generally implies that different meanings were intended." 2A Singer & Singer, Sutherland Statutory Construction, (7th ed.), § 46:6, p. 252. If the Legislature had intended the same meaning in both statutory provisions, it would have used the same word. Therefore, we disagree with the MCCA and hold that the definition of personal protection insurance benefits found in § 3107(1)(a) (including the reasonableness standard) is not equivalent to the definition of personal protection insurance coverages in § 3104(2).
The distinctive use of the term "coverages" is important. LeBlanc v. State Farm Mut. Auto. Ins. Co.,
Section 3107 excludes from the definition of "allowable expenses" within PIP "coverages" hospital charges in excess of reasonable and customary semi-private room charges and funeral and burial expenses in amounts specified in the policy (subject to a range specified in that section). This leaves all other charges open to PIP "coverage." The fact that the Legislature limited the exceptions to "coverage" so narrowly indicates that the term "coverage" is a broader term than "benefits." Moreover, because "coverages" is never given a more restrictive definition elsewhere in the statute, the word must be afforded its ordinary, everyday meaning. Sun Valley, 460 Mich. at 237,
"Coverage" is defined in dictionaries as the "[e]xtent of protection afforded by an insurance policy [or the] amount of funds reserved to meet liabilities,"
The meaning of "coverages" in MCL 500.3107 becomes clearer after considering "`its placement and purpose in the statutory scheme.'" Sun Valley, 460 Mich. at 236,
Section 3401(1) states that the MCCA is "not subject to any laws . . . with respect to insurers." Thus, the MCCA is not a no-fault insurer, and consequently it is also not a reinsurer. Because the MCCA is not a no-fault insurer, but, rather, an indemnitor of no-fault insurers for benefits in excess of the statutory threshold, § 3107 does not directly bind the MCCA; it only binds the insurer members and the insured. Section 3107 "makes both reasonableness and necessity explicit and necessary elements of a claimant's [insured's] recovery. . . ." Nasser v. Auto Club Ins. Ass'n,
The MCCA maintains that the foregoing statutory constructions will lead to higher costs to insureds and will be a disincentive for member insurers to keep payments reasonable. These fears are unfounded. The MCCA is an unincorporated nonprofit association, whose purpose is to provide insurers with indemnification for PIP policies that exceed a certain threshold. See MCL 500.3104(1). The Legislature created the MCCA "in response to concerns that Michigan's no-fault law provision for unlimited [PIP] benefits placed too great a burden on insurers, particularly small insurers, in the event of `catastrophic' injury claims." In re Certified Question, 433 Mich. at 714,
In essence, under the MCCA's preferred outcome, when a member insurer makes an agreement with an insured (often in a litigation setting, whether it be an arbitration
In response to the MCCA's concerns, it should be pointed out that the MCCA is not without a safeguard to protect against unreasonable payments. The Legislature specifically laid out powers that the MCCA can exercise to guard against unreasonable settlements of catastrophic claims. MCL 500.3104(7)(b) states that the MCCA shall
This statutory language requires and empowers the MCCA to establish procedures to protect itself from unreasonable settlements in all cases involving claims that may exceed the threshold and consequently affect the MCCA. The MCCA's plan of operation likewise echoes these statutory requirements.
Only then, not after the claimant and member insurer have reached a settlement, can the MCCA exercise control over the settlement process. Under MCL 500.3104(7)(g), the MCCA must
Thus, when § 3104(7)(g) is read in conjunction with § 3104(7)(b), the outcome is that the MCCA is required to review those reports by members that anticipate needing indemnification and to assess the adequacy of the procedures or practices of the member.
Finally, the MCCA argues that § 3104(8)(g) gives it the power to question reasonableness regardless of the statute's other provisions. Specifically, § 3104(8)(g) allows the MCCA to "[p]erform other acts not specifically enumerated in this section that are necessary or proper to accomplish the purposes of the association and that are not inconsistent with this section or the plan of operation." However, this section does not give the MCCA carte blanche to simply avoid a member insurer's agreement that it finds unreasonable. The power
Section 3104(8)(g) allows the MCCA to fulfill the specific requirements of the statute. Accordingly, we interpret § 3104(8)(g) as granting the MCCA the limited power to further its purpose of prompt and efficient indemnification of its members. To interpret that section as granting any further power, such as the power to decline indemnification on the basis of the reasonableness of the indemnification amount, would be inconsistent with the Legislature's intent.
The dissent raises the concern that a decision in favor of plaintiffs in this case will result in substantially increased insurance costs. Certainly, insurance costs are a critical concern, but they are a policy concern that belongs to the Legislature. Nonetheless, we observe that the concern appears highly speculative and, indeed, unfounded. There is no evidence that insurers have engaged or will engage in slack negotiations. It bears mentioning here that there is no indication that the settlements in these cases were unreasonable when made.
The dissent bases its concern on an affidavit from defendant's executive director in which she refers to an estimate provided by consultants to defendant. No basis is given in the affidavit for the estimated increase in costs. And there is reason to wonder about this estimate, at least inasmuch as it might be based on an anticipated decision from this Court.
First, there is no evidence that defendant has routinely or even occasionally challenged the reasonableness of insurers' settlements with their insureds until very recently. It is difficult to understand how it will cost defendant extravagant sums to give up a practice it has only recently begun. Second, it is unknown whether the actuarial assessment factored in the effect of defendant's potential use of the cost-containment procedure actually provided by the Legislature in MCL 500.3104(7)(g).
As mentioned, the Legislature has provided that "[i]f the claims procedures or practices of a member are considered inadequate to properly service the liabilities of the association, the association may undertake. . . to adjust or assist in the adjustment of claims for the member on claims that create a potential liability to the association.. . ." MCL 500.3104(7)(g). There is no evidence that the actuarial assessment considered the effect of defendant's implementation of this legislatively provided cost-savings mechanism.
The dissent additionally fails to recognize that there is a compelling policy reason to reject defendant's claim that it may review settlements for reasonableness: namely, to limit litigation and promote settlements. This Court has long recognized that "[t]he goal of the no-fault insurance system was to provide victims of motor vehicle accidents assured, adequate, and prompt reparation for certain economic losses." Nelson v. Transamerica Ins. Services,
But, again, these are policy concerns best addressed by the Legislature. It appears that the Legislature has indeed balanced these concerns in the provisions of MCL 500.3104, and there is no reason for this Court to apply a strained construction to the statutes to achieve a goal contrary to the purposes of the no-fault act. In the unlikely event that insurers become milquetoast negotiators, defendant has the statutorily provided protection to remedy the situation.
We hold that the indemnification obligation set forth in § 3104(2) does not incorporate the reasonableness standard that § 3107 requires between claimants and member insurers. Furthermore, the powers granted to the MCCA in § 3104(7) are limited to adjusting the "practices and procedures" of the member insurers and do not encompass adjustment to the payment amount agreed to between claimants and member insurers. Finally, we hold that the power granted to the MCCA under § 3104(8)(g) is limited to furthering the purposes of the MCCA, and that determining reasonableness is not one of its purposes.
Accordingly, we affirm the Court of Appeals holding that the MCCA must reimburse its member insurers 100 percent of the ultimate loss exceeding the statutory threshold for claims without a reduction based on its unilateral assessment of the reasonableness of the amount.
Affirmed.
MARILYN J. KELLY, MICHAEL F. CAVANAGH, and DIANE M. HATHAWAY, JJ., concur.
YOUNG, J. (dissenting).
I respectfully dissent.
On December 29, 2008, this Court decided these cases.
The facts have not changed. The text of the statute at issue has not changed. The parties' arguments have not changed. And the rationale advanced in the opinions of this Court has not changed. Yet, within a matter of months, a decision of this Court, thoughtfully briefed, argued, and considered by seven justices, is no longer worth the paper it was written on. Even the casual observer, however, does not really need to ask why. The reason is obvious: On January 1, 2009, the composition of this Court changed.
This case was argued on October 1, 2008. On November 4, 2008, Justice Hathaway defeated then-Chief Justice Taylor in the election for his seat on this Court. This case was decided on December 29, 2008, with former Chief Justice Taylor casting his vote with the majority.
The new majority's opinion today offers no new rationale or argument. In fact, it is merely an extended quotation of Justice Weaver's former dissent.
For over a century this Court has adhered to the principle that a motion for rehearing should be denied unless a party has raised an issue of fact or law that was not previously considered but which may affect the outcome.
As Justice Weaver's former dissent in these cases and the majority's new opinion make obvious, the parties have not raised a new issue of fact or law to merit rehearing. The only difference is in the membership of this Court. As early as 1883, this Court had the wisdom to realize that such a change is not a proper ground for rehearing. In Peoples v. Evening News Ass'n,
By ordering rehearing simply because a change in the Court has taken place, the new majority has overruled the longstanding and clear principle of Peoples.
It is apparent that the new majority feels unencumbered by such principles— even one that has endured for more than 100 years. And, perhaps, its members no longer feel a need to be cosseted by the concerns and beliefs that they professed to have for the past decade when they were members of the philosophical minority of this Court. Indeed, Chief Justice Kelly once exclaimed that a recent decision of the Court being reconsidered "has hardly had time to become outmoded."
Because nothing in the facts, arguments, or legal rationale has changed, I continue to support this Court's original decision and do not feel the need to restate it in its entirety here.
The facts and procedural history of these consolidated appeals are simple, uncontested, and have been set out by this Court in detail three times.
The central question here is whether an insurance company that strikes a bad bargain with its insured may fob off on the Michigan Catastrophic Claims Association (MCCA), a nonprofit entity created by the Legislature to spread the costs associated
Plaintiff United States Fidelity Insurance & Guaranty Company (USF & G) entered into a consent judgment with its insured, Daniel Migdal, which resulted in USF & G paying $54.84 an hour for attendant care services.
Plaintiffs brought these actions seeking declaratory judgments that the MCCA was required to reimburse the full rate of attendant care services that they paid their insureds. The circuit courts entered conflicting judgments and the aggrieved parties appealed. The Court of Appeals consolidated the appeals and held that "the MCCA is statutorily required to reimburse an insurer for 100 percent of the amount that the insurer paid in PIP [personal protection insurance] benefits to an insured in excess of the statutory threshold listed in MCL 500.3104(2), regardless of the reasonableness of these payments."
Because the composition of this Court changed on January 1, 2009, USF & G and Hartford sought rehearing
As previously noted, at issue is whether the MCCA has the authority to refuse to
I agree that "personal protection insurance benefits" are not the same as "personal protection insurance coverages."
The majority states its holding: "the indemnification obligation set forth in MCL 500.3104(2) does not incorporate the reasonableness standard that MCL 500.3107 requires between claimants and member insurers."
The majority makes additional erroneous assertions. First, the majority asserts that member insurers will have an incentive to make reasonable settlements of catastrophic claims because, if they do not, the MCCA premiums will increase.
Perhaps the majority can explain why the legislative method for containing costs for Michigan's no-fault insurance customers is an inferior purpose to their preferred policy objective. In particular, why is it an inferior purpose at a time when the Governor has requested an auto insurance rate freeze
My point is not that our decision should be premised on keeping no-fault insurance affordable. Indeed, I maintain that such "`[p]olicy decisions are properly left for the people's elected representatives in the Legislature'"
Second, the majority emphasizes that the MCCA may only adjust a member insurer's "practices and procedures."
Third, "[p]laintiffs argue[d] that if the MCCA may reject member insurer claims on the basis of the reasonableness of the charges, member insurers will need to seek assurances that the MCCA will reimburse certain payments before making them, thus delaying payment."
The majority employs this policy-based rationale to depart from its own definitions of "coverages" because otherwise "[t]his outcome goes against the legislative purpose of assuring efficient and quick recovery for claimants in the no-fault system."
The majority concedes that the MCCA has authority to "requir[e] submission of proposed settlement agreements for approval."
Thus, the issue of delay is not resolved by the majority's opinion. Moreover, the majority's opinion does not address circumstances, like the present cases, where the MCCA was not afforded an opportunity to reject the agreements, which likely explains the $693.8 million bill that will be passed onto and shared by every Michigan automobile owner because of the increased and uncontrolled liability that the new majority's opinion will create for the MCCA.
We, as jurists, are ill-prepared to make complicated policy-based judgments unrelated to the policy choices that the Legislature has enacted. We do the least damage when we merely follow the Legislature's lead by giving words of a statute a plain reading and enforcing the statute as written. "The Legislature, unlike the judiciary, is institutionally equipped to assess the numerous trade-offs associated with a particular policy choice."
Undeterred and aiming to quell the likely negative response to its policy-based decision, the new majority asserts that my concerns "appear[] highly speculative and, indeed, unfounded."
Accordingly, I respectfully dissent.
MAURA D. CORRIGAN, J., agrees.
I, Gloria Freeland, being first duly sworn, depose and swear:
1. I am the Executive Director of the Michigan Catastrophic Claims Association (the "MCCA"). I have held this position since 2007 and have been employed by the MCCA since 1991.
2. I have personal knowledge of the facts in the Affidavit, and if called upon to testify, I can do so competently.
3. Each year the MCCA's consulting actuaries estimate the loss and loss adjustment reserve expenses of the MCCA.
4. This year, as a direct result of the Michigan Supreme Court's March 27, 2009 order granting the appellees' motion for rehearing, the MCCA's actuaries recommended, and the Board of Directors accepted their recommendation, that the MCCA increase by 10% the estimated $645 million needed to pay claims expected to be incurred for the fiscal accident year beginning July 1, 2009. This represents an increase of $64.5 million.
6. Increasing by $64 5 million the amount needed to pay claims expected to be incurred for the fiscal accident year beginning July 1, 2009, and increasing the MCCA's needed reserves by $629.3 million, are largely responsible for the increase of more than 19% in this year's assessment.
MARKMAN, J. (dissenting).
I concur fully with the discussion in part IV of Justice Young's dissenting opinion and therefore also dissent.
At the time of both accidents involved in these consolidated appeals, the threshold amount was $250,000.
The dissent erroneously asserts that the justices voting to grant rehearing erred because Peoples v. Evening News Ass'n, 51 Mich. 11, 21, 16 N.W. 185 (1883), held that this Court is precluded from granting rehearing when the composition of the Court has changed, absent any new arguments from the parties in the cases. However, contrary to the dissent's assertions, this Court merely stated in Peoples that a change in the composition of this Court cannot be the basis for granting rehearing.
Accordingly, if the composition of the Court changes, and the composition becomes such that a majority of the Court sees a reason to grant rehearing, the majority is not precluded under Peoples from granting rehearing. If, for instance, four justices on the newly composed court concluded that the challenged opinion was erroneous, those justices can vote to grant rehearing. The same holds true whether the deciding vote is a new justice who joined the court after the challenged opinion was released or whether the deciding vote comes from a justice who signed the challenged opinion and changed his or her mind after further consideration.
This practice is consistent with MCR 2.119(F)(3), which creates a "palpable error" standard for rehearing cases. It is up to the moving party to show palpable error that would lead to a different disposition in the case. If a majority of the Court is convinced by the moving party, the Court has the discretion to grant rehearing. Furthermore, while MCR 2.119(F)(3) states that a motion for rehearing will generally not be granted if the motion only presents the same arguments decided in the original disposition of the case, MCR 2.119(F)(3) explicitly refrains from "restricting the discretion of the court" to grant rehearing.
Accordingly, we are not persuaded by the dissent's attempts to discredit this Court's order that granted rehearing in this case.
The new majority states that MCR 2.119(F)(3) "creates a `palpable error' standard for rehearing cases." Ante at 107 n. 12. The actual standard created is: "a palpable error by which the court and the parties have been misled . . . ." Neither the parties nor the new majority suggest that this Court was previously misled. Plaintiffs and the new majority simply disagree with this Court's prior opinion for the reasons previously stated in the flawed analysis of Justice Weaver's dissent.
Moreover, I find it odd that Justice Hathaway, who, during her Supreme Court campaign, actively promoted the fabrication that former Chief Justice Taylor slept through the oral argument of McDowell v. Detroit, 477 Mich. 1079,
The rate that USF & G pays its insured, Daniel Migdal, to cover costs associated with his catastrophic injuries is so inflated that his father (Daniel's "caregiver") started a company, Medical Management, to make a profit from the arrangement. From the $54.84 hourly payments that USF & G makes, Medical Management pays the nurses (who actually provide Daniel's care) an average of $32 an hour (including benefits!) and retains the remainder of the USF & G hourly payment for itself. So inflated was the USF & G payment that, after paying for all of Daniel's care, Medical Management earned from this arrangement approximately $200,000 in profits for 2003. Under the majority's new opinion, it will be Michigan policyholders, not USF & G, who will pay for the profits of Daniel's father.