WILDER, P.J.
Plaintiffs in both cases are healthcare providers that rendered medical treatment to individuals allegedly injured in motor vehicle accidents. The medical providers brought actions in the district court, under the no-fault act, MCL 500.3101 et seq., seeking reimbursement for medical expenses related to the treatment rendered. State Farm, the no-fault insurer allegedly responsible for payment of personal protection insurance (PIP) benefits under the no-fault act, filed motions for summary disposition in which it argued, among other things, that the injured parties were not eligible for the payment of PIP benefits and, therefore, the healthcare providers were similarly precluded from seeking such benefits. The district courts denied State Farm's motion for summary disposition in each case.
In Docket No. 320288, Raynard Jackson allegedly sustained injuries on or about September 4, 2011, while a passenger in a motor vehicle owned and operated by Mohammed Abdullah. At the time, Abdullah's vehicle was insured under a no-fault policy issued by State Farm. Because of incomplete and conflicting police reports and medical records, there were questions regarding whether Jackson was injured in the accident. Consequently, in response to Jackson's claim for PIP benefits, State Farm requested that Jackson submit to a medical examination (ME) as permitted under MCL 500.3151 and an examination under oath (EUO). Jackson failed to appear for two ME appointments scheduled in February and March 2012. He similarly failed to attend the EUO. In April 2012, State Farm advised Jackson, through his legal counsel, that because of Jackson's failure to cooperate with its investigation of the claim, State Farm was suspending his claim for benefits.
Sometime after the accident, Jackson sought treatment from plaintiff, Chiropractors Rehabilitation Group, PC. When State Farm failed to reimburse plaintiff for the charges associated with its treatment of Jackson, plaintiff filed a complaint alleging that, under the no-fault act, it was entitled to reimbursement from State Farm for the services it provided to Jackson. On May 10, 2013, State Farm moved for summary disposition under MCR 2.116(C)(10), arguing that it was not responsible for charges associated with plaintiff's treatment of Jackson. State Farm asserted that because Jackson had failed to cooperate in its investigation of the claims, he was not eligible for coverage under the policy. State Farm then reasoned that Jackson's ineligibility for coverage barred the claims of any healthcare provider seeking coverage on Jackson's behalf.
The district court denied State Farm's motion for summary disposition. The court held that questions of fact existed
In Docket No. 322317, Ricky Johnson was purportedly a passenger in a vehicle involved in an accident on June 28, 2012, but the traffic report identified only "Qutrel Monteque" as a passenger. Johnson purportedly gave the police a false name at the time of the accident. On August 23, 2012, Johnson sought treatment from plaintiff Elite Health Centers, Inc. Johnson complained of neck and back pain that he attributed to injuries sustained in the accident. Johnson also sought treatment from plaintiff Horizon Imaging, LLC, in September 2012, where he underwent three MRIs.
On September 19, 2012, Johnson filed a claim for PIP benefits with State Farm, which had issued a policy of no-fault insurance to Veretta Robinson, the owner of the vehicle in which Johnson was allegedly a passenger. On January 22, 2013, State Farm requested that Johnson appear for an EUO on February 4, 2013. Johnson failed to appear for this scheduled EUO and later failed to appear at EUOs rescheduled for March 20, 2013 and March 22, 2013.
On September 6, 2013, plaintiffs filed a first amended complaint seeking PIP benefits from State Farm. Plaintiffs sought reimbursement of nearly $20,000 in out-standing medical expenses related to plaintiffs' treatment of Johnson. On November 19, 2013, State Farm filed a motion to amend its affirmative defenses and for summary disposition. Through this motion, State Farm sought to include as an affirmative defense that plaintiffs' suit was barred because Johnson had failed to cooperate with State Farm's investigation of the claim. State Farm also argued that summary disposition of plaintiffs' claims was appropriate because Johnson's ineligibility for PIP benefits precluded plaintiffs from seeking such benefits. Additionally, State Farm asserted that the policy language at issue required Johnson to submit to an EUO as a condition precedent to the recovery of benefits. State Farm argued that Johnson's failure to cooperate made it impossible to establish whether a loss occurred or whether it was first in priority to provide no-fault coverage to Johnson. State Farm, therefore, reasoned that summary disposition was appropriate under MCR 2.116(C)(10). In response, plaintiffs argued that because EUO provisions in insurance contracts may not act as a condition precedent to the recovery of PIP benefits, State Farm was not entitled to summary disposition.
The district court denied State Farm's motion to amend its affirmative defenses and for summary disposition. The court ruled that State Farm had provided no legal authority to warrant an amendment to the affirmative defenses. With respect to the summary disposition motion, the court held that Johnson's actions did not preclude a healthcare provider's claim because a healthcare provider has a right to a separate cause of action.
On January 30, 2014, State Farm moved for reconsideration of the district court's order denying leave to amend its affirmative defenses. In this motion, State Farm argued that healthcare providers lacked standing to pursue a claim for PIP benefits, asserting that only the injured party could pursue such a claim. On February 4, 2014, the district court denied State Farm's motion for reconsideration.
In both appeals, State Farm argues that the lower courts erred by denying its motions for summary disposition. We review de novo a trial court's decision on a motion for summary disposition, Gorman v. American Honda Motor Co., Inc., 302 Mich.App. 113, 115, 839 N.W.2d 223 (2013), as well as a circuit court's affirmance of a district court's decision on a motion for summary disposition, First of America Bank v. Thompson, 217 Mich.App. 581, 583, 552 N.W.2d 516 (1996). When reviewing a motion for summary disposition brought under MCR 2.116(C)(10), this Court must consider, in the light most favorable to the party opposing the motion, "the `affidavits, together with the pleadings, depositions, admissions, and documentary evidence then filed in the action or submitted by the parties'...." Calhoun Co. v. Blue Cross Blue Shield Mich., 297 Mich.App. 1, 11, 824 N.W.2d 202 (2012), quoting MCR 2.116(G)(5). "Summary disposition is appropriate under MCR 2.116(C)(10) if there is no genuine issue regarding any material fact and the moving party is entitled to judgment as a matter of law." Dillard v. Schlussel, 308 Mich.App. 429, 444 445, 865 N.W.2d 648 (2014) (quotation marks and citation omitted). "There is a genuine issue of material fact when reasonable minds could differ on an issue after viewing the record in the light most favorable to the nonmoving party," Allison v. AEW Capital Mgt., LLP, 481 Mich. 419, 425, 751 N.W.2d 8 (2008), or "when the evidence submitted `might permit inferences contrary to the facts as asserted by the movant,'" Dillard, 308 Mich.App. at 445, 865 N.W.2d 648, quoting Opdyke Investment Co. v. Norris Grain Co., 413 Mich. 354, 360, 320 N.W.2d 836 (1982).
State Farm first argues in Docket No. 322317 that healthcare providers do not have standing under the no-fault act to bring an action against an insurer to obtain no-fault PIP benefits. We disagree.
This issue is not properly preserved because State Farm raised this argument for the first time in a motion for reconsideration. Vushaj v. Farm, Bureau Gen. Ins. Co. of Mich., 284 Mich.App. 513, 519, 773 N.W.2d 758 (2009). However, we will review this issue because it is an issue of law and all of the relevant facts are available. Id.
Whether a party has standing to bring an action is a question of law reviewed de novo on appeal. Gyarmati v. Bielfield, 245 Mich.App. 602, 604, 629 N.W.2d 93 (2001).
This Court has frequently restated the following principles of statutory construction:
Courts should give effect to every word and phrase in a statute and avoid an interpretation that renders any part of a statute surplusage or nugatory. Dep't of Environmental Quality v. Worth Twp., 491 Mich. 227, 238, 814 N.W.2d 646 (2012).
In Munson Med. Ctr. v. Auto Club Ins. Ass'n, 218 Mich.App. 375, 381-381, 554 N.W.2d 49 (1996), this Court previously recognized that medical service providers have the "right to be paid for the injureds' no-fault medical expenses ... pursuant to MCL 500.3105, 500.3107, and 500.3157...." (Emphasis added.)
This conclusion is consistent with other opinions issued by this Court that have acknowledged the viability of first-party claims brought by healthcare providers.
Next, State Farm argues in both appeals that the healthcare providers' ability to seek no-fault PIP benefits is dependent on whether the injured party would be eligible to receive those PIP benefits. Accordingly, State Farm contends that the trial courts erred by denying its motions for summary disposition because the medical providers' claims were barred because
A review of relevant Michigan caselaw indicates that a healthcare provider's eligibility to recover medical expenses is dependent on the injured party's eligibility for no-fault benefits under the insurance policy. Our decision in TBCI, PC v. State Farm Mut. Auto. Ins. Co., 289 Mich.App. 39, 795 N.W.2d 229 (2010), is instructive. In that case, the healthcare provider brought suit seeking payment of PIP benefits under the no-fault act. Id. at 40, 795 N.W.2d 229. The plaintiff had provided medical treatment to Eric Afful, who was allegedly injured in a motor vehicle accident. Id. at 40-41, 795 N.W.2d 229. State Farm, however, had refused to pay Afful's claim, contending that the claims were fraudulent. Id. at 40, 795 N.W.2d 229. Afful filed suit against State Farm, and the jury found that Afful was not entitled to no-fault benefits on account of his fraudulent conduct. Id. In the provider's suit, this Court found that the provider was similarly barred from claiming no-fault benefits:
Similarly, in Bahri v. IDS Prop. Cas. Ins. Co., 308 Mich.App. 420, 424-425, 864 N.W.2d 609 (2014), this Court held that the healthcare providers' claims for PIP benefits were barred by the fraudulent conduct of the named insured. Citing TBCI, 289 Mich.App. at 44, 795 N.W.2d 229, this Court stated, "Because [the healthcare providers] stood in the shoes of the named insured, if [the named insured] cannot recover benefits, neither can [the healthcare
In Mich. Head & Spine Institute v. State Farm Mut. Auto. Ins. Co., 299 Mich.App. 442, 830 N.W.2d 781 (2013), this Court also acknowledged the interdependence between the claims of a healthcare provider and an injured party. In that case, the healthcare provider rendered services and accommodations to Pellumbesha Biba and brought an action against Biba's no-fault insurer, State Farm, seeking to recover payment for those services. Id. at 445-446, 830 N.W.2d 781. In exchange for $35,000 and in settlement of ongoing litigation with State Farm, Biba executed a contract that released State Farm from liability for no-fault benefits incurred to date or which might be incurred in the future. Id. at 444-445, 830 N.W.2d 781. Six months after signing the release, Biba began treatment with the plaintiff, Michigan Head & Spine. Id. at 445, 830 N.W.2d 781. In reliance on the release, State Farm refused to pay Michigan Head & Spine for its treatment of Biba. Id. at 445, 830 N.W.2d 781. State Farm appealed an order granting summary disposition in favor of Michigan Head & Spine, and this Court had to determine "whether an insured's release bars a healthcare provider's claim for payment for medical services rendered to the insured after the release was executed." Id. at 448, 830 N.W.2d 781. Applying contract principles, this Court held that the plain language of the release "demonstrate[d] that, in exchange for defendant's payment of $35,000, the parties intended to discharge [State Farm's] liability altogether, including its liability for future medical services." Id. Therefore, this Court held that summary disposition should have been granted in State Farm's favor. Id. at 450, 830 N.W.2d 781.
Additionally, in Detroit Med. Ctr. v. Progressive Mich. Ins. Co., 302 Mich.App. 392, 838 N.W.2d 910 (2013), this Court implicitly recognized that a healthcare provider's claim is dependent on the injured party's entitlement to benefits under a no-fault insurance policy, although it did not directly rule on the issue. The case was initiated by the plaintiff healthcare provider that treated the injuries of a motorcyclist who was insured by the defendant insurance company. Id. at 394, 838 N.W.2d 910. The trial court entered judgment in favor of the healthcare provider based on its conclusion that the motor vehicle associated with the incident was sufficiently involved in the accident for the plaintiff healthcare provider to recover no-fault benefits. Id. at 394, 838 N.W.2d 910. This Court held that summary disposition should have been granted in favor of the defendant insurance company because the motorcyclist was not entitled to personal protection insurance benefits pursuant to the no-fault act under the facts of the case. Id. at 399, 838 N.W.2d 910.
State Farm argues that the district courts' focus on whether Jackson and Johnson were involved in the accidents or sustained injures related thereto was misplaced. Instead, according to State Farm, the courts should have focused on the undisputed fact that the injured parties failed to submit to the requested MEs and EUOs. State Farm contends that this failure to cooperate conclusively established that the injured parties were prohibited from seeking no-fault coverage. We disagree.
In order to resolve this issue, a brief review of the statutes and caselaw addressing MEs and EUOs is warranted. Beginning with MEs, MCL 500.3151 provides that "[w]hen the mental or physical condition of a person is material to a claim that has been or may be made for past or future personal protection insurance benefits, the person shall submit to mental or physical examination by physicians." MCL 500.3153 addresses the repercussions that may result if a claimant refuses to comply with a request to submit to an examination. The statute permits a court to enter orders regarding the refusal that include, but are not limited to:
Thus, under MCL 500.3153, a court is authorized to dismiss an injured person's claim for failure to submit to an examination. Muci v. State Farm Mut. Auto. Ins. Co., 478 Mich. 178, 188-189, 732 N.W.2d 88 (2007). However, no such order was entered in either case.
This Court's decision in Roberts v. Farmers Ins. Exch., 275 Mich.App. 58, 737 N.W.2d 332 (2007), is instructive. Roberts indicates that a suspension of benefits is proper if a claimant repeatedly fails to comply with his or her statutory duty to submit to MEs. Id. at 69, 737 N.W.2d 332. In Roberts, after the insured, Brittany Underwood, repeatedly missed scheduled MEs and failed to pay cancellation fees, the insurer discontinued first-party no-fault benefits. Id. at 61, 737 N.W.2d 332. This Court, in reviewing the propriety of the insurer's actions, held:
Therefore, under Roberts, State Farm may reasonably suspend claims by the injured parties due to a failure to submit to MEs, and a suspension of benefits is not an "irrevocable denial" of benefits; the eligibility for PIP benefits is simply suspended until compliance with the ME. Likewise, we conclude that evidence that an injured party failed to submit to an ME that later results in a suspension of the claim is not tantamount to dispositive evidence that the injured person is not entitled to PIP benefits.
With regard to the effect of an injured party's failure to submit to an EUO, the Supreme Court's decision in Cruz v. State Farm Mut. Auto. Ins. Co., 466 Mich. 588, 648 N.W.2d 591 (2002), is instructive. In Cruz, the Court held that EUO provisions may be included in no-fault polices, but they are only enforceable to the extent that they do not conflict with the statutory requirements of the no-fault act. Id. at 590, 648 N.W.2d 591. Accordingly, a policy provision requiring a claimant to submit to an EUO that is "designed only to ensure that the insurer is provided with the information relating to proof of the fact and of the amount of the loss sustained ... would not run afoul of the statute." Id. at 598, 648 N.W.2d 591. However, "a no-fault policy that would allow the insurer to avoid its obligation to make prompt payment upon the mere failure to comply with an EUO would run afoul of the statute and accordingly be invalid." Id.
State Farm contends, inter alia, that the injured parties are ineligible for PIP benefits because they failed to submit to EUOs. However, taken to its logical extension, State Farm's argument, that the failure to submit to an EUO is alone sufficient to render the injured person ineligible for PIP benefits, would cause compliance with EUO provisions to effectively operate as a condition precedent to State Farm's duty to pay no-fault benefits.
In these cases, it is apparent that an irrevocable denial
Our conclusion here is consistent with the public policy goals of the no-fault act. As discussed by this Court in Wyoming Chiropractic, 308 Mich.App. at 401, 864 N.W.2d 598:
Finally, State Farm argues in Docket No. 322317 that the district court abused its discretion when it failed to grant State Farm's request for leave to amend its affirmative defenses to include an allegation that Johnson's ineligibility for no-fault benefits barred plaintiffs' claims. We agree.
This Court reviews for an abuse of discretion a trial court's ruling on a motion for leave to amend a pleading. Titan Ins. Co. v. North Pointe Ins. Co., 270 Mich.App. 339, 346, 715 N.W.2d 324 (2006). "An abuse of discretion occurs when the trial court's decision is outside the range of reasonable and principled outcomes." Brown v. Home-Owners Ins. Co., 298 Mich.App. 678, 690, 828 N.W.2d 400 (2012) (quotation marks and citation omitted).
MCR 2.111(F)(3) requires that a party state its affirmative defenses in the party's responsive pleading, either as originally filed or as amended under MCR 2.118. Specifically, pursuant to MCR 2.111(F)(3)(b), a party must state the facts constituting "a defense that by reason of other affirmative matter seeks to avoid the legal effect of or defeat the claim of the opposing party, in whole or in part[.]" Under MCR 2.118(A)(2), leave to amend pleadings "shall be freely given when justice so requires."
In Johnson's case, the trial court denied State Farm's motion to amend on the basis that it failed to make a legal argument or cite any caselaw indicating that justice required an amendment of State Farm's affirmative defenses. The trial court's reasoning was equivalent to a finding that the amendment would be futile. "An amendment is futile where, ignoring the substantive merits of the claim, it is legally insufficient on its face." Gonyea v. Motor Parts Fed. Credit Union, 192 Mich.App. 74, 78, 480 N.W.2d 297 (1991). While futility may warrant denying a motion to amend a pleading, Weymers, 454 Mich. at 658, 563 N.W.2d 647, in Johnson's case, the proposed amendment was not necessarily futile. As we explained in Part II(B), a healthcare provider's ability to recover medical expenses under the no-fault act depends on whether the injured party is eligible for no-fault benefits. Accordingly, if it were established that Johnson is not eligible for no-fault benefits, the provider's cause of action would be precluded. In its brief in support of its motion to amend its affirmative defenses and for summary disposition, State Farm cited authority in support of its position that the healthcare providers stand in the shoes of Johnson, such that the healthcare providers are no more entitled to recover benefits than Johnson. Therefore, to the extent that State Farm's proposed amendment included an allegation that Johnson's ineligibility for no-fault benefits barred plaintiff's claims, State Farm should have been given leave to amend its affirmative defenses. Such an affirmative defense, if proven, would, in fact, defeat plaintiffs' claims. Therefore, the court abused its discretion when it failed to permit the proposed amendment to State Farm's affirmative defenses.
We affirm the district courts' orders denying State Farm's motions for summary disposition in Docket Nos. 320288 and 322317, reverse the order denying State Farm's motion to amend its affirmative defenses in Docket No. 322317, and remand for further proceedings consistent with this opinion in both appeals. As the prevailing party in Docket No. 320288, plaintiff may tax costs pursuant to MCR 7.219. No taxable costs in Docket No. 322317, none of the parties having prevailed in full. We do not retain jurisdiction.
SHAPIRO and RONAYNE KRAUSE, JJ., concurred with WILDER, P.J.
Finally, MCL 500.3157 provides: