Summary Disposition Reversed in Favor of Medical Provider Seeking Payment of Assigned PIP Benefits

Insured driver was injured in an auto accident on New Year’s Eve, 2017. He received medical treatment for his injuries from plaintiff-appellant on several occasions between March and November of 2018. An Assignment of Benefits was executed by the injured driver for each service appointment, whereby he transferred all payment collection rights to the plaintiff healthcare provider.

The defendant insurance company responded to the healthcare provider’s invoices with partial payments, based on its assessment of the reasonableness and necessity of treatment. The healthcare provider filed suit in February 2019 seeking full payment. The defendant carrier moved for partial summary disposition under MCR 2.116(C)(10), claiming that the medical provider had no cause of action for payment because the injured driver had not suffered a loss or damages since he had not been sued for payment. The trial court agreed with the defendant, granted the motion, and dismissed plaintiff’s claims. The plaintiff moved for reconsideration but was denied. 

The appellate court agreed that the plaintiff medical provider had the legal right under the assignment of benefits to seek payment for the balance owed from defendant carrier. Citing the case Covenant Med Ctr, Inc v State Farm Mut Auto Ins Co, 500 Mich 191, 210-217 (2017), the appellate court confirmed that the injured driver “incurred” charges for medical care at the time of treatment. The no-fault act provides that an insured party has the right to have reasonable medical expenses paid by defendant carrier, and that the payment right transfers to the medical provider under the assignment. 

The case is Mich. Inst. of Pain & Headache, PC v. State Farm Mut. Auto. Ins. Co., unpublished order of the Michigan Court of Appeals. Released June 24, 2021, No. 353033 in Oakland Circuit Court, LC No. 2019-171937-NF. 

Click on the link to read the appellate court opinion.

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