Opinion ID: 837244
Heading Depth: 2
Heading Rank: 2

Heading: Reasonableness under MCL 500.3148(1)

Text: When a no-fault insurer refuses or delays payment of PIP benefits, it has the burden of justifying its refusal or delay under MCL 500.3148(1). Ross v. Auto Club Group, 481 Mich. 1, 11, 748 N.W.2d 552 (2008). The insurer can meet this burden by showing that the refusal or delay is the product of a legitimate question of statutory construction, constitutional law, or factual uncertainty. Id. When a reviewing court makes this inquiry, the determinative factor is not whether the insurer ultimately is held responsible for benefits, but whether its initial refusal to pay was unreasonable. Id. Defendant's initial refusal to pay benefits was reasonable. Until defendant learned that the insured's boyfriend had been acquitted of criminal assault, it was legitimately factually uncertain about the true cause of its insured's injury. Relying on authority from this Court, defendant properly believed that PIP benefits were not payable if the insured's injuries arose from a criminal assault. McKenzie v. Auto Club Ins. Ass'n, 458 Mich. 214, 225-226, 580 N.W.2d 424 (1998); Bourne v. Farmers Ins. Exch., 449 Mich. 193, 198, 534 N.W.2d 491 (1995); Thornton v. Allstate Ins. Co., 425 Mich. 643, 659, 391 N.W.2d 320 (1986). In Ross, this Court concluded that the defendant's denial of benefits was reasonable because the defendant had relied on a factually similar Court of Appeals decision to adopt a reasonable position on an issue of first impression. Id. at 15, 748 N.W.2d 552. Here, defendant similarly adopted a reasonable position in reliance on analogous precedent. Additionally, defendant relied on this Court's seemingly blanket statement that assaults occurring in a motor vehicle are not closely related to the transportational function of a motor vehicle. McKenzie, supra at 222, 580 N.W.2d 424. I see no appreciable distinction between defendant's position here and that of the defendant in Ross. In both cases, the defendants relied on earlier caselaw concerning similar issues to adopt a reasonable position regarding payment of benefits. Indeed, as soon as defendant learned that its insured's boyfriend had been acquitted of criminal assault, it voluntarily paid plaintiff more than $187,908 of benefits and $16,000 of interest. Consequently, defendant's initial refusal to pay was not unreasonable under the circumstances. Moreover, defendant had a separate legitimate question of statutory interpretation regarding MCL 500.3105. [1] The only competing versions of the events involved intentional conduct: Did the boyfriend assault the insured, or did she jump from the moving vehicle? A claimant's bodily injury is accidental unless suffered intentionally by the injured person or caused intentionally by the claimant. MCL 500.3105(4). In this case, defendant's attempted investigation of the veracity of the insured's claim that her boyfriend had assaulted her was stymied by the ongoing criminal investigation. Defendant could not interview the criminal defendant-boyfriend. Moreover, during his criminal trial, the insured's boyfriend testified that defendant's insured had jumped from the moving vehicle. In contrast, the insured testified that her boyfriend had pushed her. The jury apparently accepted the boyfriend's version of events and acquitted him of all charges. On these facts, the contest is between two versions of intentional conduct, and under one version of events, the injuries suffered by the insured were not accidental because the insured's injuries were suffered intentionally . . . or caused intentionally by the claimant. MCL 500.3145(4). If its insured intentionally jumped from the moving vehicle (in what appears to me to be) an apparent suicide attempt, defendant could not have unreasonably delayed in making PIP payments because there was no accidental injury. This is a second ground for a determination that the delay in payment reasonable.