Court Opinion

ID: 9376588
Source: CourtListenerOpinion
Date Created: 2023-03-03 06:05:32.965721+00
Date Added: 2024-06-11T17:17:07.707514
License: Public Domain

If this opinion indicates that it is “FOR PUBLICATION,” it is subject to
                revision until final publication in the Michigan Appeals Reports.

                          STATE OF MICHIGAN

                          COURT OF APPEALS

CENTRIA HOME REHABILITATION, LLC,                                FOR PUBLICATION
                                                                 March 2, 2023
             Plaintiff-Appellant,                                9:20 a.m.

v                                                                No. 359371
                                                                 Oakland Circuit Court
PHILADELPHIA INDEMNITY INSURANCE                                 LC No. 2020-180029-NF
COMPANY,

             Defendant-Appellee,
and

AUTO CLUB INSURANCE ASSOCIATION,

             Defendant.

CENTRIA HOME REHABILITATION, LLC,

             Plaintiff-Appellant,

v                                                                No. 359372
                                                                 Oakland Circuit Court
PHILADELPHIA INDEMNITY INSURANCE                                 LC No. 2020-180029-NF
COMPANY,

             Defendant-Appellee,
and

AUTO CLUB INSURANCE ASSOCIATION,

             Defendant.

Before: K. F. KELLY, P.J., and MURRAY and SWARTZLE, JJ.

                                             -1-
PER CURIAM.

         In these consolidated appeals, in Docket No. 359371, plaintiff Centria Home
Rehabilitation, LLC, appeals by delayed application for leave to appeal1 the trial court’s order
granting summary disposition under MCR 2.116(C)(10) in favor of defendant Philadelphia
Indemnity Insurance Company.2 In Docket No. 359372, plaintiff appeals by right the same trial
court’s order granting defendant’s motion for case evaluation sanctions under MCR 2.403(O).
This case presents the question of whether a health care provider, acting as assignee of an insured’s
right to personal injury protection (PIP) benefits or as a plaintiff in a direct action under MCL
500.3112, may sue an insurer to recover the difference between what the assignee billed and what
the insurer paid when there is a dispute over the reasonableness of the charges. We conclude that
it does: When a healthcare provider, acting under an assignment of rights from the insured or under
a direct cause of action under MCL 500.3112, seeks to recover the balance due for PIP benefits
from an insurer and there is a dispute over the reasonableness of the charges, the health care
provider has standing to bring such a claim directly against the insurer. Thus, because the trial
court erred when it granted defendant’s motion for summary disposition, we reverse the trial
court’s order in Docket No. 359371, vacate the trial court’s order in Docket No. 359372 granting
case evaluation sanctions, and remand for further proceedings consistent with this opinion.

                      I. BASIC FACTS AND PROCEDURAL HISTORY

        On July 6, 2018, Nicholas Randall was injured while a passenger in a commercial vehicle
operated by Homes of Opportunity, Inc. and insured by defendant. Randall suffered various
injuries, including diffuse traumatic brain injury, lumbar spine fractures, and a fractured pelvis.
On December 22, 2018, plaintiff began providing 24-hour in-home attendant care prescribed for
Randall.

        Plaintiff charged $33.20 an hour for its services. For the period from December 22, 2018,
through January 12, 2019, plaintiff submitted a claim in the amount of $15,767.77. Defendant
issued a check in the amount of $12,363.12 to plaintiff, accompanied by a letter explaining that
payment was lower than billed on the basis of a “market survey conducted in April 2019.” Plaintiff
subsequently filed a single count complaint against defendant and Auto Club Insurance
Association (ACIA), alleging that Randall was entitled to receive benefits under the no-fault act
and that defendant and ACIA were obligated under the no-fault act to pay for Randall’s medical
expenses, including attendant care services. Plaintiff alleged that Randall had assigned to plaintiff
all rights to payment for services performed by plaintiff and that plaintiff possessed all right to
collect past or present benefits.

1
 Centria Home Rehab LLC v Philadelphia Indemnity Ins Co, unpublished order of the Court of
Appeals, entered March 30, 2022 (Docket No. 359371).
2
  Because defendant Auto Club Insurance Association’s claims were dismissed and is not a party
to this appeal, we will refer to Philadelphia Indemnity Insurance Company as “defendant” in this
opinion.

                                                -2-
        Defendant moved for summary disposition under MCR 2.116(C)(10), asserting that it had
paid $446,335.68 for attendant care services for Randall through February 13, 2021, the balance
claimed by plaintiff totaled $157,792.90, plaintiff’s claim to that balance arose solely from an
assignment from Randall’s mother as Randall’s caregiver and, without that assignment, plaintiff
had no cause of action against defendant for the balance. Citing McGill v Auto Ass’n of Mich, 207
Mich App 402; 526 NW2d 12 (1995), and LaMothe v Auto Club Ins Ass’n, 214 Mich App 577;
543 NW2d 42 (1996), overruled in part on other grounds by Covenant Med Ctr, Inc v State Farm
Mut Auto Ins Co, 500 Mich 191; 895 NW2d 490 (2017), defendant contended that Randall, as
assignor, had no cause of action, direct or indirect, against defendant for the balance. Thus
plaintiff, as assignee standing in the shoes of Randall, likewise had no cause of action against
defendant, and dismissal of the complaint was required as a matter of law.

        In its motion, defendant contended that under McGill and LaMothe, an insured cannot
suffer damages from a dispute regarding a balance due for medical care or expenses because an
insurer is obligated to defend and indemnify its insured in the event the insured is sued by a
provider for an outstanding balance. Defendant contended that a provider that is dissatisfied with
an insurer’s payment has no cause of action against the insurer; rather, it must sue the insured.
Thus, because an assignee acquires only the rights possessed by the assignor, Randall could not
assign a claim against defendant. Defendant also contended that any claims for payment for
services provided before March 2, 2019, were precluded by MCL500.3145(1), which limits
recovery of benefits to one year before commencement of the action and that plaintiff’s claims for
payment for services provided after January 5, 2020, the date of the assignment, were precluded
by MCL 500.3143, which provides that “an agreement for assignment of a right to benefits payable
in the future is void.”

        In plaintiff’s response to defendant’s motion for summary disposition, plaintiff admitted
that defendant had paid a portion of its charges, but denied that the hourly rate proposed by
defendant was reasonable. Plaintiff also denied that its claims were based solely on the assignment
of rights, and contended it had a statutory direct cause of action against defendant under MCL
500.3112, part of the July 2019 amendment of the no-fault act. Plaintiff disputed defendant’s
reliance on McGill, asserting that McGill was factually distinguishable from this case. Plaintiff
also discounted defendant’s reliance on LaMothe, asserting that both decisions had concluded that
the insured had not “incurred” the provider’s charge.

        Addressing defendant’s argument regarding the one-year-back rule, plaintiff stated that it
was not seeking payment for services provided before March 2, 2019. Responding to defendant’s
contention that claims were precluded for services provided after the date of the assignment,
plaintiff explained that it was not only requesting payment of PIP benefits under the assignment
of rights, but also under MCL 500.3112, which took effect on June 11, 2019, and created an
independent right for medical providers to claim PIP benefits from insurers.

        After the parties submitted their briefs but before the court issued a decision, the parties
attended facilitation. The facilitator, serving as a special case evaluation panel pursuant to the trial
court’s amended scheduling order, issued an award of $35,000 in favor of plaintiff. Defendant
accepted the award but plaintiff rejected it.

                                                  -3-
        Foregoing oral argument pursuant to MCR 2.119(E)(3), the trial court issued an opinion
and order granting summary disposition in favor of defendant. The trial court agreed with
defendant that, under McGill and LaMothe, Randall had no cause of action against defendant for
the balance due and, therefore, could not assign any cause of action to plaintiff. The trial court
also agreed that plaintiff’s challenge to the reasonableness of the rate paid by defendant must be
asserted in a suit against Randall, in which defendant would be obligated to defend and indemnify
him. Thus, the trial court granted defendant’s motion for summary disposition and dismissed
plaintiff’s complaint.

        Plaintiff subsequently moved for reconsideration under MCR 2.119(F)(3), repeating its
attempt to distinguish McGill on the ground that plaintiff had taken action to collect the balance
due by initiating this action, unlike the plaintiffs in McGill, and contending that Randall would
suffer injury to his credit rating if plaintiff is required to file suit against him for the balance due.
Citing Auto-Owners Ins Co v Compass Healthcare PLC, 326 Mich App 595; 928 NW2d 726
(2018), plaintiff contended that the reasonableness of a provider’s charges is an issue of fact
requiring presentation of evidence at trial. The trial court denied the motion as untimely, also
noting that the motion presented “the same issues as ruled on by the Court, either expressly or by
implication, and rests on legal theories and facts which could have been pled or argued prior to the
Court’s decision.”

        Defendant subsequently filed a motion for case evaluation sanctions, asserting that it had
accepted the facilitator’s case evaluation award, but plaintiff had rejected it. Thus, because the
trial court had granted defendant’s motion for summary disposition and dismissed plaintiff’s
complaint, defendant was entitled to an award of its actual costs, including a reasonable attorney
fee, for services necessitated by plaintiff’s rejection of the award under MCR 2.403(O).

        Plaintiff opposed defendant’s motion, first asserting the complaint was erroneously
dismissed because Michigan law had changed following the release of this Court’s opinion in Mich
Institute of Pain & Headache, PC v State Farm Mut Automobile Ins Co, unpublished per curiam
opinion of the Court of Appeals, issued June 24, 2021 (Docket No. 353033). Second, plaintiff
asserted that the motion for sanctions should be denied in the interest of justice under MCR
2.403(O)(11), contending that Michigan law was “unsettled” at the time the trial court had granted
summary disposition in favor of defendant, but had since been resolved in plaintiff’s favor by this
Court’s decision in Mich Institute of Pain. Finally, plaintiff asserted that the award sought by
defendant was excessive and requested an evidentiary hearing if the trial court was inclined to
grant defendant’s motion.

        One day after entry of the trial court’s order denying plaintiff’s motion for reconsideration,
plaintiff filed a second motion for relief from the trial court’s order granting summary disposition,
asserting that the recently-released decision of this Court in Mich Institute of Pain controlled this
issue and that McGill and LaMothe did not apply to this case because, unlike those cases, in this
case, as in Mich Institute of Pain, the insured had executed an assignment of rights to the provider.
Plaintiff sought relief under MCR 2.604(A), contending that fewer than all claims had been
adjudicated by the order granting summary disposition because defendant’s motion for case
evaluation sanctions had not been decided. Plaintiff also sought relief under MCR 2.612(C)(1),
contending that the trial court had misapplied the law and “it would be in the interest of justice to
correct that error without the time and expense of an appeal.” The trial court denied the motion.

                                                  -4-
        At the hearing on defendant’s motion for case evaluation sanctions, defendant disputed
plaintiff’s contention that the caselaw was unsettled, asserting that McGill and LaMothe were
binding precedent, but Mich Institute of Pain was an unpublished decision, was not binding on the
trial court, and was decided after the trial court granted the motion for summary disposition.
Defendant also asserted that no evidentiary hearing was necessary because defendant had provided
sufficient evidence supporting its request for costs and attorney fees. However, the trial court
explained that it was required to determine the reasonable attorney fee, which required further
analysis. Plaintiff repeated its argument that McGill and LaMothe were distinguishable from this
case, asserted that an award of sanctions was discretionary, and argued that an evidentiary hearing
was necessary. The trial court expressed some agreement with plaintiff’s position, noting changes
in caselaw since LaMothe and stating that “realignment of this jurisprudence is inevitable.” The
court ultimately found that the reasonable rate for defendant’s counsel ranged from $175 to $180
and, applying the factors outlined in Smith v Khouri, 481 Mich 519; 751 NW2d 472 (2008), the
court awarded case evaluation sanctions to defendant in the amount of $9,312.80.

       These appeals followed.

                                 II. STANDARDS OF REVIEW

        A trial court’s decision on a motion for summary disposition under MCR 2.116(C)(10) is
reviewed de novo. Johnson v Recca, 492 Mich 169, 173; 821 NW2d 520 (2012). Summary
disposition is proper “when there is no genuine issue regarding any material fact and the moving
party is entitled to judgment or partial judgment as a matter of law.” Pioneer State Mut Ins Co v
Dells, 301 Mich App 368, 377; 836 NW2d 257 (2013). “A trial court may grant a motion for
summary disposition under MCR 2.116(C)(10) if the pleadings, affidavits, and other documentary
evidence, when viewed in a light most favorable to the nonmovant, show that there is no genuine
issue with respect to any material fact.” Id.

        A trial court’s decision to grant or deny evaluation sanctions is generally reviewed de novo;
however, a trial court’s decision whether to apply the “interest of justice” exception is reviewed
for an abuse of discretion. Harbour v Correctional Med Servs, Inc, 266 Mich App 452, 465; 702
NW2d 671 (2005). “An abuse of discretion occurs when the decision results in an outcome falling
outside the range of principled outcomes.” Zaremba Equip, Inc v Harco Nat’l Ins Co, 302 Mich
App 7, 21; 837 NW2d 686 (2013).

                                         III. ANALYSIS

                                 A. TRIAL COURT’S RULING

        On appeal, plaintiff argues this Court’s decision in Mich Institute of Pain, in which this
Court concluded that the unpaid balances were not “balance bills” and concluded that the plaintiff
had the legal right to pursue the unpaid balance due, controls the outcome of this case. Plaintiff
contends that it pursued payment by filing the complaint in this case and, unlike McGill, the parties
dispute whether plaintiff’s charges were reasonable, which is a question for the jury. Plaintiff
argues that if defendant’s position were adopted, then any arbitrary payment by the insurer would
require the provider to sue the insured injured person directly, which contravenes the purpose of
the no-fault act.

                                                -5-
        In response, defendant contends that plaintiff lacked standing as Randall’s assignee to
pursue balance bills from defendant. Defendant suggests that Mich Institute of Pain is not
persuasive because it was released after the trial court granted summary disposition in favor of
defendant, is an unpublished decision and is not binding precedent, and does not provide a
convincing basis to reverse the trial court’s ruling in this case. According to defendant, under
Michigan law, insured individuals have no cause of action against their insurers until the insured
suffers an injury as a result of an underpayment. Thus, defendant contends that Randall had no
cause of action and he could not assign a right he did not possess.

        Under MCL 500.3107(1)(a), PIP benefits are payable for “[a]llowable expenses consisting
of reasonable charges incurred for reasonably necessary products, services and accommodations
for an injured person’s care, recovery, or rehabilitation.” A healthcare provider that renders
treatment for an accidental bodily injury covered by personal protection insurance may charge a
reasonable amount for such treatment. MCL 500.3157(1). Effective June 11, 2019, under MCL
500.3112, a healthcare provider “may make a claim and assert a direct cause of action against an
insurer . . . to recover overdue benefits payable for charges for products, services, or
accommodations provided to an injured person.” However, this applies only “to products,
services, or accommodations provided after the effective date of this amendatory act.” 2019 PA
21, enacting § 1.

        In this case, the trial court granted defendant’s motion largely in reliance on McGill and
LaMothe, concluding that “[u]nder Michigan law, a patient cannot sue his no-fault insurer to
recover the unpaid balance on charges by medical providers that the insurer has determined to be
excessive or unreasonable.” The trial court explained that, under both McGill and LaMothe,
defendant was obligated to defend and indemnify Randall in the event that plaintiff sued him to
collect the balance due. Thus, the trial court concluded, because plaintiff never sued Randall,
Randall had no cause of action against defendant to recover the balance due. Without a cause of
action, Randall could not assign any cause of action to plaintiff. The trial court also concluded
that plaintiff had no direct cause of action against defendant to recover the balance due because
any dispute regarding the reasonableness of a healthcare provider’s charges must be resolved
between the provider and the insured, rather than the provider and the insurer.

        In McGill, the six plaintiffs incurred hospital and medical treatment expenses as a result of
separate automobile accidents. McGill, 207 Mich App at 404. The defendants, their insurers,
declined to pay the amounts billed by various healthcare providers, deeming the amounts billed
unreasonable. Id. The plaintiffs sued their insurers as a class, claiming to be at risk of being sued
by their healthcare providers and seeking declaratory and injunctive relief, as well as an order
compelling the insurers to pay the amounts billed by the healthcare providers. Id. Notably,
however, the health care providers themselves never pursued a claim against any party that the
charges were unreasonable. Id. The insurers assured the court, in their pleadings and in open
court, that they would defend and indemnify the plaintiffs in the event the plaintiffs were sued by
their healthcare providers and would also attempt to protect the plaintiffs’ credit ratings if the
healthcare providers pursued collection activities. Id. Thus, the trial court granted summary
disposition in favor of the insurers, concluding that the plaintiffs had not suffered pecuniary injury.
Id. at 404-405.

                                                 -6-
        On appeal, this Court affirmed. Observing that the no-fault act limits an insurer’s liability
to charges that are reasonable and prohibits a healthcare provider from charging more than a
reasonable fee, this Court explained that, “in theory, the insureds could be sued for the difference
between what the carrier will pay and what the provider demands, but it is unlikely that the insureds
would be liable for those expenses.” Id. at 406. In addition, noting that the insurers had expressly
stated that they would defend and indemnify the plaintiffs if sued by their healthcare providers,
and that the record revealed no evidence that the plaintiffs had suffered any real or threatened
injury, this Court explained that the trial court lacked subject-matter jurisdiction to enter a
declaratory judgment because the alleged injuries were merely hypothetical and concluded the trial
court properly granted summary disposition in favor of the insurers. Id. at 407.

       In LaMothe, issued one year after McGill, this Court found McGill “dispositive.” LaMothe,
214 Mich App at 581. In that case, the plaintiff’s insurer conducted an audit, determined that a
portion of the healthcare provider’s charges were unreasonable, and refused to pay that portion of
the charges. The plaintiff filed suit against the insurer, alleging, in part, breach of the insurance
contract. Id. at 579. The trial court granted summary disposition in favor of the insurer under
MCR 2.116(C)(10), concluding the plaintiff did not submit sufficient proof of damages to create
a genuine issue of material fact, and under MCR 2.116(C)(8), concluding the plaintiff did not state
a claim for breach of contract. Id. at 579-580.

        This Court affirmed, concluding first that the defendant had not refused to pay healthcare
benefits to the plaintiff, but instead “had paid and continues to pay those charges reasonably
incurred for reasonably necessary products, services, and accommodations for plaintiff’s care.”
Id. at 581. The Court also determined that the plaintiff had suffered no damages because “the
insurer has agreed to fully defend and indemnify the insured from liability services priced in excess
of what the insurer considers to be reasonable and customary.” Id. at 583. The Court observed
that a healthcare provider was unlikely to sue an insured for an amount in excess of a reasonable
fee because “such a suit, freighted with the burden of seeking the unreasonable, would in all
probability be unsuccessful.” Id. at 585.

         For its part, plaintiff contends that resolution of this case is not controlled by McGill or
LaMothe, but is instead controlled by this Court’s unpublished decision in Mich Institute of Pain.
In that case, the plaintiff provided medical services to the insured, who executed an assignment of
rights each time the plaintiff provided a service. Mich Institute of Pain, unpub op at 1. The
plaintiff submitted its bills to the defendant-insurer, which submitted only partial payments on the
basis of its assessment of the reasonableness of the plaintiff’s charges. Id. The plaintiff then filed
suit, as assignee of the insured, seeking the difference between its charges and the amount paid by
the defendant. Id. at 2. The defendant moved for partial summary disposition, contending that the
insured could not have sued his insurer because he had not suffered any loss or damages as he had
not been sued for payment of the balance; therefore, the plaintiff, as the insured’s assignee,
likewise had no cause of action. Id. The trial court agreed, dismissing the plaintiff’s claim for the
unpaid balance. Id.

        This Court reversed, explaining that in Covenant, the Michigan Supreme Court held that
the claim for payment of PIP benefits belongs to the insured, not to the healthcare provider, but
also noted that its decision did not impair the ability of the insured to assign the right to past or
presently due benefits to the provider. Mich Institute of Pain, unpub op at 2-3. This Court rejected

                                                 -7-
the defendant’s claim that the insured had not incurred any expenses because he had not been sued
by the provider, explaining that the insured had incurred the charges for healthcare services at the
time the services were rendered. Id. at 3. Thus, the Court concluded that under the no-fault act,
the insured was entitled to have his reasonable medical expenses paid by his insurer and assigned
that right to his healthcare provider. Id. In reaching this conclusion, this Court distinguished both
McGill and LaMothe, noting that neither case involved an assignment of rights; instead, in both
cases, the insureds themselves had sued their insurers. Mich Institute of Pain, unpub op at 3. In
addition, in neither case had the healthcare providers challenged the partial payments; therefore,
“the insureds in both cases had no legal reason to contest the partial payments.” Id.

        Because Mich Institute of Pain is an unpublished decision, it is not binding on this Court,
MCR 7.215(C), and plaintiff’s contention that this unpublished decision “controls” the resolution
of this issue is not well founded. Although unpublished decisions of this Court are not binding,
MCR 7.215(J)(1), the reasoning in an unpublished decision may be adopted as persuasive.
Glasker-Davis v Auvenshine, 333 Mich App 222, 232 n 4; 964 NW2d 809 (2020). Here, we find
the reasoning of Mich Institute of Pain to be persuasive and we adopt it. Crucially, unlike in both
McGill and LaMothe, plaintiff objected to defendant’s partial payments and the trial court made
no finding regarding the reasonableness of defendant’s payments. In addition, unlike in both
McGill and LaMothe, the insured assigned his rights to payment of the PIP benefits to plaintiff,
his healthcare provider. This case is also distinguishable on the ground that in both McGill and
LaMothe, this Court found significant the fact that the insurers had expressly agreed to defend and
indemnify the insured in the event of a suit by the healthcare provider. See McGill, 207 Mich App
at 406-407; LaMothe, 214 Mich App at 580-581. However, in this case, defendant has provided
no evidence of any agreement to defend and indemnify Randall, although this Court is skeptical
of such an arrangement even if such promises were made.

        As the Court reasoned in Mich Institute of Pain, an insured incurs charges for health care
services at the time the services are rendered. See Covenant, 500 Mich at 207 (“[C]harges for
healthcare are incurred by others, most commonly patients, and those patients are the ones who
become liable for payment of those charges”); Community Resource Consultants, Inc v
Progressive Mich Ins Co, 480 Mich 1097, 1098; 745 NW2d 123 (2008) (“Generally, one becomes
liable for the payment of services once those services have been rendered.”). Once those charges
are incurred, the insured becomes liable to pay them. Thus, when the insured assigns their rights
under the no-fault act to the health care provider, the insured assigns the right to “have the
reasonable medical expenses [the insured] incurred for healthcare services provided by [the
provider] paid by [the insurer].” Mich Institute of Pain, unpub op at 3, citing Covenant, 500 Mich
at 217 n 40. Similarly, when a health care provider has a direct cause of action under MCL
500.3112, it may sue directly to “recover overdue benefits payable for charges for products,
services, or accommodations provided to an injured person.”

       The fact that there is a genuine dispute, at this stage of the litigation, regarding whether the
payments made by defendant were reasonable, is the key distinguishing factor in this case from
those cited by defendant. In Auto-Owners Ins Co v Compass Healthcare PLC, 326 Mich App
595, 608-609; 928 NW2d 726 (2018), we held that a health care provider may not seek
reimbursement against the insured under a contractual liability theory. To do so would be
“contrary to the purpose of the no-fault act, and its implications would allow medical providers to
circumvent the protective nature of the act.” Id. at 611. Thus, under Compass Healthcare, the

                                                 -8-
only circumstance in which a health care provider could pursue an insured would be under the no-
fault act, which itself would require a dispute over whether the charges were reasonable.

        In such a dispute, even assuming the insurer indemnifies and defends the insured, what is
the insured’s position supposed to be? Does the insured have any interest in the outcome, since
the insurer will purportedly indemnify them? What would prevent the insured from simply
admitting to the allegations in the complaint to short circuit the process and end the litigation to
save everyone the time and expense? See Flowers v Wilson, unpublished per curiam opinion of
the Court of Appeals, issued September 22, 2022 (Docket No. 354436 (Swartzle, J., concurring),
at 3 (“If the insured patient believes that the unpaid bill was for a necessary service reasonably
priced, and that patient admits this in her answer to a provider’s lawsuit against her, will the insurer
then accept the admission and cover the bill in full?”). Or would the insured be forced to adopt
the insurer’s position in exchange for indemnification? What happens if the insurer refuses to
offer indemnification?

        It is evident that the implications of a ruling in defendant’s favor are fraught with peril and
uncertainty. Moreover, the formalism insisted on by defendant would be contrary to the purpose
of the no-fault act, which is to “provid[e] assured, adequate, and prompt recovery for economic
loss arising from motor vehicle accidents.” Adanalic v Harco Nat’l Ins Co, 309 Mich App 173,
197; 870 NW2d 731 (2015). By recognizing a health care provider’s ability to bring a claim
against an insurer for the difference between what was billed and what was paid, claims concerning
these amounts will be most efficiently litigated by the parties with the pecuniary interest at stake.
On the other hand, by insisting that a health care provider sue its patient and have the insurer
defend and indemnify, the interests in the litigation become misaligned and the costs and expenses
to all parties only increase.

        Not deterred, defendant advances three alternative grounds to affirm the trial court’s order.3
First, defendant contends that plaintiff’s claim for PIP benefits is barred because plaintiff
submitted fraudulent billing statements. This argument lacks merit. The no-fault act does not
include fraud as a defense to PIP coverage, Meemic Ins Co v Fortson, 506 Mich 287, 303-304; 954
NW2d 115 (2020), although an insurer may deny a particular claim if it concludes the claim is
fraudulent. Shelton v Auto Owners Ins Co, 318 Mich App 648, 655; 899 NW2d 744 (2017).
However, we have consistently held that the element of intent required to show fraud is almost
always a question for the jury and not appropriate for summary disposition. Shelton v Auto-Owners
Ins Co, 318 Mich App 648, 658-660; 899 NW2d 744 (2017). It is not self-evident that the
purported discrepancies in the statements provided by plaintiff, which form the basis of
defendant’s fraud allegation, are the product of fraudulent intent.

       As the second alternative ground for affirming the trial court, defendant asserts that the
one-year-back rule, MCL 500.3145(2), requires dismissal of all claims for services rendered before
March 2, 2019. This issue was raised in defendant’s motion for summary disposition and, in its
response, plaintiff asserted that it was only seeking the balance due for services rendered after

3
  An appellee may generally urge alternative grounds to affirm a trial court’s decision without
filing a cross-appeal, even if the alternative grounds were considered and rejected in the trial court.
Boardman v Dep’t of State Police, 243 Mich App 351, 358; 622 NW2d 97 (2000).

                                                  -9-
March 17, 2019. Thus, this issue is moot, as plaintiff is not seeking damages for services rendered
before March 2, 2019.

        Finally, defendant asserts that plaintiff’s claims for services provided after January 5,
2020—the date that Randall executed the assignment of rights to plaintiff—should be dismissed
pursuant to MCL 500.3143, which provides that an assignment of rights to benefits payable in the
future is void. However, the 2019 amendment to MCL 500.3112 provides that, after June 11,
2019, a healthcare provider “may make a claim and assert a direct cause of action against an
insurer . . . to recover overdue benefits payable for charges for products, services, or
accommodations provided to an injured person.” MCL 500.3112. This amendment applies “to
products, services, or accommodations provided after the effective date of this amendatory act.”
2019 PA 21, enacting § 1. Thus, plaintiff had no need for an assignment to claim payment for
services rendered after June 11, 2019.

        Because plaintiff was entitled to assert a cause of action against defendant for the balance
due, the trial court erred when it granted defendant’s motion for summary disposition. When a
health care provider, acting under an assignment of rights from an insured or under a direct cause
of action under MCL 500.3112, seeks to recover the balance due for PIP benefits from an insurer
and there is a dispute over the reasonableness of the charges, the health care provider has standing
to bring such a claim directly against the insurer. Accordingly, we reverse the trial court’s order
granting defendant’s motion for summary disposition.

                             B. CASE EVALUATION SANCTIONS

      Plaintiff contends that because the trial court erred when it granted defendant’s motion for
summary disposition, its subsequent order granting case evaluation sanctions was also erroneous.
We agree.

        At the time the trial court decided defendant’s motion for case evaluation sanctions, MCR
2.403 stated that if a party rejects a case evaluation award that was accepted by an opposing party,
the rejecting party “must pay the opposing party’s actual costs unless the verdict is more favorable
to the rejecting party than the case evaluation.” MCR 2.403(O)(1), as amended May 1, 2019.4
The definition of “verdict” included a “judgment entered as a result of a ruling on a motion after
rejection of the case evaluation.” MCR 2.403(O)(2)(c), as amended May 1, 2019. Thus, because
there is no longer a “verdict” in this case as a result of this Court’s opinion, the order awarding
case evaluation is vacated. See Chouman v Home Owners Ins Co, 293 Mich App 434, 444-445;
810 NW2d 88 (2011).

4
  Effective January 1, 2022, MCR 2.403 was amended and Subrule (O), the provision authorizing
case evaluation sanctions, was deleted. MCR 2.403, as amended January 1, 2022, 508 Mich clxiii.
However, when reviewing the trial court’s decision to award case evaluation sanctions, this Court
applies the court rule in effect at the time of the trial court’s decision on defendant’s motion. See
In re Guardianship of Brosamer, 328 Mich App 267, 272 n 1; 936 NW2d 870 (2019).

                                                -10-
        We reverse the trial court’s order granting defendant’s motion for summary disposition and
vacate the court’s order granting defendant’s motion for case evaluation sanctions, and remand the
case to the trial court for further proceedings consistent with this opinion. We do not retain
jurisdiction. Plaintiff, as the prevailing party, may tax costs. MCR 7.219(A).

                                                            /s/ Kirsten Frank Kelly
                                                            /s/ Christopher M. Murray
                                                            /s/ Brock A. Swartzle

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