Court Opinion

ID: 9717350
Source: CourtListenerOpinion
Date Created: 2023-08-26 07:02:07.612316+00
Date Added: 2024-06-11T18:23:52.742985
License: Public Domain

Ryan, J.
This case presents still another variation of the application of § 3109(1) of the no-fault insurance act.1
Section 3109(1) provides:
"Benefits provided or required to be provided under the laws of any state or the federal government shall be subtracted from the personal protection insurance benefits otherwise payable for the injury.”
The primary issue is whether a portion of the social security old-age benefits being received by the appellant is the type of governmental benefit which, under § 3109(1), must be deducted from no-fault wage-loss benefits otherwise due.
We hold, on the facts of the case, that it is not and reverse the judgment of the Court of Appeals.
I
On June 27, 1977, plaintiff Joseph W. Jarosz, then 64 years of age, was injured while riding in a motor vehicle that was struck broadside. His injuries disabled him from working as a manager for Borman Foods where he had been paid $285 per week. As a result, DAIIE, his no-fault insurer, began paying him work-loss benefits under § 3107 of the no-fault act, correctly computed at 85% of his $285 weekly salary. On November 1, 1977, after turning 65 years of age, Mr. Jarosz began mandatory retirement pursuant to company policy. At about the same time, he applied for and began receiving social security retirement benefits *570of $455.20 per month, the amount to which he was entitled as an unemployed retiree.
On March 25, 1978, after learning of Mr. Jarosz’s retirement, DAIIE terminated the payment of work-loss benefits. Shortly thereafter, Mr. Jarosz furnished the insurance company with proof that, but for the accident, he would have gone to work for Supreme Steel Company on November 1, 1977, earning $200 per week. DAIIE therefore resumed the payment of work-loss benefits, retroactive to March 26, 1978.
In September, 1978, the insurer learned that Mr. Jarosz was receiving the full social security benefits for a retiree who has no work-related income. Ordinarily, retirees over 65 years of age may work full-time and receive social security retirement benefits; however, as wages increase, benefits are reduced according to a statutory formula. The formula calls for the deduction of $1 for every $2 earned over a specified amount. See 42 USC 403(b); 20 CFR 404.401-404.467. Upon learning that Mr. Jarosz was receiving social security benefits computed for a person who was unemployed, DAIIE took the position that it was entitled to deduct from the no-fault work-loss benefits the amount by which the social security benefits would have been reduced had appellant been earning $200 a week and collecting social security benefits. Mr. Jarosz believed that no deduction was permissible and protested the insurance company’s deduction of work-loss benefits. When the dispute could not be resolved amicably, Mr. Jarosz filed suit in the circuit court. In May, 1979, DAIIE tendered a check to appellant for an amount which represented a deduction for asserted overpayment of work-loss benefits. Appellant returned the check uncashed.
*571Appellant moved for summary judgment pursuant to GCR 1963, 117.2(3), claiming that there was no genuine issue concerning the material fact that DAIIE was not entitled to deduct any amount from no-fault benefits upon the basis of the amount of social security benefits he was entitled to receive. The trial court denied the motion by letter, and on March 13, 1980, granted the defendant’s corresponding motion for summary judgment, declaring:
"[T]he defendant can take into account social security benefits received by plaintiff to the extent that plaintiff is made whole, as it is the intent of the law to put the injured party in the same position that he would have been had there been no injury.”
Mr. Jarosz appealed.
In the Court of Appeals and before this Court, the insurer argued that this case turns upon the correct interpretation and application of § 3107 which defines the meaning of "work loss” and mandates the payment of no-fault work-loss benefits. According to appellee, a correct computation of Mr. Jarosz’s "loss of income” for purposes of determining the amount of work-loss benefits due under § 3107 would reveal that his income actually increased as a result of the accident. This is so, appellee argues, because the combination of full social security benefits and no-fault work-loss benefits computed on the basis of a loss of $200 per week salary is greater than the total of $200 per week salary and the reduced social security benefits for a working retiree, which is what he would have received had he not been injured and had been working at Supreme Steel.
Since, according to DAIIE, one of the purposes of the no-fault act is to restore an injured party to *572the position in which he would have been had he not been injured, but no better position, the no-fault work-loss benefits due under § 3107 should be reduced to an amount which, when taken together with the full social security benefits appellant is receiving, would restore him to the position in which he would have been had there been no accident. DAIIE claims that the financial effect upon Mr. Jarosz of reducing the no-fault benefits is identical to the result that would obtain had appellant not been injured and had been receiving social security benefits in the reduced amount to which he would have been entitled if he had earned wages of $200 per week.
The Court of Appeals preferred to rest its analysis and decision upon § 3109(1), but concluded that the insurer’s proposed result was correct: DAIIE was entitled under § 3109(1) to subtract from the no-fault work-loss benefits otherwise due an amount equal to the portion of social security benefits representing the differential described above because that amount duplicated the no-fault work-loss benefits.2
We granted appellant’s application for leave to appeal.3
Like the Court of Appeals, we think this litigation is correctly analyzed under § 3109(1) of the no-fault act and not § 3107. Nevertheless, in Part III, we will address DAIIE’s § 3107 theory.
II
While, we have not considered a case involving facts precisely duplicating those presented by this case, resolution of the legal problem, as we per*573ceive it, does not require us to navigate entirely uncharted waters. We have considered the application of § 3109(1) in other factual settings,4 and in each case we have been required, as we are here, to determine whether governmental benefits of various kinds must be deducted from no-fault personal protection income benefits otherwise due. To repeat, § 3109(1) provides:
"Benefits provided or required to be provided under the laws of any state or the federal government shall be subtracted from the personal protection insurance benefits otherwise payable for the injury.”
The specific question we are required to decide in this case is whether the social security old-age benefits Mr. Jarosz is receiving are the kind of governmental benefits the Legislature intended to be subtracted from no-fault benefits. In answering that question, we take this occasion to delineate a standard or test by which such benefits may be identified in future cases.
A
Certainly not all "[b]enefits provided or required to be provided under the laws of any state or the federal government” must be subtracted from no-fault personal protection insurance benefits otherwise due. Some governmental benefits bear no relationship whatever to no-fault benefits or to the reason no-fault benefits are paid. Benefits bearing *574no such relationship are not subject to setoff. Our task is to find a formula by which governmental benefits which are required to be set off under § 3109(1) can be distinguished from those which are not. The task was begun in O’Donnell v State Farm Mutual Automobile Ins Co, 404 Mich 524; 273 NW2d 829 (1979). We agree with the Court of Appeals and the parties before us today that O’Donnell established the analytical framework from which the standard we seek may be derived. In O’Donnell, as in this case, we were confronted with claims that a setoff of governmental benefits against no-fault benefits violated the Equal Protection and Due Process Clauses of the state and federal constitutions.5 In O’Donnell, social security survivors’ benefits were involved; here, old-age retirement benefits are involved. We held that social security survivors’ benefits were properly deductible from no-fault survivors’ benefits under § 3109(1). We were led to that conclusion by a two-step analytical approach: first, we determined whether social security survivors’ benefits were the kind of "[bjenefits provided or required to be provided under the laws of any state or the federal government” that the Legislature declared must be subtracted from no-fault benefits under § 3109(1). Second, having decided that they were, we determined whether the legislatively mandated subtraction was constitutional.
In making the first determination in O’Donnell, p 544, we observed that
"[t]he history of § 3109(1) indicates that the Legislature’s intent was to require a setoff of those government benefits that duplicated the no-fault benefits payable because of the accident and thereby reduce or contain the cost of basic insurance.”
*575It was plain, we thought, that survivors’ benefits under the federal Social Security Act served substantially the same purpose as no-fault insurance survivors’ benefits. Both were meant to compensate persons dependent on the decedent-wage earner by affording them protection from the economic hardship caused by the loss of the wage earner’s support. Id., pp 545-546. In addition, they were paid as a result of the decedent’s fatal accident. It was clear that the provisions of both the no-fault and the social security plans specifically entitled the beneficiaries to payment of benefits for the same purpose upon the happening of the same event. The social security benefits were duplicative of the no-fault survivors’ benefits and thus clearly were subject to setoff under § 3109(1).
The second issue in O’Donnell, the constitutionality of § 3109(1), resulted in a determination of the law’s validity because, we concluded, the legislative purpose of reducing or containing the cost of no-fault insurance was a matter of legitimate governmental interest and the means chosen, a setoff of duplicate government benefits, was rationally related to that goal. This constitutional standard, that legislation enacted pursuant to the police power bear a rational relationship to a permissible legislative objective, is essentially the same for due process and equal protection analyses. Shavers v Attorney General, 402 Mich 554, 612-613; 267 NW2d 72 (1978). Measured against this requirement, we held the setoff of social security survivors’ benefits against no-fault survivors’ benefits to be constitutional.
Our decision in O’Donnell, which we specifically confined to its own facts,6 provided, therefore, a framework for determining the kinds of govern*576mental benefits which must be subtracted from no-fault benefits under § 3109(1), but did not purport to announce a specific standard or test for application to other kinds of governmental benefits. While our vision down the litigation tunnel is not limitless, we will delineate that standard today in order to enable bench, bar, insurers, and our citizens to predict with greater certainty the financial effect of coordinated no-fault benefits under § 3109(1).
Despite the self-limiting reach of the decision announced in O’Donnell, we have cited it as authority for the method by which it is to be determined whether other governmental benefits are within the ambit of § 3109(1).7 The parties in this case agree as to the application of O’Donnell’s very generalized standard; they disagree about how it is to be particularized for their case.
Appellant argues that the correct application of § 3109(1) will result in a subtraction of governmental benefits from no-fault benefits when two threshold requirements are met: 1) the state or federal benefits are provided or required to be provided "as a result of the same accident”, and 2) they "duplicate in varying degrees the no-fault benefits due”.
DAIIE, on the other hand, contends that the proper analysis requires only the one-step determination whether the state or federal benefits duplicate the no-fault benefits and argues that in O’Donnell the fact that the social security benefits and no-fault benefits were paid on account of the same accident was not the application of a separate criterion, but only an indication that the benefits were duplicative.8 DAIIE declares:
*577"Contrary to the assertions of plaintiff, it is duplication of benefits, not the event which triggers payment, which is the focus of the analysis of the social security benefits in O’Donnell. This Court repeatedly emphasized that § 3109(1) was intended to avoid duplication of benefits and thus to enable insurers to keep premiums low without harm to beneficiaries. O’Donnell, supra, pp 544-546, 547-549. The fact that the benefits at issue in O’Donnell were paid as a result of the same accident which resulted in payment of PIP benefits is nothing more than an indication that the benefits are duplicative. It is not a separate criterion for application of § 3109(1).” (Emphasis in original.)
We agree with DAIIE’s response that the keystone of the correct analysis is whether the benefits are duplicative. However, to complete the analysis, more is required.
B
We conclude that the correct test is: state or federal benefits "provided or required to be provided” must be deducted from no-fault benefits under § 3109(1) if they:
1) Serve the same purpose as the no-fault benefits,9 and
2) Are provided or are required to be provided as a result of the same accident.
*578Some confusion may have been engendered by two statements we made in O’Donnell which at first reading may appear to conflict. The first statement comports with the two-step formulation proposed by appellant, and the second more nearly replicates the test we have announced today.
In O’Donnell, p 538, we said:
"We conclude that § 3109(1) does require a setoff of these government benefits but is not arbitrary because the benefits are paid as a result of the same accident and duplicate in varying degrees the no-fault benefits otherwise due.”
However, we also said:
"The survivors’ benefits received pursuant to § 202 of the Social Security Act were likewise paid as a result of the decedent’s fatal accident and served substantially the same purpose as the no-fault benefits”. Id., p 545.
In isolating the first of the foregoing statements as a correct statement of the test for application of § 3109(1) in other governmental benefit cases, the appellant was mistaken. That statement was concerned with the issue of the constitutionality of the setoff of social security survivors’ benefits against no-fault survivors’ benefits and not with establishing a standard for determining whether the social security benefits in O’Donnell fell within the scope of § 3109(1), as the second statement was. In O’Donnell, which was explicitly limited to its facts, the duplicative nature of social security survivors’ benefits and no-fault survivors’ benefits was obvious. We were not primarily concerned, in the first of the quoted statements concerning constitutionality, with enunciating a test for determining the range of comparable benefits covered *579by § 3109(1). The test we have formulated today follows, therefore, the analysis we employed in O’Donnell in the second statement quoted above and applied in subsequent cases:
"In the leading case concerning § 3109(1), O’Donnell v State Farm Mutual Automobile Ins Co, 404 Mich 524; 273 NW2d 829 (1979) * * * [w]e observed that government benefits provided as a result of the same accident for which no-fault benefits are also payable, and which serve the same purpose as no-fault benefits, are within the scope of § 3109(1)”. LeBlanc v State Farm Mutual Automobile Ins Co, 410 Mich 173, 190; 301 NW2d 775 (1981). See O’Donnell, p 545.
See also Citizens Ins Co of America v Tuttle, 411 Mich 536, 551, fn 9; 309 NW2d 174 (1981); Mathis v Interstate Motor Freight System, 408 Mich 164, 187, fn 7; 289 NW2d 708 (1980).
At the risk of belaboring the point, still another word might be in order to further clarify the standard we announce today and, in the process, to bring a heightened measure of certainty and predictability to the application of this difficult area of no-fault law.
In examining our decisions in O’Donnell, Mathis, and LeBlanc, it appears that we may have used the word "duplicate”, and its adjectival form duplicative, somewhat imprecisely in an effort to characterize the kind of governmental benefits that must be subtracted from no-fault benefits under § 3109(1). We have said, for example, that such benefits are "paid as a result of the same accident and duplicate in varying degrees the no-fault benefits otherwise due”. Mathis, supra. Actually, it is more accurate to conceptualize duplicate benefits as those which satisfy both elements of today’s two-pronged test: 1) benefits which serve *580the same purpose as no-fault benefits, and 2) benefits which are provided or required to be provided as a result of the same accident. If both criteria are met, the governmental benefit can be said to be duplicative and thus subject to setoff under § 3109(1).10
In every case, in order to determine whether the governmental and no-fault benefits serve the same purpose (criterion 1), a particularized assessment of the questioned governmental benefit is necessary to identify the ultimate beneficiary, the nature of the benefits, the reason for paying them, and the events triggering entitlement to them. If an inappropriately generalized notion of purpose or legislative intent is used, it might be concluded that almost any governmental benefit can be seen as duplicating no-fault benefits. For example, at first glance, social security old-age benefits can be seen as a substitute for wages which would otherwise be earned, just as no-fault work-loss benefits are a substitute for wages which would have been earned, and, therefore, both benefits appear to satisfy the first prong of our two-pronged test: benefits which serve the same purpose. More careful analysis reveals, however, that social security old-age benefits are meant to be a substitute for wages earned, but age, usually the age of the beneficiary, triggers payment and identifies the eligible person. No-fault work-loss benefits, on the other hand, are a substitute for wages which a *581person actually would have earned but for an automobile accident. Clearly, since the occurrence of an accident is totally irrelevant to Congress’ social security old-age benefits plan, the legislative purpose or intent regarding the identity of beneficiaries as well as the triggering event for payment of old-age benefits differs from that underlying no-fault work-loss benefits.
Similarly, the fact that benefits are paid as a result of the same accident (criterion 2) is a characteristic of duplicate benefits. To the extent that DAIIE contends that benefits can be duplicative and not paid as a result of the same accident, we disagree. In reality, if benefits are duplicative, then they are paid as a result of the same accident. But the converse is not necessarily true. Put another way, if benefits are not paid as a result of the same accident, they are not duplicative.
To some extent, this second criterion (benefits required to be provided as a result of the same accident) of the two-part test overlaps the first criterion (serving the same purpose). That is inevitable and it is because both are characteristics of duplicative benefits.
Still, we find that application of the two-part test is useful, partly because the event triggering payment is easily verifiable. Moreover, the fact that one can determine easily whether benefits are not paid as a result of the same accident provides a quick, accurate method of determining if benefits are not duplicative. In such a case, further analysis of certain benefits thus becomes unnecessary.
Determining whether benefits are paid as a result of the same accident seems self-explanatory. Yet, we will elaborate in order to clarify any misconceptions.
For benefits to be duplicative under the standard *582we have announced today, substantially equivalent qualifications and provisions would have to exist. In other words, the federal or state law that provides the governmental benefits or requires them to be provided must specifically base payment of benefits upon the happening of an event, and an automobile accident must qualify as such an event.
This is not to say that federal or state statutes must be identical to no-fault provisions in every way, but they must be substantially the same, at least in the triggering mechanism for payment. For purposes of the second criterion of our two-part test, the benefits received must be contingent upon the occurrence of the same automobile accident.
C
Applying our two-part test to the facts of this case, we find that the amount in dispute — the difference between what the plaintiff is now receiving and what he would have been paid had he been receiving reduced social security benefits together with wages from Supreme Steel — may not be set off against no-fault work-loss benefits otherwise due. The challenged payment fails both portions of the test. First, this differential amount, although arguably serving the same general purpose as no-fault benefits, the prevention of hardship due to lost wages, does not serve the same particular purpose as work-loss no-fault benefits. The differential payment challenged in this case was not made because the plaintiff was disabled from work and thereby suffered work loss. It was made because the plaintiff did not have additional income in excess of the statutory limit. For purposes of the disputed differential payment, the *583reason why the plaintiff does not have income in excess of the statutory limit is irrelevant; any reason is sufficient and a disabling injury causing work loss is not required. Therefore, the particular purpose served by the differential amount is not the same as the purpose served by the no-fault work-loss benefits. Second, the triggering event for the challenged differential payment is not the disabling automobile accident which triggers the no-fault work-loss payment. Instead, the triggering event for the challenged differential amount is the plaintiff’s age.11 The challenged differential benefit is not "provided or required to be provided” because the plaintiff is disabled; it is only "provided or required to be provided” to persons who have reached 65 years of age. Therefore, the triggering event is not a disabling automobile accident causing work loss; the triggering event is the plaintiff’s age. Even assuming that, but for the accident, the plaintiff would not have received the disputed amount, the accident is not the triggering event since the accident alone will not precipitate payment of the disputed benefit. The disputed payments are made only if the plaintiff does not have outside income in excess of the statutory limits, for whatever reason, and the plaintiff has reached 65 *584years of age. Therefore, it is the confluence of purpose and triggering event which demonstrates that the governmental benefits in question fail to meet the two parts of the O’Donnell test as we have restated it today. Therefore, the challenged benefits do not duplicate no-fault work-loss benefits.
Ill
DAIIE’s primary argument is that Mr. Jarosz’s social security benefits must be considered in determining the amount of loss of income as a result of the accident, for the purpose of determining no-fault "work loss” benefits under MCL 500.3107; MSA 24.13107.
DAIIE’s innovative analytical approach to this case, offered for the first time in the Court of Appeals and repeated before this Court in oral argument, is that "§ 3109 never comes into play here”. Instead, the insurer argues, Mr. Jarosz’s social security benefits must be considered in determining the amount of loss of income that resulted from the accident for the purpose of determining the amount of no-fault work-loss benefits due under § 3107. According to DAIIE, because of Mr. Jarosz’s social security benefits, he is actually receiving, together with his no-fault work-loss benefits, more money than he would be receiving if he were working at Supreme Steel and collecting reduced social security benefits. Consequently, DAIIE asserts, Mr. Jarosz has no actual loss of income as a result of the accident. Thus, his work-loss benefits should be reduced until the combination of benefits equals what he would have been receiving if he were working.
What DAIIE fails to recognize is that work-loss *585benefits are paid for loss of income from loss of work. Section 3107 provides:
"Personal protection insurance benefits are payable for the following:
"(b) Work loss consisting of income from work an injured person would have performed during the first 3 years after the date of the accident if he had not been injured”.
Social security old-age benefits may arguably be income, but they are not income from work. The fact that Mr. Jarosz has income in the form of social security old-age benefits does not, in any way, vitiate the fact that he has lost income from work.
We find that the manifest intent of the Legislature was to define "work loss” under § 3107 as income loss attributable solely to the inability to work without regard to non-work-related sources of income. To the extent that the Legislature shares DAIIE’s concern that an insured should not be financially better off not working after an accident than while working before the accident, it has addressed the subject in § 3109 and has provided for the coordination and setoff of certain kinds of benefits according to the formula we have discussed.
The decision of the Court of Appeals is reversed and the trial court’s summary judgment for the appellee is vacated. Summary judgment for the appellant on the issue whether appellee is entitled to set off social security benefits against no-fault work-loss payments is granted. The case is remanded to the circuit court for proceedings consistent with this opinion.
*586Williams, C.J., and Cavanagh and Boyle, JJ., concurred with Ryan, J.

 MCL 500.3101 et seq.; MSA 24.13101 et seq.

 109 Mich App 86; 310 NW2d 903 (1981).

 414 Mich 872 (1982).

 O'Donnell v State Farm Mutual Automobile Ins Co, 404 Mich 524; 273 NW2d 829 (1979) (social security survivors’ benefits) app dis 444 US 803; 100 S Ct 22; 62 L Ed 2d 16 (1979); Mathis v Interstate Motor Freight System, 408 Mich 164; 289 NW2d 708 (1980) (worker compensation benefits); LeBlanc v State Farm Mutual Automobile Ins Co, 410 Mich 173; 301 NW2d 775 (1981), reh den 411 Mich 1119; 306 NW2d 311 (1981).

 US Const, Am XIV; Const 1963, art 1, §§ 2, 17.

 O’Donnell, supra, p 538, fn 5.

 See LeBlanc v State Farm Mutual Automobile Ins Co, 410 Mich 173, 190; 301 NW2d 775 (1981); Mathis v Interstate Motor Freight System, 408 Mich 164, 187; 289 NW2d 708 (1980).

 As indicated, appellee’s theory in this case is that "§ 3109(1) never *577comes into play here”, that the case merely concerns the correct computation of the amount of loss of income under § 3107. See Part III. Appellee did respond, however, in its brief and at oral argument, to the § 3109(1) analysis of the appellant and the Court of Appeals.

 This prong of the test requires the Court to determine whether the challenged benefit payment serves the same purpose as the no-fault benefit payment. To be properly deductible under § 3109(1), the challenged benefit payment must serve the same purpose as the no-fault benefit payment. It is not sufficient that the challenged benefit payment has the same effect as the no-fault benefit payment; it must have the same purpose. It is the purpose, not the effect, which the Court considers in determining whether or not the challenged benefit payment duplicates the no-fault benefit payment.

 The goal of any test for offsetting benefits under § 3109(1) is to determine whether the challenged benefit payment "duplicates” the no-fault benefit payment. Both elements of this two-pronged analysis directly test whether the challenged benefits duplicate the no-fault benefits. As this Court has held in other cases, benefits which do not duplicate no-fault benefits are not to be set off under § 3109(1). A finding that the challenged benefit payment does not duplicate the no-fault benefit is not altered by a finding that the claimant is placed ultimately in a "better financial position”.

 It is Justice Levin’s view that the benefits are payable because of the automobile accident and not just because the claimant is over 65 years of age. While we agree that the benefits are not payable solely because the claimant is over 65 years of age and that the payments would be reduced if the claimant were earning in excess of an established amount, we do not agree that the reason for the payment is the claimant’s automobile accident. Rather, the reason for the payment is the fact that the claimant does not earn in excess of the federally established maximum. Whether the claimant does not earn more than the federally established maximum because of a disability or because of a choice to be fully retired is not relevant in determining the amount of the claimant’s payments. The only relevant factor is that the claimant does not earn in excess of the federally established maximum. Therefore, the "reason” for the payment is not the disability; it is the fact that the claimant earns less than the federally established maximum.