Litigation Blog

GENERAL FRAUD EXCLUSIONS: AN IMPOSING DEFENSE IN MICHIGAN PIP ACTIONS

Personal Injury Protection (PIP) benefits cases are on the rise in Michigan. However, with the 2014 Michigan Court of Appeals decision in Bahri v. IDS Property Cas. Ins. Co., 308 Mich. App 402; 864 NW2d 609 (2014), defendants are finding these cases defensible. [1]

The effect of the Court’s ruling in Bahri and defense reliance on general fraud exclusions found in insurance policies continue to reveal themselves.  Most recently, in Thomas v. Frankenmuth Mutual Insurance Co., COA No. 326744 (Unpublished July 12, 2016), the Court of Appeals upheld Wayne County Circuit Court Judge Sheila Ann Gibson’s dismissal of a matter on the basis of fraud.

In Thomas, the plaintiff received treatment following a July 6, 2013, motor vehicle accident. During his medical treatment, he was instructed not to drive from the date of the accident through January 21, 2014. During plaintiff’s deposition, he denied driving an automobile at any time during that period. However, surveillance revealed plaintiff driving a vehicle on two occasions, despite claiming a need for medical transportation on those dates as well.

The Court of Appeals, relying on and quoting the Bahri decision, noted that the plaintiff had the ability to explain why he was driving during his deposition. Instead, plaintiff continued to represent that he had not driven at all during the relevant time period. Plaintiff’s counsel attempted to sway the court by arguing that his client’s representations were simple mistakes. However, the court noted, “If they were not knowing misrepresentations, then they were certainly reckless ones, in the face of the proof that he drove his car at least twice on the same day he availed himself of transportation services.” Id at 3.

The Court’s recent decision in Thomas strengthens the argument that the Bahri ruling was deliberate and intentional and that its effects will continue to garner attention in the trial and appellate courts. Michigan courts continue to be increasingly weary of fraudulent representations and are willing to dismiss entire PIP claims as a result. Since incidents of fraud have been on the rise over the past several years, defense counsel finding themselves in similar actions should be willing and able to offer this defense at trial.

[1] In Bahri, Plaintiff was found to have fraudulently pursued PIP and Uninsured Motorist benefits in connection with a vehicle accident. The Court granted Defendant’s Motion for Summary Disposition which sought dismissal pursuant to the general fraud exclusion in the insurance policy.  The Court stated, “[r]easonable minds could not differ in light of this clear evidence that plaintiff made fraudulent representations for purposes of recovering PIP benefits.”