Court applies recent limiting Supreme Court decisions to longstanding PIP dispute with Farmers Insurance over "integrated" care needs
Roland and Janis Prendushi sued Farmers Insurance Exchange to recover some of their attendant care and housing expenses relating to the catastrophic injuries suffered by Roland's wife (Janis's mother). Mrs. Prendushi suffered traumatic brain and spinal cord injuries in a 1999 wreck and is a quadriplegic. The current lawsuit is the fourth by the Prendushis, attempting to hold Farmers to its No Fault statutory obligations. The last previous lawsuit resulted in a case evaluation of $630,000.00 for the Prendushis which Farmers accepted and paid.
In the instant action, the parties disagreed about how much attendant care was appropriate, the rate at which it should be paid, and whether or not some or all of their apartment rental should be included in PIP benefits. The trial judge had denied Farmers' motions for summary disposition and to exclude evidence, and Farmers appealed. The appellate court ruled that since neither Farmers nor the family had properly documented their summary disposition arguments, that aspect of the case must be returned to the lower court. It then attempted to provide guidance for the trial judge's future decision-making.
The judges ruled that the rate that husband and father should be paid for services is determined by the specialized skills they were applying--not by their own certification or lack thereof. Thus, if they have been taught and are now rendering highly specialized care, the value of that care is the market value professionals would charge to provide it--regardless of the family's professional licensure or certification.
The Court also discussed the distinction which the Republican, insurance-oriented Michigan Supreme Court majority drew in recent decisions that have rejected longstanding PIP obligations for food and transportation services. It noted that if the family was living in space that "integrated" care needs for the patient, the rental cost must be paid in full. If, on the other hand, the victim's special needs were addressed by accommodations that were merely "combined" with the ordinary needs of life, the insurer is obligated to reimburse only the injury accommodation expenses. The Court deemed the record from the trial court inadequate to answer this question in the instant case.
There has been a longstanding disagreement among judges with regard to whether the "integrated/combined" distinction really draws a firm line for reference. The disagreement was best illustrated in the Admire v. Auto-Owners case, where the Republican majority reversed several decades of law and practice and held that the insurer need not cover the base cost of a van that was essential to a wheelchair- bound patient's medical transportation.