PIP insurer wins battle with doctors over payment of PIP benefits after second accident
In Bahri, Nouri and Iskander v. IDS Property Casualty Insurance, two doctors appealed after summary disposition was granted to IDS, the no fault insurer of their patient. The patient was involved in a motor vehicle collision in March of 2011 and in a second collision in October. At the time of the second collision, the patient was insured with IDS.
The patient had sought payment of $20 per day during October of 2011 for household replacement services; during that period, surveillance video suggested that she was capable of "bending, lifting, driving and running errands." The insurer characterized this video as evidence of fraudulent misrepresentation and sought summary disposition of the woman's PIP claim. The Court granted the motion.
The intervening doctors appealed, seeking payment for the services they had provided after the second collision. The Court of Appeals held that the medical providers "stood in the shoes of" the injured patient, such that if she was precluded from recovery, they were as well. It noted that the original submission to IDS was for services provided from October 1 through October 20 and therefore "fraudulent," as the IDS-insured accident hadn't occurred yet. It left no room for explanation that the claim may have been the result of an innocent error in submitting the claim to the wrong insurer (the PIP insurer for the March collision).
The Court held that since the video showed Bahri performing yard work and running errands when she claimed she needed help with those and similar tasks, the Court deemed summary disposition and invalidation of the entire policy--appropriate, regardless of any explanation that the woman might offer.