Michigan Court of Appeals Rules in Favor of Novara Law Insurance Client

Novara Law is pleased to announce a favorable opinion from the Michigan Court of Appeals (COA) for an insurance client. An alleged fraudulent insurance claim of forged referrals submitted to the MACP by the Plaintiff was in question.

The COA agreed with Partner Kaitlyn Cramer’s burden of proof argument, confirming Plaintiff did not satisfy their burden of proof for a Motion for Summary Disposition that they did not know the claim was a forgery and upon review of the evidence, no reasonable mind could conclude that Plaintiff hadn’t forged the referral. Cramer had satisfied the client’s burden by producing an affidavit and referrals in other cases, ultimately saving the client nearly $45,000 on the bill in question. 

Under the Motion at issue, the Court had to consider the Supreme Court’s recent decision in Williamson v AAA, which confirmed that an insurer assigned by the MACP can still file a Motion for Summary Disposition based on a fraudulent insurance claim, even if that "claim" is made after litigation is filed. Prior opinions issued by the Court of Appeals had attempted to distinguish between claims submitted before litigation and discovery submitted during litigation, holding that anything submitted in litigation was not a demand for payment, and therefore, could not be a fraudulent insurance claim. The Court’s opinion in Cramer’s case confirms there is no such distinction in cases involving the MACP. Discovery documents that contain referrals, prescriptions, or other information regarding the medical expenses at issue are indeed a "claim."

Link to Opinion: https://www.courts.michigan.gov/siteassets/case-documents/uploads/OPINIONS/FINAL/COA/20241008_C367770_33_367770.opn.pdf