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Michigan No-Fault Insurance Claim Denied After Victim Failed To Present Evidence of Injury

Posted on Aug 21, 2012

In Akaazua v. Titan, un-published opinion per curiam of the Court of Appeals decided October 11, 2011, (Docket No. 298384) Plain-tiff was injured in an April 21, 2008 car accident when he “clunked” heads with a fellow passenger. Titan, as plaintiff’s no-fault insurance provider paid medical costs expenses of plaintiff until October 21, 2008, when plaintiff’s own doctors concluded that he either was purposefully exaggerating the extent of his injury or was suffering from an unknown and unrelated psychological malady.

The trial court dismissed plaintiff’s first-party no-fault action, finding that after October 21, 2008, his claimed injuries lacked any connection to the motor vehicle accident. The Plaintiff appealed. MCL 500.3105(1) of the Michigan No-Fault Act pro-vides that “[u]nder personal protection insurance an insurer is liable to pay benefits for accidental bodily injury arising out of the ownership, operation, maintenance or use of a motor vehicle as a motor vehicle.” (Emphasis added.) MCL 500.3107(1), in turn, provides for the payment of “allowable expenses” in connection with the insured’s accidental bodily injury in Michigan car accident.

The causation element has been described as “more than incidental, fortuitous, or ‘but for.’” In this case, the Court found that the entirety of the evidence, including the reports of plaintiff’s own doctors, establishes that plaintiff did not have any injury “arising out of” or caused by the car accident. Immediately following the motor vehicle accident, plaintiff was transported to the emergency room by ambulance.

Plaintiff complained of head and neck pain, but the examining physician saw no signs of trauma and CT scans were normal. Based solely on plaintiff’s subjective complaints, the doctor noted a possible concussion and a cervical sprain, but released plaintiff without restrictions. During subsequent appointments, plaintiff’s primary care physician noted that he was uncooperative with testing. When the doctor tried to conduct a neuromuscular examination, plaintiff refused to exert any physical effort, thereby exaggerating his weakness.

Over a year after the accident, plaintiff continued to exaggerate symptoms during examinations but behaved in a normal manner in the doctor’s presence both before and after the exam. Plaintiff subsequently began evaluation and treatment at Mary Free Bed. The intake evaluation noted that the Plaintiff “exhibited cognitive problems that were way out of proportion to the mild nature of his injury, especially since he was injured about 5 months ago.”

There were numerous other examples cited by the Court of Plaintiff fabricating and exaggerating his symptoms. Based on the foregoing, the Court held that the trial court did not engage in improper fact finding or credibility assessments. Rather, all the evidence, when viewed in the light most favorable to plaintiff, showed that plaintiff had no signs of injury which was caused by the motor vehicle accident.

Lawrence J. Buckfire
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