A recent Michigan Court of Appeals case upheld the award of attorney’s fees in a No-Fault Insurance case.  The case was tried before a jury by Daniel Buckfire and the appeal was written by Thomas Economy, both members of the law firm of Buckfire & Buckfire, P.C.In Tillman v. State Farm, unpublished opinion per curiam of the Court of Appeals, decided January 24, 2008 [Docket No.  271702].  Our client suffered a torn rotator cuff and other injuries in a West Bloomfield, Michigan car accident.  Her own insurance company at the time was State Farm Insurance Company.

State Farm refused to pay for medical expenses and loss wages due to the rotator cuff tears in the Plaintiff’s right and left shoulders. State Farm claimed that the injuries were not related to the accident.   Our firm sued State Farm on behalf of Ms. Tillman. At trial, Daniel Buckfire obtained a verdict in favor of the Plaintiff in the amount of $39,552.00 (plus interest and costs) for medical expenses, wage loss benefits an no-fault penalty interest. Following trial, the court awarded the Plaintiff an additional $30,250.00 in penalty attorney fees under § 3148 of the No-Fault Act. State Farm appealed the decision arguing that the denial of Plaintiff’s No-Fault benefits was not unreasonable because there was a “bona fide dispute” as to the nature and extent of the Plaintiff’s injures. Thomas Economy handled the case on appeal for the Plaintiff.            

The Court of Appeals held that the trial court was correct when it awarded the Plaintiff attorney fees under MCL 500.3148 of the Michigan No-Fault Act (MCL 500.3101 et seq.)  The Court disagreed with the Defendant, and found that State Farm did not attempt to resolve the contradictory opinions of Plaintiff’s doctors and the doctors hired by State Farm to examine the Plaintiff. 

In addition, the Court held that it was improper for an insurer to deny coverage when the insurer knew, or should have known, that the opinion of its doctors was based on an inaccurate or incomplete review of plaintiff’s medical records, which were also in the insurer’s possession. Further, the Court noted that State Farm’s adjuster made no effort to reconcile the conflicting medical reports in plaintiff’s records. Moreover, at trial, defendant’s adjuster demonstrated a very limited understanding of plaintiff’s medical condition, including how and where rotator cuff injuries occur or how they are diagnosed. Based on the forgoing, the Court found that State Farm acted unreasonably when it denied Plaintiff’s no-fault benefits.

This case is a perfect example of an insurance company accepting premiums and issuing a policy, but then refusing to pay the benefits that were promised in the policy.  The award of attorney’s fees is necessary in these cases because the insurance companies would have nothing to lose by denying every claim if they could not be penalized for improperly denying claims.

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