A minor investment to investigate the facts of an accident is the difference between no-fault coverage paying versus private pay or government reimbursement.

A man was walking was walking his dog on a road.  A car and a snowmobile were approaching in opposite directions to the man and his dog.  The car had its headlight on.  The operator of the snowmobile testified that the car's headlights blinded/obstructed his vision such that he did not see the man walking his dog.  The snowmobile struck the pedestrian who sustained accidental bodily injuries.

The pedestrian had his own auto no-fault policy issued by Citizens.  Thus, Citizens was the priority insurer potentially liable to pay his medical expenses.  MCL 500.3114(1) and MCL 500.3115(1).  The man presented his medical expense claims but Citizens refused to pay arguing that the insured's accidental bodily injuries did not "arise out of the ownership, operation, maintenance or use of a motor vehicle as a motor vehicle" as contemplated by MCL 500.3105(1).  The Michigan Court of Appeals agreed with Citizens reasoning that the car's headlights were as coincidental as a setting sun that just as easily could have blinded the snowmobile operator's vision.  The Court distinguished the factual scenario presented in this case with other pedestrian/motorcycle accidents involving a motor vehicle which do trigger no-fault liability.  The Court explained that in those other cases, typically the car's involvement forced the other person/biker to change his course of travel to avoid a collision.

What this means for accident victims and medical providers.

You cannot generally apply the facts of this case to the next one that walks into your ER department because no two cases are exactly the same.  You must strictly analyze the facts of how the accident actually occurred.  Simply relying upon what a police report says or what a pedestrian/snowmobile operator/motorcyclist patient says they recall occurred does not adequately resolve the critical factual riddle.  You must take sworn statements of all persons/operators involved, probing into each their collective memory of what happened and what they each did to avoid the accident before a fully informed conclusion can be reached regarding no-fault application.  Never rely on the auto insurer's self-serving analysis.  Just because the facts did not ultimately bear out in this particular case, does not mean the next case will not.  A minor investment to investigate the facts of an accident is the difference between no-fault coverage paying versus private pay or government reimbursement.

You can read this opinion here.

Authored by L. Page Graves