After Titan refused to pay PIP benefits based on Mr. Sheridan's alleged misrepresentations, he sued.

Titan moved for summary disposition, arguing that his omissions and false statements constituted fraudulent insurance acts and, therefore, that he was ineligible to receive PIP benefits for his claim.

In response, Mr. Sheridan contended that he was confused by the questions in the application for PIP benefits, that he did not believe his prior medical conditions were relevant to the injuries he sustained in the accident, and that he may have mistakenly put the wrong dates on the attendant care forms. Therefore, he argued, he had not committed a fraudulent insurance act.

The trial court granted Titan's motion for summary disposition, and Mr. Sheridan appealed.

The Appellate Court's Decision

The appellate court affirmed.

In its decision, the appellate court found that the record demonstrated that Mr. Sheridan presented, or caused to be presented, false written statements in support of his claim for PIP benefits. It explained that in his application for PIP benefits, Mr. Sheridan stated that he suffered injuries to his shoulders, back, neck, ribs, legs, and elbows as a result of the motor vehicle accident and that, when asked whether he had previously suffered from any of these injuries or whether he had "any medical conditions" before the accident, he answered "No" and "N/A," respectively. The appellate court pointed out, however, that hospital records revealed that, previously, Mr. Sheridan had suffered a left knee injury in a slip-and-fall accident and that he also had total knee replacement surgery.

Moreover, the appellate court added, at the same time Mr. Sheridan supposedly was receiving attendant care services, he was hospitalized for various medical conditions, including congestive heart failure, respiratory failure, pancreatitis, and other conditions – most of which were unrelated to the motor vehicle accident. The appellate court pointed out that it was "impossible" for Mr. Sheridan to be receiving attendant care services from family members at the same time he was hospitalized.

The appellate court concluded that Mr. Sheridan's "confusion" and "mistakes" regarding his claim for PIP benefits were "unavailing." It ruled that the questions on the application were "clear and unambiguous," asking: "Were you injured in the accident?" "Did you already suffer from any of these injuries before the accident?" "Please list any medical conditions you had and/or medications you were taking before this accident." "Had you sought treatment for any prior conditions before this accident?"

The appellate court found that the record established that Mr. Sheridan both (1) knowingly omitted material information regarding his prior medical conditions in submitting his application for PIP benefits, and (2) knowingly made false, material statements regarding attendant care services he received.

Accordingly, the appellate court concluded, Mr. Sheridan's "fraudulent insurance acts" rendered him ineligible for payment of PIP benefits under the MACP, and the trial court did not err in granting Titan's motion for summary disposition on that basis.

The case is Sheridan v. Titan Ins. Co., No. 342704 (Mich. Ct. App. Sep. 10, 2019).