October 16, 2026
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seva firm
Van Heusen v. MAIPF: PIP Medical Opt-Out Bars Recovery Through the Assigned Claims Plan
By Pratheep Sevanthinathan, Esq. The Seva Law Firm
Case: Gary Jack Van Heusen v. Michigan Automobile Insurance Placement Facility, No. 373182 (Mich. Ct. App. Oct. 15, 2026) (Published) Court: Michigan Court of Appeals
Panel: Korobkin, P.J., and Riordan and Mariani, JJ.
Decision: Reversed and Remanded — Authored Opinion
Lower Court: Washtenaw Circuit Court, Case No. 23-001605-NF
1. Introduction
In a published decision addressing a question of first impression, the Michigan Court of Appeals held that a person who validly opts out of PIP medical coverage cannot obtain those same medical benefits from the Michigan Assigned Claims Plan merely because the person was injured as a nonoccupant of a motor vehicle. In Van Heusen v. Michigan Automobile Insurance Placement Facility, the Court ruled that the plaintiff’s Auto-Owners policy remained personal protection insurance “applicable to the injury” even though he had selected the Medicare opt-out and carried no PIP medical coverage. Because identifiable and applicable PIP insurance existed, the plaintiff did not satisfy the Assigned Claims Plan eligibility requirements in MCL 500.3172(1).
The decision is important for Michigan motorists considering a PIP medical opt-out. It confirms that an insured generally cannot pay a reduced premium by declining PIP medical coverage and later turn to the Assigned Claims Plan for medical benefits after an accident.
2. Facts
On December 20, 2022, Gary Jack Van Heusen and his wife were traveling in their Honda CRV when another driver rear-ended them. The drivers pulled into the right lane and exited their vehicles to inspect the damage. A third vehicle then struck the car behind Van Heusen, forcing that vehicle forward into Van Heusen and the other driver. Van Heusen suffered serious injuries, including a broken leg and a pulmonary embolism, and incurred substantial medical expenses.
At the time of the accident, Van Heusen was the named insured on an Auto-Owners policy covering the Honda. He had Medicare Parts A and B and had elected under MCL 500.3107d to opt out of PIP medical coverage. His policy still provided other PIP benefits, including replacement-services and survivor’s-loss coverage, but it did not provide medical or work-loss coverage. The opt-out reduced his insurance premium.
Van Heusen sought PIP medical benefits from the Michigan Assigned Claims Plan. The Michigan Automobile Insurance Placement Facility, which administers the Plan, denied the claim because Van Heusen had identifiable and applicable no-fault insurance and had chosen to opt out of medical coverage.
Van Heusen sued. The Washtenaw Circuit Court held that, because he was standing outside the vehicles when injured, MCL 500.3115 allowed him to seek PIP benefits through the Assigned Claims Plan. The trial court granted declaratory relief to Van Heusen and denied the MAIPF’s motion for summary disposition. The MAIPF appealed.
3. Issues
The central issue was whether a person injured in a motor-vehicle accident while not occupying a motor vehicle may recover PIP medical benefits through the Michigan Assigned Claims Plan when that person has an identifiable no-fault policy but voluntarily opted out of PIP medical coverage based on Medicare eligibility.
The case required the Court to read several interconnected provisions of the no-fault act together: the nonoccupant priority provision in MCL 500.3115, the general priority rule in MCL 500.3114(1), the Medicare opt-out in MCL 500.3107d, and the independent eligibility requirements for Assigned Claims Plan benefits in MCL 500.3172(1).
4. Holding
The Court of Appeals reversed and held that Van Heusen was not eligible for PIP medical benefits through the Assigned Claims Plan.
First, the Court explained that MCL 500.3115 does not by itself establish eligibility for Assigned Claims Plan benefits. Although that statute says a qualifying nonoccupant “shall claim” benefits under the Plan, it expressly points to MCL 500.3171 through MCL 500.3175. Those provisions contain their own eligibility requirements. Relying on Steanhouse v. Michigan Automobile Insurance Placement Facility (On Remand), 351 Mich App 209 (2024), the Court held that a claimant must independently satisfy MCL 500.3172(1).
Second, the Court held that Van Heusen’s Auto-Owners policy was identifiable and “applicable to the injury” under MCL 500.3172(1). A lawful Medicare opt-out removes PIP medical coverage from a no-fault policy; it does not transform the policy into something other than a PIP policy. Van Heusen remained the named insured under a policy described in MCL 500.3101(1), and the policy still included replacement-services and survivor’s-loss benefits. The Court rejected an analysis that would isolate the medical portion of the policy and ignore the policy as a whole.
Third, none of the four statutory conditions for Assigned Claims Plan eligibility applied. Van Heusen’s policy could be identified, it was applicable to his injury, there was no dispute between insurers preventing identification of the responsible insurer, and there was no insurer insolvency. The Plan therefore could not serve as a substitute source for the medical coverage he had elected not to purchase.
The Court acknowledged that MCL 500.3114(4), governing injured vehicle occupants, expressly excludes medical opt-outs from the Assigned Claims Plan, while MCL 500.3115 contains no identical exclusion for nonoccupants. That difference gave Van Heusen’s argument some persuasive force. Still, the Court concluded that MCL 500.3172(1)’s independent requirements controlled and limited Plan eligibility.
Finally, the Court reasoned that its interpretation was consistent with the 2019 no-fault reforms. Those reforms prioritize individual choice and allow qualifying insureds to reduce premiums by declining PIP medical coverage. Permitting a person to make that election and then collect the declined benefits from the Assigned Claims Plan would undermine that statutory choice. Because the medical opt-out is available only to people with qualified health coverage, such as Medicare, the decision also preserves the Plan’s role as an insurer of last resort.
5. Conclusion
The Court of Appeals reversed the trial court and remanded for entry of summary disposition in favor of the MAIPF. Van Heusen could not claim PIP medical benefits through the Michigan Assigned Claims Plan because his Auto-Owners no-fault policy remained identifiable and applicable to his injury despite his Medicare opt-out. The Court did not decide whether the opening “except” clause in MCL 500.3115 independently barred the claim, nor did it reach the MAIPF’s separate argument under MCL 500.3173.
Because the opinion is published, it is binding precedent unless reversed or modified by the Michigan Supreme Court.
6. What Does This Mean for Our Clients?
A PIP medical opt-out has serious consequences. If you decline PIP medical benefits because you have Medicare or other qualified health coverage, you should not expect the Assigned Claims Plan to replace the coverage you declined—even if you are struck while standing outside a vehicle.
Being a pedestrian or other nonoccupant does not automatically establish Assigned Claims Plan eligibility. MCL 500.3115 directs certain nonoccupants to the Plan, but every claimant must also satisfy the separate requirements in MCL 500.3172. The existence of an identifiable and applicable PIP policy may bar recovery through the Plan.
A policy can remain “applicable” even when it does not cover the particular benefit requested. The Court treated Van Heusen’s policy as a single PIP policy. His election to remove medical coverage did not make the entire policy inapplicable, particularly because it retained replacement-services and survivor’s-loss benefits.
Review the tradeoff before selecting lower PIP limits or opting out. Reduced premiums may come with substantial exposure after a serious crash. Medicare or health insurance may not cover every service, provider, copayment, deductible, rehabilitation need, or other expense that PIP medical coverage might pay. Coverage decisions should be made with a clear understanding of those potential gaps.
Priority and Assigned Claims Plan cases remain highly technical. The no-fault act contains layers of cross-referenced statutes, exceptions, and eligibility rules. Whether a policy is identifiable, applicable, disputed, or subject to an exclusion can determine who must pay—and whether benefits are available at all.
If you were injured in a Michigan motor vehicle accident and an insurer or the Michigan Assigned Claims Plan denied your benefits, contact The Seva Law Firm. We can evaluate the applicable policies, coverage elections, and priority statutes and help determine what benefits may still be available.
Pratheep Sevanthinathan is the owner and managing attorney of The Seva Law Firm, located at 100 W. Big Beaver Rd, Suite 500, Troy, MI 48084. He can be reached at (248) 385-5704.
This article is for informational purposes only and does not constitute legal advice. Every case is different, and past results do not guarantee future outcomes.