VHS of Michigan v. MAIPF 

August 7, 2026
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seva firm

VHS of Michigan v. MAIPF: Court of Appeals Affirms That the Rebuttable Presumption Under MCL 500.3107c(3) Applies When an Insured Selects the $50,000 PIP Option Without Meeting Medicaid Eligibility

By Pratheep Sevanthinathan, Esq. The Seva Law Firm

Case: VHS of Michigan, Inc. v. Michigan Automobile Insurance Placement Facility, No. 375886 (Mich. Ct. App. August 7, 2026) (Unpublished)

Court: Michigan Court of Appeals

Panel: Ackerman, P.J., and Bazzi and Lievense, JJ.

Decision: Affirmed — Per Curiam

Lower Court: Wayne Circuit Court, Case No. 22-001462-NF

Read the full opinion here

  1. Introduction

The Michigan Court of Appeals has once again addressed the interplay between the no-fault PIP coverage selection provisions and the rebuttable presumption under MCL 500.3107c(3). In VHS of Michigan v. MAIPF, the Court affirmed the trial court’s grant of summary disposition in favor of USA Underwriters Insurance Company, holding that the law-of-the-case doctrine required adherence to the prior ruling in Downer v. USA Underwriters (2024), and that USA’s affidavit was sufficient to establish the rebuttable presumption that the premium paid corresponded to the $50,000 PIP coverage level. This decision is part of a growing line of cases interpreting the 2019 no-fault reforms and their impact on PIP coverage limits — an area of law that directly affects how much medical providers and injured individuals can recover after an automobile accident.

  1. Facts

On March 16, 2021, Angerica L. Downer applied for a no-fault automobile insurance policy from USA Underwriters Insurance Company (USA). On her application, Downer checked “No” when asked whether her driver’s license had been suspended or revoked in the past three years — a false statement, as her license had been suspended from October 2018 to December 2018. Downer also selected the $50,000 PIP coverage option under MCL 500.3107c(1)(a), but this option is only available to individuals enrolled in Medicaid. Downer was not enrolled in Medicaid at the time of her application. USA issued the policy without discovering either error.

On May 12, 2021, Downer was injured in an automobile accident with another driver, Nakaylin Ashburn. The Detroit Medical Center (DMC), operated by plaintiff VHS of Michigan, Inc., treated Downer for her injuries and submitted bills to USA for reimbursement under Downer’s no-fault policy. After USA discovered Downer’s prior license suspension and her lack of Medicaid enrollment, it rescinded the policy ab initio on July 16, 2021.

Downer sued USA, Ashburn, and the Michigan Automobile Insurance Placement Facility (MAIPF). DMC brought a separate provider’s action under MCL 500.3112(1), and the cases were consolidated. The central dispute became the applicable PIP coverage limit: DMC argued that because Downer was ineligible for the $50,000 option, the selection was ineffective, and the policy should provide unlimited PIP benefits under MCL 500.3107c(4). USA argued that the rebuttable presumption under MCL 500.3107c(3) applied — meaning the premium Downer actually paid should determine the coverage level.

In the prior appeal, the Court of Appeals in Downer v. USA Underwriters (2024) sided with USA on the legal issue, holding that MCL 500.3107c(3) does apply when an insured makes an ineffective selection, but remanded because USA had not yet submitted a sufficient affidavit to establish the presumption. On remand, USA submitted an affidavit from underwriting specialist Takara Thompkins, detailing Downer’s premium payments and comparing them to the premiums that would have applied at higher coverage levels. The trial court found the presumption established and granted summary disposition to USA. DMC appealed again.

  1. Issues

Two primary issues were before the Court:

  1. Whether the rebuttable presumption under MCL 500.3107c(3) applies when an insured selects the $50,000 PIP coverage limit without meeting the Medicaid eligibility requirement — an issue DMC sought to relitigate in light of the Court’s subsequent decision in Northland Radiology, Inc. v. Allstate Fire and Casualty Insurance Co. (2026).
  2. Whether USA’s affidavit from Takara Thompkins was legally sufficient under MCR 2.119(B)(1) to establish the rebuttable presumption that the premium paid corresponded to the $50,000 coverage level.
  3. Holding

The Court of Appeals affirmed the trial court on both issues.

On the applicability of MCL 500.3107c(3), the law-of-the-case doctrine controlled. The Court held that the prior Downer decision had already resolved the question of whether the rebuttable presumption applies when an insured makes an ineffective PIP selection. DMC’s attempt to relitigate this issue — by arguing that the subsequent Northland Radiology decision undermined the Downer holding — was rejected. The Court explained that Northland Radiology addressed a different statutory provision (MCL 500.3107d, which governs opting out of PIP benefits entirely) and expressly recognized that MCL 500.3107c contains a rebuttable presumption in Subsection (3) that is absent from MCL 500.3107d. As the Court noted, “The Legislature could have included similar language in MCL 500.3107d, but it did not.” The two cases addressed distinct statutory questions, and Northland Radiology did not undermine the Downer holding.

On the sufficiency of the affidavit, the Court found Thompkins’s affidavit adequate. DMC challenged the affidavit on the ground that Thompkins did not expressly state it was based on “personal knowledge” as required by MCR 2.119(B)(1). The Court disagreed. Thompkins identified herself as a USA underwriting specialist assigned to review Downer’s application and payment history. Her statements regarding those matters “logically flowed from the review she was assigned to conduct, making it apparent that the affidavit was based on her personal knowledge.” Thompkins affirmed under penalty of perjury that her statements were true, and the affidavit was supported by attached exhibits including Downer’s insurance application, her Medicaid card, payment receipts, and a quote calculator reflecting premium amounts for each PIP coverage level. The Court concluded that “this evidence sufficiently connects the dots between the amount of the premium paid and the selection of limited PIP coverage.”

  1. Conclusion

The Court of Appeals affirmed the trial court’s grant of summary disposition in favor of USA Underwriters on the PIP policy-limit issue. Under the law-of-the-case doctrine, the rebuttable presumption of MCL 500.3107c(3) applies when an insured makes an ineffective PIP selection, and USA’s affidavit was sufficient to establish that presumption. The $50,000 coverage limit stands.

  1. What Does This Mean for Our Clients?

This decision has important implications for anyone injured in a car accident in Michigan — especially those dealing with PIP coverage disputes under the 2019 no-fault reforms.

The $50,000 PIP coverage limit can stick even if the insured was ineligible to select it. This is the most significant takeaway. Under the rebuttable presumption in MCL 500.3107c(3), if an insured selects the $50,000 PIP option (which requires Medicaid enrollment) but is not actually enrolled in Medicaid, the coverage does not automatically jump to unlimited benefits. Instead, the insurer can invoke the rebuttable presumption by showing that the premium paid corresponds to the $50,000 level. If the insured paid a $50,000-level premium, the court will presume that is the applicable coverage — unless the injured party or medical provider can rebut that presumption.

This creates a significant gap in coverage for injured people. If you were in an accident and your insurer issued you a $50,000 PIP policy that you were not eligible for, you may be stuck with only $50,000 in medical coverage — far less than what your treatment may cost. This is true even though the insurer’s own failure to verify your Medicaid status contributed to the problem. The Court of Appeals has now repeatedly held that the consequences of an improper selection fall on the insured, not the insurer.

Medical providers face real limitations. For providers like DMC that treat auto accident patients, this line of cases means that the amount recoverable from the no-fault insurer may be capped at $50,000 even when the insured should never have been offered that option. Providers need to be aware of the coverage level on a patient’s policy early in treatment and plan accordingly.

The rebuttable presumption is not automatic — it can be challenged. While the presumption is powerful, it is rebuttable. Under Bronson Health Care Group, Inc. v. Esurance (2023), the insurer must affirmatively establish the presumption through admissible evidence, including documentation connecting the premium paid to the coverage level selected. If the insurer’s evidence is insufficient — as it was in the first Downer appeal — the presumption fails, and unlimited coverage under MCL 500.3107c(4) would apply. Injured individuals and their attorneys should scrutinize the insurer’s evidence carefully.

Review your PIP coverage selection carefully. If you are purchasing auto insurance in Michigan, make sure you understand the coverage level you are selecting and that you are eligible for it. If you selected the $50,000 option but are not enrolled in Medicaid, you may face serious consequences if you are ever in an accident. Contact an attorney to review your policy and options.

If you have been injured in an automobile accident and are facing a coverage dispute, a claim denial, or a fight with your insurer over PIP benefits, contact The Seva Law Firm. We stay on top of the latest developments in Michigan no-fault law to give our clients every advantage.

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.