Court of Appeals Clarifies MACP Eligibility for Drivers Who Opt Out of PIP Medical Coverage
Van Heusen v Michigan Automobile Insurance Placement Facility
COA Opinion Published: October 15, 2026 (Korobkin, P.J., and Riordan and Mariani, JJ.)
COA Docket No. 373182
Washtenaw County Circuit Court
Holding: In a published opinion addressing a question of first impression, the Court of Appeals held that a person injured in a motor vehicle accident while not an occupant of a motor vehicle may not claim personal protection insurance (PIP) medical benefits through the Michigan Assigned Claims Plan (MACP) if that person has a PIP policy but opted out of PIP medical coverage. Although MCL 500.3115 directs injured nonoccupants to claim PIP benefits under the MACP, the claimant must still satisfy the eligibility requirements of the MACP statutes, MCL 500.3171 to MCL 500.3175. Because a PIP policy with a Medicare opt-out under MCL 500.3107d is still a PIP policy “applicable to the injury” under MCL 500.3172(1), plaintiff was ineligible for MACP benefits. The Court reversed the trial court’s order granting declaratory relief and judgment to plaintiff and remanded for entry of summary disposition in favor of defendant.
Facts: On December 20, 2022, plaintiff’s vehicle was rear-ended by another driver. After plaintiff and the other driver pulled over and got out to assess the damage, a third driver struck the second vehicle from behind, forcing it forward into both of them. Plaintiff suffered serious injuries, including a broken leg and a pulmonary embolism, and incurred significant medical expenses.
At the time of the accident, plaintiff and his wife had an Auto-Owners policy covering their vehicle. The policy included PIP coverage for replacement services and survivor’s loss benefits, but not medical or work-loss coverage. As the named insured, plaintiff had opted out of PIP medical coverage on the insurance selection form, certifying that he was covered under Medicare Parts A and B and that his spouse and resident relatives had qualified health coverage or other PIP medical coverage. As a result, he paid a reduced premium.
Plaintiff submitted a claim for PIP benefits to defendant, the Michigan Automobile Insurance Placement Facility (MAIPF), which administers the MACP. Defendant denied the claim because plaintiff had identifiable and applicable insurance through Auto-Owners and had elected to opt out of medical coverage. Plaintiff sued, seeking no-fault medical benefits under MCL 500.3115 as a nonoccupant, along with declaratory relief, damages, and attorney fees and costs. The trial court granted plaintiff’s motion for declaratory relief under MCR 2.605, denied defendant’s motion for summary disposition under MCR 2.116(C)(8) and (C)(10), and entered judgment for plaintiff under MCR 2.116(I)(2), concluding that plaintiff was injured as a nonoccupant, was not covered for medical expenses under his policy, and was not otherwise excluded from benefits. The Court of Appeals granted defendant leave to appeal.
Key Appellate Holdings:
A nonoccupant claiming PIP benefits through the MACP under MCL 500.3115 must independently satisfy the eligibility requirements of MCL 500.3172(1).
MCL 500.3115 provides that, “[e]xcept as provided in [MCL 500.3114(1)],” a person injured while not an occupant of a motor vehicle “shall claim personal protection insurance benefits under the assigned claims plan under [MCL 500.3171 to MCL 500.3175].” The parties disputed whether the “except” clause bars a nonoccupant named in a PIP policy from using the MACP at all. Assuming, without deciding, that it did not bar plaintiff, the Court held that he was still ineligible under the MACP statutes themselves. The Court thus left open whether the clause categorically precludes PIP-insured nonoccupants, including those who seek MACP benefits because of a dispute between insurers or an insurer’s financial inability under MCL 500.3172(1)(c) or (d).
The Court held that Steanhouse v Mich Auto Ins Placement Facility (On Remand), 351 Mich App 209; 34 NW3d 627 (2024), was controlling. In Steanhouse, although MCL 500.3114(4) provided that an uninsured occupant “shall claim” benefits through the MACP, the claimant was ineligible because his out-of-state accident did not satisfy MCL 500.3172(1). As Steanhouse explained, the MACP statutes “contain their own eligibility requirements.” Id. at 218. Applying the same analysis under MCL 500.3115, plaintiff could recover only if one of the four conditions in MCL 500.3172(1) applied: (a) no PIP insurance is applicable to the injury; (b) no applicable PIP insurance can be identified; (c) applicable PIP insurance cannot be ascertained because of a dispute between insurers; or (d) the only identifiable applicable PIP insurance is inadequate because of an insurer’s financial inability. Subsections (c) and (d) did not apply, and the Auto-Owners policy could be identified, so the question was whether that policy was “applicable to the injury.”
The Court rejected plaintiff’s argument that MCL 500.3172(1) merely lists ways a person may claim MACP benefits rather than the only ways. That argument was implicitly considered and rejected in Steanhouse, 351 Mich App at 219-221, a case plaintiff’s brief did not address or attempt to distinguish.
A PIP policy with a Medicare opt-out under MCL 500.3107d is still “a personal protection insurance policy described in [MCL 500.3101(1)]” and is therefore “applicable to the injury” under MCL 500.3172(1).
Under MCL 500.3114(1), a PIP policy described in MCL 500.3101(1) “applies to accidental bodily injury to the person named in the policy.” Plaintiff argued that because MCL 500.3101(1) begins “[e]xcept as provided in [MCL 500.3107d],” a policy with a medical opt-out is not a policy “described in” MCL 500.3101(1). The Court disagreed. The “except” clause merely acknowledges that, in specified circumstances, a PIP policy need not include “the full panoply of PIP benefits”; it does not negate the policy’s “fundamental character as a PIP policy.”
The text of MCL 500.3107d(1) supports this reading, because it permits the opt-out “[f]or an insurance policy that provides the security required under [MCL 500.3101(1)].” In other words, plaintiff did not opt out of a policy described in MCL 500.3101(1); he opted out of medical coverage in such a policy. Reading the statute otherwise would render MCL 500.3107d’s language nugatory. See Esurance Prop & Cas Ins Co v Mich Assigned Claims Plan, 507 Mich 498, 508-509; 968 NW2d 482 (2021). Reading the act as a whole, the Court also noted that plaintiff kept PIP coverage for replacement services under MCL 500.3107(1)(c) and survivor’s loss benefits under MCL 500.3108, and it found no authority to split off the medical-coverage portion of the policy from the rest. Plaintiff’s policy therefore “applies” to his injury under MCL 500.3114(1) and is “personal protection insurance applicable to the injury” under MCL 500.3172(1)(a) and (b), which makes him ineligible for MACP benefits. Having resolved the appeal under MCL 500.3172(1), the Court did not reach defendant’s alternative argument that plaintiff was also ineligible under MCL 500.3173.
The absence from MCL 500.3115 of the express opt-out exclusion found in MCL 500.3114(4) does not make nonoccupant opt-outers eligible for MACP benefits.
MCL 500.3114(4), which governs injured occupants, expressly states that it “does not apply to a person insured under a policy for which the person named in the policy has elected to not maintain coverage for personal protection insurance benefits under section 3107d . . . .” MCL 500.3115 contains no similar language. Plaintiff argued that this omission shows the Legislature intended to let opt-outers injured as nonoccupants claim MACP benefits. The Court acknowledged that the argument had “some persuasive value” under the canon that the Legislature acts intentionally when it includes language in one section but omits it from another. But canons are merely general “rules of thumb” that “should not be used mechanically.” People v Pinkney, 501 Mich 259, 285 n 63; 912 NW2d 535 (2018); Milne v Robinson, 513 Mich 1, 12; 6 NW3d 40 (2024).
Two considerations outweighed the canon here. First, Steanhouse binds the Court to examine whether a claimant satisfies MCL 500.3172(1), even when another section says the person “shall claim” MACP benefits. Second, the two statutes are not truly comparable. MCL 500.3114(4) applies to an occupant “who is not covered” under a PIP policy, and a medical opt-outer could appear to fit that phrase, so the Legislature needed express language to keep occupant opt-outers out of the MACP. MCL 500.3115 contains no “not covered” language, and MCL 500.3172(1) does the work of limiting eligibility.
The Court added that its reading is consistent with the purposes of the 2019 no-fault reforms, which prioritize “personal choice in insurance policies” and were intended to “control the cost of automobile insurance.” Mary Free Bed Rehab Hosp v Esurance Prop & Cas Ins Co, ___ Mich App ___; ___ NW3d ___ (2026) (Docket No. 370846); slip op at 12, lv gtd ___ Mich ___ (2026) (Docket No. 169926); West Mich Home Care Servs, Inc v Meemic Ins Co, ___ Mich App ___; ___ NW3d ___ (2025) (Docket No. 369151); slip op at 3, quoting Andary v USAA Cas Ins Co, 512 Mich 207, 214; 1 NW3d 186 (2023). Allowing a person who opted out of medical coverage in exchange for a lower premium to then obtain that coverage through the MACP would undercut those goals. And because the opt-out is available only to those with qualified health coverage, and the MACP remains an insurer of last resort, the holding is also consistent with the act’s aim of ensuring that most accident victims have some form of medical coverage.
