THE INSURANCE CODE OF 1956
Act 218 of 1956
500.3173a Eligibility for benefits; initial determination; denial; notice; false statement.
Sec. 3173a.
(1) The Michigan automobile insurance placement facility shall review a claim for personal protection insurance benefits under the assigned claims plan, shall make an initial determination of the eligibility for benefits under this chapter and the assigned claims plan, and shall deny a claim that the Michigan automobile insurance placement facility determines is ineligible under this chapter or the assigned claims plan. If a claimant or person making a claim through or on behalf of a claimant fails to cooperate with the Michigan automobile insurance placement facility as required by subsection (2), the Michigan automobile insurance placement facility shall suspend benefits to the claimant under the assigned claims plan. A suspension under this subsection is not an irrevocable denial of benefits, and must continue only until the Michigan automobile insurance placement facility determines that the claimant or person making a claim through or on behalf of a claimant cooperates or resumes cooperation with the Michigan automobile insurance placement facility. The Michigan automobile insurance placement facility shall promptly notify in writing the claimant and any person that submitted a claim through or on behalf of a claimant of a denial and the reasons for the denial.
(2) A claimant or a person making a claim through or on behalf of a claimant shall cooperate with the Michigan automobile insurance placement facility in its determination of eligibility and the settlement or defense of any claim or suit, including, but not limited to, submitting to an examination under oath and compliance with sections 3151 to 3153. There is a rebuttable presumption that a person has satisfied the duty to cooperate under this section if all of the following apply:
(a) The person submitted a claim for personal protection insurance benefits under the assigned claims plan by submitting to the Michigan automobile insurance placement facility a complete application on a form provided by the Michigan automobile insurance placement facility in accordance with the assigned claims plan.
(b) The person provided reasonable proof of loss under the assigned claims plan as described in section 3172.
(c) If required under this subsection to submit to an examination under oath, the person submitted to the examination, subject to all of the following:
(i) The person was provided at least 21 days' notice of the examination.
(ii) The examination was conducted in a location reasonably convenient for the person.
(iii) Any reasonable request by the person to reschedule the date, time, or location of the examination was accommodated.
(3) The Michigan automobile insurance placement facility may perform its functions and responsibilities under this section and the assigned claims plan directly or through an insurer assigned by the Michigan automobile insurance placement facility to administer the claim on behalf of the Michigan automobile insurance placement facility. The assignment of a claim by the Michigan automobile insurance placement facility to an insurer is not a determination of eligibility under this chapter or the assigned claims plan, and a claim assigned to an insurer by the Michigan automobile insurance placement facility may later be denied if the claim is not eligible under this chapter or the assigned claims plan.
(4) A person who presents or causes to be presented an oral or written statement, including computer-generated information, as part of or in support of a claim to the Michigan automobile insurance placement facility, or to an insurer to which the claim is assigned under the assigned claims plan, for payment or another benefit knowing that the statement contains false information concerning a fact or thing material to the claim commits a fraudulent insurance act under section 4503 that is subject to the penalties imposed under section 4511. A claim that contains or is supported by a fraudulent insurance act as described in this subsection is ineligible for payment of personal protection insurance benefits under the assigned claims plan.
(5) The Michigan automobile insurance placement facility may contract with other persons for all or a portion of the goods and services necessary for operating and maintaining the assigned claims plan.
History: Add. 1984, Act 426, Eff. Mar. 29, 1985 ;-- Am. 2012, Act 204, Eff. Sept. 1, 2012 ;-- Am. 2019, Act 21, Imd. Eff. June 11, 2019
Compiler's Notes:
Enacting section 1 of Act 204 of 2012 provides:
"Enacting section 1. Sections 3172, 3173a, 3174, and 3175 of the insurance code of 1956, 1956 PA 218, MCL 500.3172, 500.3173a, 500.3174, and 500.3175, as amended by this amendatory act, take effect on the date the assigned claims plan is approved by the insurance commissioner under section 3171(3) of the insurance code of 1956, 1956 PA 218, MCL 500.3171."
PopularName Notes:
Act 218
PopularName Notes:
Essential Insurance
PopularName Notes:
No-Fault Insurance
Notes of Decisions
Bronson Health Care Grp. Inc v. Titan Ins. Co., 887 N.W.2d 205 (Mich. Ct. App. 2016).
“3 MCL 500.3173a(l) requires the “Michigan automobile insurance placement facility [to] make an initial determination of a claimant’s eligibility for benefits under the assigned claims plan,” and unless the claimant is obviously ineligible, MCL 500.”
Gividen v. Bristol West Ins., 305 Mich. App. 639 (Mich. Ct. App. 2014).
“” MCL 500.3173a. And as ACIA argued on appeal, it mistakenly paid no-fault benefits before learning that the Jeep had been modified to the extent that it was no longer designed for operation on a public highway.”
Orlando Scott v. Michigan Auto. Ins. Placement Facility (Mich. Ct. App. 2022).
· cites it 32× “Northland asserted that defendants waived the fraud defense by failing to state the circumstances of fraud with particularity because they merely made general statements in their affirmative defenses that Scott’s claims may be barred by MCL 500.”
Est. of Charles Williamson v. Aaa of Michigan (Mich. Ct. App. 2022).
· cites it 27× “The trial court entered an order concluding that the Estate “committed a fraudulent insurance act by knowingly presenting material misrepresentations in support of its claim for no-fault benefits,” and therefore the Estate was “ineligible for payment or benefits pursuant to MCL…”
Russell Loiola v. Citizens Ins. Co. of Am. (Mich. Ct. App. 2020).
· cites it 20× “Finally, Citizens maintained that Loiola was disqualified from receiving personal protection insurance (PIP) benefits under MCL 500.3173a(2) because he made, or caused to be made, false statements in support of a claim for benefits under the MACP.”
Alfonzo Washington v. Nationwide Mut. Fire Ins. Co. (Mich. Ct. App. 2025).
· cites it 19× “24, blank” in violation of MCL 500.3173a. The trial court granted Nationwide partial summary disposition and dismissed plaintiff’s claims regarding the second accident, whereupon plaintiff filed a claim of appeal.”
Reginald Lee Mapp v. Allstate Ins. Co. (Mich. Ct. App. 2021).
· cites it 18× “Defendant moved for summary disposition, arguing that plaintiff and HealthCall committed a “fraudulent insurance act” under MCL 500.3173a of the no-fault act. Specifically, defendant argued that the surveillance showed that Mapp did not require 24-hour attendant care because he…”
Ronnie Fields v. Nat'l Gen. Ins. Co. (Mich. Ct. App. 2023).
· cites it 17× “” MCL 500.3173a governs the initial determination of eligibility for benefits through the MAIPF, and more specifically, MCL 500.”
20231130_C362230_36_362230.Opn.Pdf (Mich. Ct. App. 2023).
· cites it 17× “A claim that contains or is supported by a fraudulent insurance act as described in this subsection is ineligible for payment of personal protection insurance benefits under the assigned claims plan.”
Elijah Woody v. Auto Club Ins. Ass'n (Mich. Ct. App. 2020).
· cites it 16× “Furthermore, plaintiff’s argument that answers to interrogatories can be amended is immaterial to the question whether plaintiff committed a fraudulent misrepresentation under MCL 500.3173a, because he did not, in fact, attempt to amend his answers at any point in the…”
— Mich. Comp. Laws § 500.3173a(1) — 17 cases
— Mich. Comp. Laws § 500.3173a(2) — 37 cases
Orlando Scott v. Michigan Auto. Ins. Placement Facility (Mich. Ct. App. 2022).
“Northland asserted that defendants waived the fraud defense by failing to state the circumstances of fraud with particularity because they merely made general statements in their affirmative defenses that Scott’s claims may be barred by MCL 500.”
Russell Loiola v. Citizens Ins. Co. of Am. (Mich. Ct. App. 2020).
“Finally, Citizens maintained that Loiola was disqualified from receiving personal protection insurance (PIP) benefits under MCL 500.3173a(2) because he made, or caused to be made, false statements in support of a claim for benefits under the MACP.”
Elijah Woody v. Auto Club Ins. Ass'n (Mich. Ct. App. 2020).
“Furthermore, plaintiff’s argument that answers to interrogatories can be amended is immaterial to the question whether plaintiff committed a fraudulent misrepresentation under MCL 500.3173a, because he did not, in fact, attempt to amend his answers at any point in the…”
— Mich. Comp. Laws § 500.3173a(2)(a) — 1 case
— Mich. Comp. Laws § 500.3173a(2)(c) — 2 cases
— Mich. Comp. Laws § 500.3173a(3) — 2 cases
— Mich. Comp. Laws § 500.3173a(4) — 25 cases
Est. of Charles Williamson v. Aaa of Michigan (Mich. Ct. App. 2022).
“The trial court entered an order concluding that the Estate “committed a fraudulent insurance act by knowingly presenting material misrepresentations in support of its claim for no-fault benefits,” and therefore the Estate was “ineligible for payment or benefits pursuant to MCL…”
Ronnie Fields v. Nat'l Gen. Ins. Co. (Mich. Ct. App. 2023).
“” MCL 500.3173a governs the initial determination of eligibility for benefits through the MAIPF, and more specifically, MCL 500.”
Alfonzo Washington v. Nationwide Mut. Fire Ins. Co. (Mich. Ct. App. 2025).
“24, blank” in violation of MCL 500.3173a. The trial court granted Nationwide partial summary disposition and dismissed plaintiff’s claims regarding the second accident, whereupon plaintiff filed a claim of appeal.”
— Mich. Comp. Laws § 500.3173a(l) — 1 case
Bronson Health Care Grp. Inc v. Titan Ins. Co., 887 N.W.2d 205 (Mich. Ct. App. 2016).
“3 MCL 500.3173a(l) requires the “Michigan automobile insurance placement facility [to] make an initial determination of a claimant’s eligibility for benefits under the assigned claims plan,” and unless the claimant is obviously ineligible, MCL 500.”
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