Merrill H. Gordon, for Ian McPherson. Garan Lucow Miller, P.C. (by James L. Borin, Daniel Saylor, and Robert D. Goldstein), for Progressive Michigan Insurance Company.
MEMORANDUM OPINION

Plaintiff developed a neurological disorder as a result of injuries sustained in a 2007 motor vehicle accident. Subsequently, in 2008, while driving a motorcycle, he experienced a seizure consistent with that disorder, lost control of the motorcycle, crashed into a parked car, and sustained a severe spinal cord injury that left him quadriplegic. Plaintiff did not assert that he was entitled to no-fault benefits for the spinal cord injury as a result of the 2008 crash. Rather, he claimed that he was entitled to no-fault benefits for the spinal cord injury as a result of the 2007 accident, asserting that the spinal cord injury “ar [ose] out of” the 2007 accident for purposes of MCL 500.3105(1). Defendant Progressive Michigan Insurance Company moved unsuccessfully for partial summary disposition in the trial court, and the Court of Appeals affirmed on leave granted. We ordered and heard oral argument on whether to grant Progressive's application for leave to appeal or take other peremptory action.

Given that there is no dispute regarding the material facts and that the parties agree that the 2007 accident involved the use of a motor vehicle as a motor vehicle and that plaintiff is entitled to personal protection insurance (PIP) benefits from Progressive for all injuries “arising out of” that accident, including the neurological disorder, the only question here is whether the spinal cord injury plaintiff suffered in the 2008 crash “ar[ose] out of” the 2007 accident for purposes of MCL 500.3105(1).

Pursuant to MCL 500.3105(1), a PIP provider is liable “to pay benefits for accidental bodily injury arising out of the ownership, operation, maintenance or use of a motor vehicle as a motor vehicle....” In Griffith v. State Farm. Mut. Auto. Ins. Co., 472 Mich. 521, 531, 697 N.W.2d 895 (2005), this Court explained this causal requirement:

[A]n insurer is liable to pay benefits for accidental bodily injury only if those injuries “aris[e] out of” or are caused by “the ownership, operation, maintenance or use of a motor vehicle....” It is not any bodily injury that triggers an insurer's liability under the no-fault act. Rather, it is only those injuries that are caused by the insured's use of a motor vehicle.
Regarding the degree of causation between the injury and the use of the motor vehicle that must be shown, this Court has established that an injury arises out of the use of a motor vehicle as a motor vehicle when “the causal connection between the injury and the use of a motor vehicle as a motor vehicle is more than incidental, fortuitous, or ‘but for.’ ” Thornton v. Allstate Ins. Co., 425 Mich. 643, 659, 391 N.W.2d 320 (1986).

In this case, the causal connection between the 2008 spinal cord injury and the 2007 accident is insufficient to satisfy the “arising out of” requirement of MCL 500.3105(1). Plaintiff did not injure his spinal cord while using the vehicle in 2007. Rather, he injured it in the 2008 motorcycle crash, which was caused by his seizure, which was caused by his neurological disorder, which was caused by his use of a motor vehicle as a motor vehicle in 2007. Under these circumstances, we believe that the 2008 injury is simply too remote and too attenuated from the earlier use of a motor vehicle to permit a finding that the causal connection between the 2008 injury and the 2007 accident “is more than incidental, fortuitous, or ‘but for.’ ” Thornton, 425 Mich. at 659, 391 N.W.2d 320.

We reject plaintiff's argument that Scott v. State Farm. Mut. Auto. Ins. Co., 278 Mich.App. 578, 751 N.W.2d 51 (2008), is relevant to this case. The Court of Appeals held in Scott that summary disposition was premature because the plaintiff had raised a genuine issue of material fact whether her hyperlipidemia occurred as a direct result of an injury she had received in an automobile accident or was attributable to other factors. That is, the issue was whether the evidence was sufficient to support a finding that the first injury caused the second injury in a direct way. In this case, plaintiff claims as fact that his spinal cord injury occurred as a result of the neurological disorder from the first accident in combination with the intervening motorcycle accident. The facts alleged by plaintiff are insufficient to support a finding that the first injury caused the second injury in any direct way. Rather, the facts alleged by plaintiff only support a finding that the first injury directly caused the second accident, which in turn caused the second injury. Thus, the second injury alleged by plaintiff is too attenuated from the first accident to permit a finding that the second injury was directly caused by the first accident. Though we are troubled by Scott's use of a causal-connection standard this Court has never recognized—that “[a]lmost any causal connection will do,” id. at 586, 751 N.W.2d 51—it is nonetheless clearly distinguishable from this case because plaintiff admits that, absent the intervening motorcycle accident, his spinal cord injury would not have occurred as a direct result of the neurological disorder.

Because plaintiff's spinal cord injury had only this limited causal connection to the use of a motor vehicle in 2007, the injury did not arise out of the use of a motor vehicle for purposes of MCL 500.3105(1). Accordingly, the trial court erred by failing to grant Progressive summary disposition on that basis, and the Court of Appeals erred by affirming that decision. In lieu of granting Progressive's application for leave to appeal, we reverse the judgment of the Court of Appeals and remand for entry of summary disposition in favor of Progressive.

YOUNG, C.J., and MARKMAN, MARY BETH KELLY, ZAHRA, and McCORMACK, JJ., concurred.

CAVANAGH, J. (dissenting).

I respectfully dissent because I believe that plaintiff is able to satisfy the requirement in MCL 500.3105(1) that his 2008 injuries “ar[ose] out of” his 2007 motor vehicle accident.

As the majority explains, there is no dispute that plaintiff's 2007 accident involved the use of a motor vehicle as a motor vehicle and that Progressive Michigan Insurance Company is statutorily obligated under MCL 500.3105(1) to provide personal protection insurance (PIP) benefits for all injuries “arising out of” that accident, including plaintiff's seizure disorder.

This Court has explained that coverage under MCL 500.3105(1) is available “only where the causal connection between the injury and the use of a motor vehicle as a motor vehicle is more than incidental, fortuitous, or ‘but for.’ ” Thornton v. Allstate Ins. Co., 425 Mich. 643, 659, 391 N.W.2d 320 (1986). Thus, the motor vehicle must be the “instrumentality” of the injury. Id. at 660, 391 N.W.2d 320.

Thornton's application is relatively straightforward when faced with an acute injury. For example, if an insured suffers a broken arm while involved in a motor vehicle accident, it is clear that the motor vehicle was the instrumentality of the broken arm because that injury occurred at the moment of the accident. Accordingly, the causal connection between the broken arm and the use of a motor vehicle as a motor vehicle is more than incidental, fortuitous, or “but for.”

Although slightly more difficult, applying Thornton's logic to some chronic injuries is also fairly straightforward. For example, if an insured suffered a kidney injury in a motor vehicle accident and, after a period of time, required a kidney transplant because of the continuing deterioration of the kidney, it is clear that the need for the transplant, although separated from the accident by time, would nevertheless constitute a progression of the injury that occurred in the accident. Accordingly, the causal connection between the need for the kidney transplant and the use of the motor vehicle as a motor vehicle would be more than incidental, fortuitous, or “but for.”

This case, however, presents a difficult issue because of the chronic, yet intermittent, nature of the injury that plaintiff suffered in the 2007 motor vehicle accident.Accordingly, in order to properly apply Thornton and MCL 500.3105(1), it is necessary to understand the nature of a seizure disorder.

According to his physician, shortly after the 2007 accident plaintiff suffered a grand mal seizure. The physician testified that “posttraumatic seizure can happen at any time. You can have head trauma today, you can have a seizure from posttrauma [sic] two days later, you can have it a year later, you can have it the rest of your life.” According to the Mayo Clinic, grand mal seizures have two phases—tonic and clonic—that exhibit different symptoms. In the tonic phase, “[l]oss of consciousness occurs, and the muscles suddenly contract and cause the person to fall down.” Mayo Clinic, Grand Mal Seizure < http:// www. mayoclinic. com/ health/ grand- mal- seizure/ DS 00222/ DSECTION = symptoms> (accessed April 2, 2013) (emphasis added). In the clonic phase, “[t]he muscles go into rhythmic contractions, alternately flexing and relaxing. Convulsions usually last for less than two minutes.” Id.

Thus, a person with a seizure disorder may go long periods without exhibiting any signs of the disorder. However, even during those nonsymptomatic periods, the person nevertheless has a seizure disorder, and in plaintiff's case, the seizure disorder arose out of the use of a motor vehicle as a motor vehicle. Unlike an insured with a kidney injury whose condition consistently and predictably worsens over time, plaintiff's injury has resulted in sudden, unpredictable symptomatic episodes. And during those sudden symptomatic episodes, plaintiff's seizure disorder causes him to unexpectedly lose consciousness and muscle control and fall down.

As the majority's analysis demonstrates, the intermittent nature of plaintiff's seizure disorder lends itself to the conclusion that any subsequent injury is caused by an intervening accident rather than the seizure disorder itself. Specifically, the majority focuses on the activity that plaintiff was engaged in when he suffered the 2008 seizure and concludes that the motorcycle accident was an intervening event that caused plaintiff's 2008 injury. However, once the nature of a seizure disorder is properly understood, I believe the majority's analysis is incorrect. Plaintiff's fall during his 2008 seizure was not an intervening cause; rather, it was an inextricable aspect of his seizure disorder, and any injuries sustained during the loss of consciousness and fall arose out of the motor vehicle accident that caused the seizure disorder. Simply put, loss of consciousness and falling down is part of a seizure. While I agree that the severity of the person's injuries may be exacerbated depending on what the person is doing at the time of a seizure, that does not change the fact that a seizure disorder caused the person to unexpectedly fall and suffer an injury. Stated differently, plaintiff's seizure disorder cannot be separated from his 2008 fall and attendant injuries in any meaningful way. Because plaintiff's fall was an inextricable aspect of his seizure, I believe that plaintiff can satisfy MCL 500.3105(1).

In summary, I think that the 2007 motor vehicle accident bore more than an incidental, fortuitous, or “but for” connection to plaintiff's 2008 injuries because plaintiff's 2008 injuries are directly related to the seizure disorder, i.e., the 2008 injuries were an inextricable result of his seizure disorder. Accordingly, I dissent from the majority's decision to grant summary disposition in favor of Progressive.

VIVIANO, J., took no part in the decision of this case.