June 13, 2011
In the unpublished opinion of Raterink v State Farm, unpublished opinion per curiam of the Court of Appeals, dated May 3, 2011 (Docket No. 295084), the Court of Appeals found that there was sufficient evidence to demonstrate that the decedent required treatment from physicians, physical therapy, and attendant care for complications from her diabetic condition that were ultimately triggered by her initial motor vehicle accident on April 26, 2002.
The disposition of this appeal boiled down to whether the decedent’s injuries, disability, and need for medical treatment arose out of her initial April 26, 2002, motor vehicle accident, of which State Farm was the defendant’s insurer. State Farm argued that it was not liable to pay benefits for injuries arising from a subsequent accident in May 2006, for which it was not the insurer, or due to complications from decedent’s pre-existing medical conditions.
State Farm first took issue with the trial court’s grant of summary disposition to plaintiff for amounts claimed with respect to Heartland Home Care, arguing that plaintiff failed to present any evidence that decedent’s stay in the facility from January to June 2008 was related to either motor vehicle accident. The record revealed that the decedent suffered a heart attack in December of 2007, for which she was treated at St. Mary’s Hospital, and then subsequently transferred to Heartland. Ultimately, the court found that there was no indication from the record that the expenses from Heartland were related to the first accident. Although decedent’s treating physician, Dr. John Anderson, was able to suggest that the decedent’s injuries and complications all flowed from her broken ankles in the first motor vehicle accident, he was unable to provide any specifics regarding the decedent’s post heart attack treatment. Furthermore, the court found there was little to no reference in the Heartland records tying decedent’s treatment to the first motor vehicle accident. Accordingly, since the Court of Appeals is limited to the record presented to it, it concluded that plaintiff failed to specifically identify an undisputed factual issue related to Heartland, and support its position with necessary evidentiary support. Drawing all reasonable inferences in favor of State Farm, the Court of Appeals concluded that reasonable minds could differ, and found a genuine issue of material fact existed with respect to expenses related to Heartland, reversing the trial court in this regard.
State Farm next argued against the expenses that were awarded to plaintiff related to attendant care, treating physicians, and a case manager. State Farm heavily relied upon the case worker’s report that the decedent’s disability and need for attendant care and wheelchair accessibility were directly related to the second accident, and as such, it should not be responsible for same. The Court of Appeals dismissed this argument by stating the case worker’s opinion did not necessarily refute the opinions of Dr. Anderson and the other examining physician, Dr. Michael Holda, who both indicated that decedent’s disability arose from the first accident. Specifically, Dr. Anderson testified that the decedent’s diabetes, from which her then-current complications resulted, were all triggered by traumatic injuries in the first accident. As such, the court found that the record demonstrated that the decedent required treatment from physicians, physical therapy and attendant care for complications from her diabetic condition that was ultimately triggered by the first accident. The record clearly indicated that a sizeable amount of the expenses incurred were related to attendant care. Dr. Anderson testified that the decedent required a minimum of two hours per day and three days per week of attendant care from the date of the first accident until she passed away. Summary disposition was therefore appropriate with regard to this claim.
As such, the Court of Appeals reversed the trial court’s decision in refusing to award no-fault penalty interest. Penalty interest must be assessed against a no-fault insurer if the insurer refuses to pay benefits and is later determined to be liable, irrespective of the insurer’s good faith in not promptly paying the benefits. Williams v. AAA Mich, 250 Mich App 249, 265 (2002). The trial court denied plaintiff’s request for no-fault penalty interest because defendant did not become aware of most of the claims until the litigation. However, the Court of Appeals concluded that in this case, minimally, plaintiff submitted various expenses as part of its motion for summary disposition, as well as attaching invoices and billing summaries from various health care providers to its brief to substantiate its claims. As such, the Court of Appeals concluded that plaintiff’s filings in the trial court level constituted reasonable proof of loss and that the trial court erred in deciding the plaintiff was not entitled to no-fault penalty interest.
Conversely, the Court of Appeals affirmed the trial court’s decision to deny no-fault attorney fees. The Court of Appeals pointed out that this is a complex case in that it arose from two separate accidents, one in April 2002 and the other in May 2006, which complicated the decedent’s pre-existing medical conditions and caused factual issues regarding expenses from various treaters, particularly Heartland Home Care. Accordingly, the Court of Appeals here agreed with the trial court’s decision that a bona fide factual uncertainty initially existed as to whether the benefits sought by plaintiff were related to the first accident, which uncertainty was resolved on summary disposition.
Based on the foregoing, the Court of Appeals here affirmed in part and reversed in part, the decision of the trial court, remanding the case to the trial court for proceedings consistent with this opinion.
SAVE THE DATE
The 4th Annual Cherry-Roubaix bicycle race, sponsored by Garan Lucow Miller, P.C., will be held from August 12th through the 14th, 2011, on the streets of Traverse City, Michigan and neighboring Leelanau County, and will feature the 2011 State Road Race Championships. There will also be a charity fun ride out Old Mission Peninsula. Please see the event website at www.cherry-roubaix.com for more details.
Please mark your calendars to join us at this exciting event. Garan Lucow Miller will be hosting special VIP viewing areas at each race, please advise Peter Worden, in our Traverse City office at (231) 941-1611 or firstname.lastname@example.org, if you will be available to join in the festivities.
SAVE THE DATE
EVENT: Garan Lucow Miller’s Annual Golf Outing
DATE: Tuesday, August 23, 2011
VENUE: Forest Akers West Golf course on the campus of MSU
Banquet dinner to be on campus at the University Club
The Troy Breakfast Seminar will be held on Thursday October 27, 2011 at the Troy Marriott.
Please watch Law Fax for further information.