Allstate Insurance v. Frankel

259 F.R.D. 274, 2009 WL 2778081
CourtDistrict Court, E.D. Michigan
DecidedAugust 28, 2009
DocketNo. 06-15382
StatusPublished
Cited by2 cases

This text of 259 F.R.D. 274 (Allstate Insurance v. Frankel) is published on Counsel Stack Legal Research, covering District Court, E.D. Michigan primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Allstate Insurance v. Frankel, 259 F.R.D. 274, 2009 WL 2778081 (E.D. Mich. 2009).

Opinion

AMENDED OPINION AND ORDER

VICTORIA A. ROBERTS, District Judge.

I. BACKGROUND AND PROCEDURAL HISTORY

Allstate Insurance Company (“Allstate”) filed a Complaint against Defendants on October 25, 2006 in Oakland County Circuit Court. The case was removed here on December 4, 2006. The primary issue is whether the defendant facilities (“Rehabilitation Facilities”) were required to be licensed as psychiatric units and/or adult foster care facilities in order for their services to be considered “lawfully rendered” within the meaning of Michigan’s No-Fault Statute, MCLA § 500.3101 et seq.

On July 13, 2007, Allstate filed a Second Amended Complaint alleging: (1) fraudulent and innocent misrepresentation; (2) unjust enrichment; (3) fraud and silent fraud; (4) practicing psychology and psychiatry without a license; (5) providing medical services without a license; (6) illegal fee splitting; (7) corporate practice of medicine; (8) civil conspiracy; and (9) breach of statutory duty.

Defendants Dr. Roman Frankel, New Start, Inc. (“New Start”), The Healing Place, Ltd. (“THP”), Another Step Forward, Inc. (“ASF”), and THP Intensive Services, Inc. (“THP Intensive”) filed a Counter-Complaint alleging tortious interference with a contractual relationship, tortious interference with a business expectancy, and fraud and misrepresentation.

On November 20, 2007, Allstate filed a “Motion for Leave to File a Motion for Summary Disposition.” Allstate believes it was entitled to judgment as a matter of law based on Healing Place at N. Oakland Med. Ctr. v. Allstate Ins. Co., 277 Mich.App. 51, 744 N.W.2d 174 (2007) (“Healing Place”). It contends that the Healing Place’s holding— that THP and New Start were not properly licensed to lawfully render services within the meaning of MCLA § 500.3157 (and, therefore, not entitled to be paid for services rendered) — is dispositive.

The Court denied Allstate’s motion without prejudice and stayed these proceedings because Defendants filed a motion for reconsideration of the Healing Place decision. The motion for reconsideration was denied, and the Michigan Supreme Court denied the application for leave to appeal. This Court lifted the stay on September 8, 2008.

Now before the Court is Allstate’s “Motion for Summary Judgment.” (Doc. # 59). Allstate seeks reimbursement of $1,503,977.58 in no-fault automobile personal protection insurance benefits it paid New Start, THP, and ASF between November 1,1998 and November 1, 2006 for services provided Roger Haines, Matthew Mullins, Steven Nucci, Johnny Hamilton, Jeremy Cottrell, Trade Hopkins, Joseph Peregord, and Calvin Clark. The essence of Allstate’s motion is that neither the Rehabilitation Facilities nor Dr. Frankel had the proper license to “lawfully render” services within the meaning of MCLA § 500.3157. Allstate says the “lawfully rendered” requirement must be met before it becomes obligated to pay no-fault benefits.

THP Intensive is not listed as a payee on the chart Allstate provides as Exhibit F to its summary judgment motion. Therefore, the services THP Intensive provided Allstate’s [277]*277insureds, and whether it was properly licensed, are not now part of this Court’s considerations.

Oral argument was heard on April 29, 2009. Allstate filed a supplemental brief on May 6, 2009. Defendants filed a supplemental brief on May 14, 2009.

Allstate’s motion is GRANTED IN PART AND DENIED IN PART. The Court finds the following as a matter of law, for reasons set forth in this Opinion and Order:

(1) Defendants are entitled to no-fault insurance benefits: (a) if the services they provided were reasonably necessary for the insureds’ care, recovery, or rehabilitation; and (b) the services provided were: (i) within the scope of the Rehabilitation Facilities’ operating licenses; (ii) rendered by individuals who did not need a license to provide the services; or (iii) rendered by individuals who had the requisite license.

(2) Allstate must pay the individual or facility who lawfully rendered the services. For example, if an individual lawfully rendered services that the facility itself could not render because it required a license to perform that service, Allstate must pay the individual who lawfully rendered services, not the facility.

(3) Healing Place is not dispositive.

(4) THP meets the statutory definition of “psychiatric unit.” Allstate is, therefore, entitled to reimbursement for any psychiatric services that were unlawfully performed by either THP or individuals not licensed to practice Psychiatry.

(5) Allstate is entitled to reimbursement for the psychological services Dr. Frankel provided Allstate’s insureds at New Start on 1/3/02, 1/8/02, 2/5/02, 2/19/02, 3/12/02, 3/19/02, 3/27/02, 4/9/02, 4/17/02, 4/23/02, 5/1/02, and 7/16/02 because Dr. Frankel held himself out as a Psychologist, rendered services as such, but was not licensed to render psychological services.

(6) Allstate is entitled to reimbursement for the psychotherapy services Dr. Frankel unlawfully rendered Mr. Nucci from February 1, 2003 through June 4,2003.

(7) If THP provided Allstate’s insureds services that were within its operating license; or, individuals lawfully performed services other than psychiatric at THP, Defendants are entitled to receive no-fault insurance benefits.

In addition, the Court finds genuine issues of material fact exist concerning whether Dr. Frankel fraudulently concealed that he was not a licensed Psychologist, and whether the Rehabilitation Facilities fraudulently concealed that they did not have psychiatric unit and/or adult foster care licenses.

II. STANDARD OF REVIEW

Fed.R.Civ.P. 56(c) provides that summary judgment is appropriate “if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law.” In reviewing a motion for summary judgment, “the evidence as well as all inferences drawn therefrom must be read in a light most favorable to the party opposing the motion.” Kochins v. Linden-Alimak, Inc., 799 F.2d 1128, 1133 (6th Cir.1986).

The movant has the initial burden to demonstrate the absence of a genuine issue of material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 91 L.Ed.2d 265 (1986). If the movant meets this burden, the nonmoving party must, by affidavit or otherwise as provided by Rule 56, “set forth specific facts showing that there is a genuine issue for trial.” Fed.R.Civ.P. 56(e). A genuine issue of material fact exists “if the evidence is such that a reasonable jury could return a verdict for the nonmoving party.” Anderson v. Liberty Lobby, Inc., 477 U.S.

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Bluebook (online)
259 F.R.D. 274, 2009 WL 2778081, Counsel Stack Legal Research, https://law.counselstack.com/opinion/allstate-insurance-v-frankel-mied-2009.