Chiropractors Rehabilitation Group, PC v. State Farm Mutual Automobile Insurance Co.

313 Mich. App. 113
CourtMichigan Court of Appeals
DecidedOctober 29, 2015
DocketDocket 320288 and 322317
StatusPublished
Cited by12 cases

This text of 313 Mich. App. 113 (Chiropractors Rehabilitation Group, PC v. State Farm Mutual Automobile Insurance Co.) is published on Counsel Stack Legal Research, covering Michigan Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Chiropractors Rehabilitation Group, PC v. State Farm Mutual Automobile Insurance Co., 313 Mich. App. 113 (Mich. Ct. App. 2015).

Opinion

WILDER, P.J.

These consolidated appeals are before this Court by leave granted. 1 In each case, defendant, State Farm Mutual Automobile Insurance Company (State Farm), appeals a circuit court order affirming a district court order denying a motion for summary disposition. In Docket No. 322317, State Farm also *117 challenges the district court’s order denying leave to amend its affirmative defenses. We affirm in part and reverse in part.

i

Plaintiffs in both cases are healthcare providers that rendered medical treatment to individuals allegedly injured in motor vehicle accidents. The medical providers brought actions in the district court, under the no-fault act, MCL 500.3101 et seq., seeking reimbursement for medical expenses related to the treatment rendered. State Farm, the no-fault insurer allegedly responsible for payment of personal protection insurance (PIP) benefits under the no-fault act, filed motions for summary disposition in which it argued, among other things, that the injured parties were not eligible for the payment of PIP benefits and, therefore, the healthcare providers were similarly precluded from seeking such benefits. The district courts denied State Farm’s motion for summary disposition in each case.

a

In Docket No. 320288, Raynard Jackson allegedly sustained injuries on or about September 4, 2011, while a passenger in a motor vehicle owned and operated by Mohammed Abdullah. At the time, Abdul-lah’s vehicle was insured under a no-fault policy issued by State Farm. Because of incomplete and conflicting police reports and medical records, there were questions regarding whether Jackson was injured in the accident. Consequently, in response to Jackson’s claim for PIP benefits, State Farm requested that Jackson submit to a medical examination (ME) as permitted under MCL 500.3151 and an examination under oath (EUO). Jackson failed to appear for two ME appoint *118 ments scheduled in February and March 2012. He similarly failed to attend the EUO. In April 2012, State Farm advised Jackson, through his legal counsel, that because of Jackson’s failure to cooperate with its investigation of the claim, State Farm was suspending his claim for benefits.

Sometime after the accident, Jackson sought treatment from plaintiff, Chiropractors Rehabilitation Group, PC. When State Farm failed to reimburse plaintiff for the charges associated with its treatment of Jackson, plaintiff filed a complaint alleging that, under the no-fault act, it was entitled to reimbursement from State Farm for the services it provided to Jackson. On May 10, 2013, State Farm moved for summary disposition under MCR 2.116(C)(10), arguing that it was not responsible for charges associated with plaintiffs treatment of Jackson. State Farm asserted that because Jackson had failed to cooperate in its investigation of the claims, he was not eligible for coverage under the policy. State Farm then reasoned that Jackson’s ineligibility for coverage barred the claims of any healthcare provider seeking coverage on Jackson’s behalf.

The district court denied State Farm’s motion for summary disposition. The court held that questions of fact existed regarding whether Jackson was eligible for coverage under the no-fault act and whether Jackson’s ineligibility would bar the provider’s claims. The district court also denied State Farm’s motion for reconsideration. On appeal, the circuit court affirmed the district court’s order.

B

In Docket No. 322317, Ricky Johnson was purportedly a passenger in a vehicle involved in an accident on June 28, 2012, but the traffic report identified only *119 “Qutrel Monteque” as a passenger. Johnson purportedly gave the police a false name at the time of the accident. On August 23, 2012, Johnson sought treatment from plaintiff Elite Health Centers, Inc. Johnson complained of neck and back pain that he attributed to injuries sustained in the accident. Johnson also sought treatment from plaintiff Horizon Imaging, LLC, in September 2012, where he underwent three MRIs.

On September 19,2012, Johnson filed a claim for PIP benefits with State Farm, which had issued a policy of no-fault insurance to Veretta Robinson, the owner of the vehicle in which Johnson was allegedly a passenger. On January 22, 2013, State Farm requested that Johnson appear for an EUO on February 4, 2013. Johnson failed to appear for this scheduled EUO and later failed to appear at EUOs rescheduled for March 20, 2013 and March 22, 2013.

On September 6, 2013, plaintiffs filed a first amended complaint seeking PIP benefits from State Farm. Plaintiffs sought reimbursement of nearly $20,000 in outstanding medical expenses related to plaintiffs’ treatment of Johnson. On November 19, 2013, State Farm filed a motion to amend its affirmative defenses and for summary disposition. Through this motion, State Farm sought to include as an affirmative defense that plaintiffs’ suit was barred because Johnson had failed to cooperate with State Farm’s investigation of the claim. State Farm also argued that summary disposition of plaintiffs’ claims was appropriate because Johnson’s ineligibility for PIP benefits precluded plaintiffs from seeking such benefits. Additionally, State Farm asserted that the policy language at issue required Johnson to submit to an EUO as a condition precedent to the recovery of benefits. State Farm argued that Johnson’s failure to *120 cooperate made it impossible to establish whether a loss occurred or whether it was first in priority to provide no-fault coverage to Johnson. State Farm, therefore, reasoned that summary disposition was appropriate under MCR 2.116(0(10). In response, plaintiffs argued that because EUO provisions in insurance contracts may not act as a condition precedent to the recovery of PIP benefits, State Farm was not entitled to summary disposition.

The district court denied State Farm’s motion to amend its affirmative defenses and for summary disposition. The court ruled that State Farm had provided no legal authority to warrant an amendment to the affirmative defenses. With respect to the summary disposition motion, the court held that Johnson’s actions did not preclude a healthcare provider’s claim because a healthcare provider has a right to a separate cause of action.

On January 30, 2014, State Farm moved for reconsideration of the district court’s order denying leave to amend its affirmative defenses. In this motion, State Farm argued that healthcare providers lacked standing to pursue a claim for PIP benefits, asserting that only the injured party could pursue such a claim. On February 4, 2014, the district court denied State Farm’s motion for reconsideration.

The circuit court denied State Farm’s application for leave to appeal, finding that State Farm had failed to show that it would suffer substantial harm by awaiting final judgment. This Court thereafter granted leave to appeal.

ii

In both appeals, State Farm argues that the lower courts erred by denying its motions for summary *121 disposition.

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Bluebook (online)
313 Mich. App. 113, Counsel Stack Legal Research, https://law.counselstack.com/opinion/chiropractors-rehabilitation-group-pc-v-state-farm-mutual-automobile-michctapp-2015.