De Etta Gardner v. State Farm Mutual Automobile Insurance Company

CourtMichigan Court of Appeals
DecidedApril 7, 2016
Docket325606
StatusUnpublished

This text of De Etta Gardner v. State Farm Mutual Automobile Insurance Company (De Etta Gardner v. State Farm Mutual Automobile Insurance Company) 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
De Etta Gardner v. State Farm Mutual Automobile Insurance Company, (Mich. Ct. App. 2016).

Opinion

STATE OF MICHIGAN

COURT OF APPEALS

DE ETTA GARDNER, a/k/a DEETTA UNPUBLISHED GARDNER, April 7, 2016

Plaintiff-Appellee, and

THERAPY FIRST, LLC, d/b/a THERAPY 1ST,

Intervening Plaintiff-Appellee,

v No. 325606 Wayne Circuit Court STATE FARM MUTUAL AUTOMOBILE LC No. 11-002164-NF INSURANCE COMPANY,

Defendant-Appellant.

Before: M. J. KELLY, P.J., and CAVANAGH and SHAPIRO, JJ.

PER CURIAM.

This dispute over the award of attorney fees after a jury trial on the payment of first-party no-fault benefits returns to this Court after an earlier appeal on the same issue.1 Defendant, State Farm Mutual Automobile Insurance Company, again appeals by right the trial court’s orders compelling it to pay the attorney fees of plaintiff, De Etta Gardner, and intervening plaintiff, Therapy First, LLC, which does business as Therapy 1st. On appeal, State Farm argues that the trial court erred by ordering it to pay the attorney fees because, in its view, the undisputed evidence established that it reasonably refused to pay the claims by Gardner and Therapy First. It also argues in the alternative that the trial court erred in calculating the fees. On appeal, we conclude that the trial court did not err when it ordered State Farm to pay the attorney fees of Gardner and Therapy First. Accordingly, we affirm.

1 See Gardner v State Farm Mut Auto Ins Co, unpublished opinion per curiam of the Court of Appeals, issued June 17, 2014 (Docket No. 313351).

-1- I. BASIC FACTS

On June 5, 2010, Phillip Allred drove his truck into the rear end of a car being driven by Gardner. Although Gardner seemed alright after the accident, Allred conceded that his truck had significant damage.

Karen Winters testified that she is a claim representative with State Farm. In June 2010, State Farm first received a claim for first-party no-fault benefits by Gardner. Winters said State Farm began to receive claims from health providers who treated Gardner in July 2010. However, there was initially an issue as to whether Gardner was an eligible insured person. Gardner was driving her boyfriend’s sister’s Durango at the time. Winters determined that Gardner was a qualified insured in late August 2010. In early September 2010, she sent Gardner various forms to use for making claims and a form to authorize the release of her medical records. At that time, Winters had not made a determination as to whether Gardner was eligible for benefits, but did list various potential expenses as compensable in State Farm’s digital logs. She made those determinations on the basis of Gardner’s word alone.

Winters noted that Gardner went to her primary care physician in June 2010, but then switched to a new physician, Aaron Goldfein, M.D., in July 2010. Gardner admitted at trial that she was already scheduled to see Goldfein even before she met with her family physician about her injuries and had already hired a lawyer. She did not treat with her family physician, she stated, because he refused to handle automobile accident cases.

Winters stated that, as a result of her conversations with Gardner and her receipt of some medical records, she “began to question if there was an actual injury that was sustained in this accident.” She also believed that the size of the vehicles—Gardner was in a Durango and Allred was in an F-150—made it unlikely that Gardner would suffer an injury. Accordingly, on August 31, 2010, Winters switched the entry for Gardner’s claims from compensable to under investigation. She then sent out letters requesting more information. Winters got the medical authorizations in October 2010. She sent out requests for Gardner’s medical records in early November 2010, but she did not receive Gardner’s records from Goldfein.

Gardner sued State Farm for first-party no-fault benefits in February 2011.

Because Goldfein did not send the requested records, Winters stated, she hired a physician to represent State Farm’s interests—what insurers commonly refer to as an “independent” medical examiner or IME—and scheduled Gardner for an examination in April 2011. Neil Friedman, M.D., conducted the examination. Friedman opined in his report that Gardner did not suffer any injury and, even if she had, it would have been a cervical strain that would have healed in 4 to 6 weeks.

Winters testified that, after Friedman sent her his opinion, she decided to approve Gardner’s medical claims through July 31, 2010. She indicated that everything after that date, which was the date by which Friedman opined Gardner would have healed if she had in fact suffered a strain, would not be paid. She, however, rejected the claims for replacement services, mileage, and attendant care. She rejected those claims because Friedman stated that Gardner would not have needed those services even if she suffered a cervical strain.

-2- Winters admitted that she received claims from Therapy First for services that it provided to Gardner from June 29, 2010 through August 4, 2011. The total that Therapy First claimed for services was $63,974.21.

The parties tried their dispute before a jury in late February and early March of 2012. After hearing the evidence, the jury returned a verdict in favor of Gardner and Therapy First. The jury found that Gardner sustained “an accidental bodily injury” in the accident, but found that she did not incur any “allowable expenses.” The jury, however, found that she did incur some “replacement services expenses” and awarded her $1,720, plus interest. It further found that she incurred some mileage expenses and a medical bill of $400. The jury found that all these expenses became overdue on October 7, 2010. On a separate verdict form, the jury also found that Gardner sustained an injury that resulted in allowable expenses that were provided by Therapy First. It awarded Therapy First $7,500 of its claimed expenses and found that those expenses became overdue on October 7, 2010.

The trial court entered judgment in favor of Gardner in April 2012. It ordered State Farm to pay Gardner $62,167.39, which included over $52,000 in attorney fees. In October 2012, the trial court entered a judgment in favor of Therapy First. It ordered State Farm to pay $57,168.75 to Therapy First, which included over $46,000 in attorney fees.

State Farm appealed in this Court the trial court’s decision to award attorney fees to Gardner and Therapy First. On appeal, this Court stated that the trial court did not make specific findings as to whether State Farm’s decision to deny payments was unreasonable under MCL 500.3148; rather, it appeared to improperly rely on the fact that the jury found that there were overdue payments.2 Because this Court did not have a sufficient record to properly review the trial court’s decision to award attorney fees under MCL 500.3148, it remanded the case back to the trial court. Id. at 6-7.

In July 2014, the trial court held a hearing on remand from this Court. At the hearing, State Farm’s lawyer argued that State Farm could reasonably refuse to pay the claims at issue after its independent medical examiner opined that Gardner did not suffer an injury, or, at most suffered a sprain or strain that would have only required a few weeks of therapy. The trial court expressed concern that State Farm refused to pay medical and therapy bills arriving as early as July 2010, even though the independent medical examination did not occur until nearly a year after the accident. The court noted that the emergency room had already diagnosed Gardner with a sprain-strain in June 2010, and it wondered if it was reasonable to deny coverage for Gardner’s sprain-strain injury without a medical opinion to contradict the hospital’s physician and Gardner’s physician.

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Bluebook (online)
De Etta Gardner v. State Farm Mutual Automobile Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/de-etta-gardner-v-state-farm-mutual-automobile-insurance-company-michctapp-2016.