DeLuca v. AMICA Mutual Insurance Company

CourtDistrict Court, E.D. Michigan
DecidedSeptember 19, 2019
Docket2:14-cv-12175
StatusUnknown

This text of DeLuca v. AMICA Mutual Insurance Company (DeLuca v. AMICA Mutual Insurance Company) 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
DeLuca v. AMICA Mutual Insurance Company, (E.D. Mich. 2019).

Opinion

UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MICHIGAN SOUTHERN DIVISION ELIZABETH DeLUCA, and EDS CARE MANAGEMENT, INC., Plaintiffs/Counter-Defendants, Case No. 14-12175 vs. HON. AVERN COHN AMICA MUTUAL INSURANCE COMPANY, Defendant/Counter-Plaintiff. ________________________________/ ORDER GRANTING IN PART AND DENYING IN PART DEFENDANT/COUNTER- PLAINTIFF’S MOTION FOR SUMMARY JUDGMENT (Doc. 83) In a broad jurisprudential sense, equity means the power to do justice in a particular case by exercising discretion to mitigate the rigidity of strict legal rules. In this broad sense, equity means the power to adapt the relief to the circumstances of the particular case.1

1Kevin C. Kennedy, Equitable Remedies and Principled Discretion: The Michigan Experience, 74 U. Det. Mercy L. Rev. 609 (1996-1997). I. Introduction This is a long suffering insurance dispute under Michigan’s No-Fault Act. Plaintiffs/Counter-defendants, Elizabeth DeLuca (DeLuca) and EDS Care Management, LLC (EDS) (collectively, where appropriate, EDS) sued defendant/counter-plaintiff Amica Mutual Insurance Company (Amica) seeking payment of personal insurance

protection (PIP) benefits from Amica. The PIP benefits were for the care of Stephanie Rudd (Rudd), the insured. While Amica paid some PIP benefits, it later ceased payments. Amica eventually filed a counterclaim (Doc. 4) and an amended counterclaim (Doc. 49) seeking recoupment of benefits. The amended counterclaim makes equitable claims for mistake of fact and unjust enrichment and is based on Amica’s contention that EDS is not entitled to any benefits because it was not a “licensed adult foster care facility” which is required to obtain benefits under Michigan law. After years of litigation and intervening changes in the law, only Amica’s

amended counterclaim remains in the case. Now before the Court is Amica’s motion for summary judgment, seeking to recoup $268,555.00 in benefits it paid to EDS for services that Amica says were not “lawfully rendered.” For the reasons that follow, the motion will be GRANTED IN PART AND DENIED IN PART. Although EDS was not entitled to the benefits, Amica is not entitled to recover against EDS. II. Background A. Factual Background This dispute arose from an automobile accident that occurred on December 26, 2002 in which then 14 year old Stephanie Rudd (Rudd or the insured) suffered what 2 was later to be determined as a traumatic brain injury. The injury occurred when the airbag deployed and smashed into her face and skull. She required around the clock care. At the time of the accident, Rudd was insured under an automobile policy held with Amica, through her father. In 2007, Rudd's mother sued Amica on behalf of Rudd in state court, seeking PIP

benefits through April 18, 2008. The case settled for $200,000, and a Stipulation and Order for Dismissal was entered. In 2010, Rudd's mother filed a second lawsuit against Amica for PIP benefits that occurred after April 18, 2008. The parties went into arbitration on this claim, and Rudd was awarded $178, 593.96. This award covered the period of April 18, 2008 through October 26, 2011. In 2012, DeLuca was appointed as Rudd's new legal guardian. DeLuca is both the guardian of Rudd and the owner of the facility that provided care for Rudd, EDS. EDS says that is has incurred reasonable expenses in caring for Rudd during her recovery from the accident, and sought payment for those expenses from Amica.

Amica negotiated payment with EDS in the amount of $268,555.50 for the period of August 19, 2012 through July 31, 2013, and $41,815.88 with DeLuca for the period of February 15, 2012 through October 31, 2013. At some point, Amica stopped paying on EDS's claims. B. Procedural History DeLuca and EDS sued Amica in state court seeking to recover guardianship, conservatory, and trustee expenses, as well as expenses associated with residential and attendant care services supplied to Rudd from May 12, 2013 and beyond. Amica removed the case to federal court based on diversity jurisdiction and filed 3 a counterclaim seeking to recoup the funds that it claims have been erroneously paid to EDS. In seeking this recoupment of funds, Amica maintained that Rudd did not in fact suffer a traumatic brain injury or that her injuries are not related to the accident. Amica's counterclaim alleged mistake of fact (Count I) and unjust enrichment (Count II) against EDS, and breach of fiduciary duty (Count III) against both DeLuca and EDS.

EDS filed a motion for summary judgement on Amica's counterclaims, contending that (1) Amica does not have standing and/or is not the real party in interest to pursue these claims since it has been reimbursed for any payments exceeding $300,000 by the Michigan Catastrophic Claims Association, (2) Amica's claims are barred by res judicata of prior litigation between Rudd and Amica. The Court denied the motion for summary judgment on Amica's counter claims. (Doc. 31). Thereafter, the parties engaged in discovery during which Amica says it became aware that EDS is not a licensed care facility. Amica said that this information provided them with a plausible defense to non-payment. Amica then moved to amend their

answer to add this as an affirmative defense and amend their counterclaim based on EDS not being a licensed adult foster care facility. (Doc. 43). The Court granted the motion. (Doc. 47). Thereafter, Amica filed a motion for summary judgment based on its amended answer and counterclaim. (Doc. 55). Amica also filed a separate motion to dismiss based on the Michigan Supreme Court’s decision in Covenant Med. Ctr., Inc. v. State Farm, 500 Mich. 191 (2017), holding that medical service providers, like EDS, have no cause of action to collect PIP benefits directly from no-fault insurers, like Amica. (Doc. 55). 4 The Court denied Amica’s motion to dismiss as moot because the parties agreed to permit EDS to amend its complaint to include an assignment of rights count. The Court also held Amica’s motion for summary judgment in abeyance pending the outcome of whether EDS obtained a valid assignment. (Doc. 65). Amica filed a motion to dismiss EDS’s First Amended Complaint (Doc. 67) and a

motion for summary judgment (Doc. 52). The Court granted Amica’s motion to dismiss and denied the summary judgment motion as moot. (Doc. 72). That left Amica’s counterclaim. The Court gave Amica time in which to advise the Court whether it wanted to proceed on its amended counterclaim in light of the dismissal of EDS’s complaint. Amica advised that it wanted to proceed. During a subsequent status conference, the Court indicated it was going to dismiss Amica’s counterclaim. The Court later entered an order dismissing the counterclaim and closing the case (Doc. 75).2 Amica filed a motion for reconsideration, contending that the Court did not follow proper procedure before dismissing its

counterclaim. The Court granted the motion, reopened the case, and reinstated Amica’s amended counterclaim. (Doc. 80). III. Legal Standard "The court shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a). A moving party may meet that burden "by 'showing'-that is, pointing out to the district court-that there is an absence of evidence to

2The Court had hoped that Amica, after years of litigation which was largely resolved in its favor, would see the value of closure. 5 support the nonmoving party's case." Celotex Corp. v. Catrett, 477 U.S. 317, 325 (1986).

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Bluebook (online)
DeLuca v. AMICA Mutual Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/deluca-v-amica-mutual-insurance-company-mied-2019.