Gray v. Auto-Owners Insurance Company

CourtDistrict Court, E.D. Michigan
DecidedJuly 31, 2020
Docket2:18-cv-13888
StatusUnknown

This text of Gray v. Auto-Owners Insurance Company (Gray v. Auto-Owners 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
Gray v. Auto-Owners Insurance Company, (E.D. Mich. 2020).

Opinion

EASTERN DISTRICT OF MICHIGAN SOUTHERN DIVISION

BILLIE GRAY,

Plaintiff, Case No. 18-13888 vs. HON. MARK A. GOLDSMITH

AUTO-OWNERS INSURANCE GROUP,

Defendants. ___________________________________/

OPINION & ORDER DENYING DEFENDANT’S MOTIONS FOR SUMMARY JUDGMENT (Dkts. 17, 23)

Plaintiff Billie Gray was in a motor vehicle accident on July 18, 2018. Gray filed suit when his insurer, Defendant Auto-Owners Insurance Group (“Auto-Owners”), refused to pay numerous bills he alleges Auto-Owners is obligated to pay under his no-fault personal protection insurance (“PIP”) plan. Now, Auto-Owners has filed two motions for summary judgment (Dkts. 17, 23), which collectively present four issues: (i) whether the case should be dismissed under the insurance policy’s contractual bar on recovery when the insured party has committed fraud, (ii) whether compensation for Gray’s attendant and replacement services should be limited to the period for which a doctor prescribed those services, (iii) whether Gray’s Medicare claim should be dismissed, and (iv) whether judicial estoppel justifies dismissal of the case in its entirety.1 Auto-Owners agreed that a fact issue exists as to the third question. See 1st Reply (Dkt. 24). For the reasons that follow, Auto-Owners’ motion is denied in full. I. STANDARD OF REVIEW A motion for summary judgment under Federal Rule of Civil Procedure 56 shall be granted “if the movant shows that there is no genuine dispute as to any material fact and the movant is

1 Auto-Owners received permission to file a second motion for summary judgment (Dkt. 22). exists when there are “disputes over facts that might affect the outcome of the suit under the governing law.” Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). “[F]acts must be

viewed in the light most favorable to the nonmoving party only if there is a ‘genuine’ dispute as to those facts.” Scott v. Harris, 550 U.S. 372, 380 (2007). “Where the record taken as a whole could not lead a rational trier of fact to find for the nonmoving party, there is no genuine issue for trial.” Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986) Once the movant satisfies its initial burden of demonstrating the absence of any genuine issue of material fact, the burden shifts to the nonmoving party to set forth specific facts showing a triable issue of material fact. Scott, 550 U.S. at 380; Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). The nonmoving party “must do more than simply show that there is some metaphysical doubt as to the material facts,” Scott, 550 U.S. at 380 (quoting Matsushita, 475 U.S. at 586), as the “mere existence of some alleged factual dispute between the parties will not defeat an otherwise

properly supported motion for summary judgment,” id. (quoting Anderson, 477 U.S. at 247-248) (emphasis in original); see also Babcock & Wilcox Co. v. Cormetech, Inc., 848 F.3d 754, 758 (6th Cir. 2017) (“A mere scintilla of evidence or some metaphysical doubt as to a material fact is insufficient to forestall summary judgment.”). II. ANALYSIS Auto-Owners’ remaining arguments are (i) that Gray’s right to benefits were voided when he committed fraud, (ii) that he is not entitled to replacement and attendant services beyond the period for which they were prescribed, and (iii) that Gray should be estopped from pursuing his claims because he failed to disclose this lawsuit when he received bankruptcy relief. None of these arguments entitles Auto-Owners to summary judgment. Gray’s policy with Auto-Owners allows Auto-Owners to deny coverage to “any person . . . who has made fraudulent statements or engaged in fraudulent conduct with respect to

procurement of this policy or to any occurrence for which coverage is sought.” Insurance Policy, Ex. F to 1st Mot. for Summ. J., at PageID.202 (Dkt. 17-7). Auto-Owners has alleged that Gray made fraudulent statements as to three issues: (i) whether he had experienced hearing loss prior to the 2018 accident, (ii) whether he had experienced memory problems and headaches prior to the 2018 accident, and (iii) whether he had been involved in an automobile accident in 2017. See 1st Mot. at 18-20. These allegations and Gray’s explanation of his statements are below, followed by an analysis of these claims under Michigan law. 1. Auto-Owners’ Allegations of Fraud The allegedly fraudulent statements concerning Gray’s medical history occurred during a deposition Auto-Owners took of Gray during the course of litigating this case. Under the

questioning of Gray’s attorney, the following exchange occurred: Q: And did you have any of these problems prior to the motor vehicle accident in 2018? A: No. My other glasses was [sic] all right. But I had to have them—I couldn’t see out of them. Q: But I’m talking about all your hearing, your— A: No. No. Q: —memory and all of that. Did you have any of that problems [sic] before the accident? A: No, ma’am, not at all. Not at all. Not at all.

Pl. Dep., Ex. 8 to 1st Resp., at PageID.483 (Dkt. 20-9). In addition to this exchange, Gray had the following exchange with counsel for Auto-Owners: Q. Have you ever treated with any doctors or complained of any medical conditions or injuries to your ears prior to July, 2018? A. No. Q. So no issues with loss of hearing before this 2018 accident? None? A. No.

Id. at PageID.440. indicate a long history of memory problems and headaches:  On July 22, 2011, following a motor vehicle accident, Gray complained of headaches, memory loss, and difficulty focusing. Records from Plaintiff’s 2011 Car Accident, Ex. B PageID.157-158 (Dkt. 17-3).

 On December 13, 2011, Plaintiff had surgery at Michigan Spine & Rehab so that a P-STIM device could be installed, in part to help relieve his headaches. Id. at PageID.161.

 In February 2012, Gray said he was having headaches three times per week. Id. at PageID.162-163.

 In April of 2012, Gray said he had headaches every other day and they lasted for 90 minutes. (This allegation is uncited.)

 In February 2013, Gray sought further evaluation of his headaches. Id. at PageID.164.

Similarly, the records reflect hearing loss prior to the 2018 accident. Id. at PageID.155; 2017 Sinai Grace Hospital Records, Ex. D. to 1st Mot., at PageID.176 (Dkt. 17-5); 2017 Records of Dr. Vijaya Challa, Ex. C to 1st Mot., at PageID.169-171 (Dkt. 17-4) (“2017 Challa Recs.”). Auto-Owners argues that Gray committed further fraud by testifying that aside from the 2018 accident, his only other car accident occurred in 2011. Pl. Dep. at PageID.444. According to a medical record, he told his primary care provider on June 15, 2017, that he had been involved in another motor vehicle accident in May 2017 and had a left knee hairline fracture. 2017 Challa Recs. at PageID.172-174. Auto-Owners presents no other evidence that Gray was in an accident in 2017. 2. Gray’s Explanation of His Testimony Gray defends against the claim of fraud with respect to prior medical conditions by attempting to place two factual items in dispute. First, he claims he understood the questions to refer to his condition immediately prior to the accident and answered them truthfully; second, he argues that he may have experienced a memory lapse during the deposition.

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Gray v. Auto-Owners Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/gray-v-auto-owners-insurance-company-mied-2020.