Healthcall of Detroit, Inc. v. State Farm Mutual Automobile Insurance

632 F. Supp. 2d 676, 2009 U.S. Dist. LEXIS 31173, 2009 WL 982195
CourtDistrict Court, E.D. Michigan
DecidedApril 13, 2009
Docket05-74434
StatusPublished
Cited by5 cases

This text of 632 F. Supp. 2d 676 (Healthcall of Detroit, Inc. v. State Farm Mutual Automobile Insurance) 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
Healthcall of Detroit, Inc. v. State Farm Mutual Automobile Insurance, 632 F. Supp. 2d 676, 2009 U.S. Dist. LEXIS 31173, 2009 WL 982195 (E.D. Mich. 2009).

Opinion

OPINION AND ORDER RE: ATTORNEY FEES AND INTEREST

R. STEVEN WHALEN, United States Magistrate Judge.

Before the Court are (1) Plaintiffs Post-Trial Motion for Penalty Interest, Attorney Fees, and Prejudgment Interest [Docket # 133], (2) Defendant’s Motion for Attorney Fees Pursuant to M.C.L. § 500.3148(2) [Docket #134], and (3) Plaintiffs Motion for Clearance or Deter *678 mination of Prior Counsel’s Lien [Docket # 141]. All three motions will be GRANTED, with modifications as discussed below.

I. BACKGROUND

This is a diversity action brought under the Michigan No-Fault Insurance Act, M.C.L. § 500.3101, et. seq. Plaintiff HealthCall of Detroit, a provider of home health care services, sought payment from Defendant State Farm, the insurer, for allowable expenses it claimed to have provided to Vincent Ross, a severely disabled young man who as an infant was injured in an automobile accident. Following trial, a jury awarded Plaintiff $1,066,159.97 in allowable expenses. In addition, the jury found that all of the benefits claimed were thirty days or more past due, with the exception of six specific vouchers for “high-tech home health aide service.” As indicated on the verdict form, the jury also found that the six submitted claims were fraudulent in nature. 1

II. PLAINTIFF’S MOTION RE: FEES AND INTEREST [DOCKET # 133]

A. Penalty Interest

M.C.L. § 500.3142(2) provides that “[p]ersonal protection insurance benefits are overdue if not paid within 30 days after an insurer receives reasonable proof of the fact and of the amount of loss sustained.” Section 500.3142(3) provides that “[a]n overdue payment bears simple interest at the rate of 12% per annum.” This statutory interest “is awarded as a penalty for the insurer’s misconduct and is not intended to compensate for damages.” Regents of the University of Michigan v. State Farm Mutual Ins. Co., 250 Mich.App. 719, 734, 650 N.W.2d 129, 138 (2002). “If there is a failure to pay benefits and it is later determined benefits are due, penalty interest must be assessed.” Bach v. State Farm Mutual Insurance Co., 137 Mich.App. 128, 132, 357 N.W.2d 325, 326 (1984).

In Section II of the verdict form (“Penalty Interest”), the jury specifically found that $1,066,159.97 in benefits owed to HealthCall were 30 days or more past due. Therefore, Plaintiff is entitled to statutory penalty interest (simple interest) of 12% on that amount. Plaintiff has correctly calculated the penalty interest as $262,389.38 as of January 21, 2009. See Plaintiffs Motion, Amended Exhibit O. The overdue amount was paid to Plaintiffs counsel two months later, on or about March 21, 2009. The additional penalty interest for that two-month period is $21,326.00, bringing the total penalty interest to $283,715.38.

B. Attorney Fees
1. Entitlement to Statutory Attorney Fees

M.C.L. § 500.3148(1) provides as follows regarding attorney fees:

“Sec. 3148. (1) An attorney is entitled to a reasonable fee for advising and representing a claimant in an action for personal or property protection insurance benefits which are overdue. The attorney’s fee shall be a charge against the insurer in addition to the benefits recovered, if the court finds that the insurer unreasonably refused to pay the claim or unreasonably delayed in making proper payment.”

In Moore v. Secura Insurance, 482 Mich. 507, 517, 759 N.W.2d 833 (2008), the Court described the two requirements for attorney fees under the statute:

“MCL 500.3148(1) establishes two prerequisites for the award of attorney fees. First, the benefits must be overdue, *679 meaning ‘not paid within 30 days after [the] insurer receives reasonable proof of the fact and of the amount of loss sustained.’ MCL 500.3142(2). Second, in postjudgment proceedings, the trial court must find that the insurer ‘unreasonably refused to pay the claim or unreasonably delayed in making proper payment.’ MCL 500.3148(1). Therefore, assigning the words in MCL 500.3142 and MCL 500.3148 their common and ordinary meaning, ‘attorney fees are payable only on overdue benefits for which the insurer has unreasonably refused to pay or unreasonably delayed in paying.’ Proudfoot v. State Farm Mut. Ins. Co., 469 Mich. 476, 485, 673 N.W.2d 739 (2003) (emphasis omitted).”

In the present case, the jury explicitly found that the majority of claimed benefits, to the tune of $1,066,159.97, were overdue. 2 The first statutory prerequisite has therefore been satisfied.

As to reasonableness, Moore held that “[u]nder the plain language of the statute, the claimant shoulders the initial burden to supply reasonable proof of her entire claim, or reasonable proof for some portion thereof.” Id. at 523, 759 N.W.2d 833. Upon making that showing, “an insurer’s refusal or delay places a burden on the insurer to justify its refusal or delay.” Ross v. Auto Club Group, 481 Mich. 1, 11, 748 N.W.2d 552 (2008). “The insurer can meet this burden by showing that the refusal or delay is the product of a legitimate question of statutory construction, constitutional law, or factual uncertainty.” Id.

The evidence at trial clearly showed that the Plaintiff provided reasonable proof of the majority of its claims. The question, then, is whether the Defendant has met its burden of showing that its refusal to pay any portion of the claims, not just the six invoices related to Vincent Ross’s freshman year in high school, was reasonable. It was not. Defendant has not raised any question as to statutory construction or constitutional law. As to whether there was any “factual uncertainty,” there was no dispute that Mr. Ross was severely disabled, and required round-the-clock home care, regardless of what services were or were not provided while he was in school. At trial, Mr. Ross’s physicians testified that he in fact received excellent care from Health Call providers, as evidenced by the relative stability and improvement in his physical well-being. Defendant has not shown, beyond speculation, that at the time it decided to cease payment, there was a bona fide factual uncertainty as to the legitimacy of all of HealthCall’s claims on behalf of Vincent Ross. Whatever dispute Defendant had for some portion of the claims did not justify withholding all

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632 F. Supp. 2d 676, 2009 U.S. Dist. LEXIS 31173, 2009 WL 982195, Counsel Stack Legal Research, https://law.counselstack.com/opinion/healthcall-of-detroit-inc-v-state-farm-mutual-automobile-insurance-mied-2009.