Morales v. State Farm Mutual Automobile Insurance

761 N.W.2d 454, 279 Mich. App. 720
Michigan Court of Appeals·Decided July 24, 2008·No. Docket 275224·Published·Cited by 49 cases

Opinion

Per CURIAM.

Defendant State Farm Mutual Automobile Insurance Company appeals by right the judgment entered on a jury award of no-fault benefits under MCL 500.3107 for the plaintiff, Jorge Morales. No-fault per *722 sonal protection insurance benefits (so-called “PIP benefits”) are payable for “accidental bodily injury arising out of the ownership, operation, maintenance or use of a motor vehicle as a motor vehicle.” MCL 500.3105(1). The jury found that plaintiff sustained an injury in an automobile accident, thereby incurring reasonable and reasonably necessary allowable expenses of $216,000, work-loss benefits of $76,032, and replacement services expenses of $21,900. The jury also awarded $62,786 as penalty interest under MCL 500.3142. Subsequently, the trial court awarded plaintiff attorney fees of $148,562.50 under MCL 500.3148(1), taxable costs of $12,478.54, and judgment interest. The court entered judgment for plaintiff in the amount of $597,351.40. We affirm.

I. FACTUAL BACKGROUND

Plaintiff was injured in a rollover accident on June 12, 2002, while driving a boom truck in the course of his electric-sign-repair business. Before the accident, plaintiff had various health problems: he had a heart attack in 1993, was an insulin-dependent diabetic, and suffered hypertension and arteriosclerosis. Plaintiffs family doctor, Dr. Robert Brateman, diagnosed plaintiff with a closed head injury as a result of the accident, but on November 11, 2002, Dr. Brateman released plaintiff to return to work. Plaintiff and his wife maintain that he tried to return to work in a supervisory capacity, but the attempt lasted only one or two weeks because plaintiff experienced dizziness, could not distinguish color-coded wiring, made unsafe decisions, and argued with employees. Defendant initially paid plaintiff work-loss benefits but stopped after three months and did not pay any further no-fault benefits. 1

*723 On December 17, 2002, plaintiff experienced an acute cardiac event resulting in his hospitalization. Although this was initially thought to have been another myocardial infarction (heart attack), the incident was diagnosed as unstable angina and treated with angioplasty. Plaintiff does not dispute that this incident was temporarily disabling for the period of hospitalization and few days of recovery.

In February 2003, plaintiff suffered an incident of confusion and disorientation, which was attributed to a transient ischemic attack (TIA). Dr. Brateman testified that the TIA had only temporary effects and would not permanently disable plaintiff. Dr. Brateman conceded that plaintiff might also have small vessel disease of the brain caused by his diabetes and arteriosclerosis, which could produce similar symptoms of confusion, memory loss, dizziness, or sometimes a TLA.

On November 3, 2003, plaintiff signed an application for a pension or compensation from the federal Department of Veterans Affairs (VA). Plaintiff testified that his wife filled out all the forms for him. Plaintiffs wife testified that someone had suggested to her that because her husband was a veteran, the VA might provide benefits. Plaintiffs wife asked Dr. Brateman to write letters supporting the benefit application. Dr. Brateman wrote a letter for the purpose of the VA-benefits application on November 3, 2003, that listed, among plaintiffs other ailments, “ischemic heart disease, post myocardial infarction with congestive heart failure and a second myocardial infarction in 2002” and indicated plaintiffs “inability to work secondary to ischemic heart disease, diabetes neuropathy, and peripheral vascular occlusive disease.” This letter did not mention plaintiffs motor vehicle accident or plaintiffs having a closed head injury. Apparently, the VA responded to the *724 application with a letter dated December 3, 2003, which requested that plaintiff sign medical releases and submit additional information to support his claim. Dr. Brateman wrote a second letter on December 14, 2003, that was sent directly to the VA representative processing plaintiffs claim. In this letter, Dr. Brateman listed plaintiffs problems as “1) ischemic heart disease, post myocardial infarction x2 with congestive heart failure; 2) motor vehicle accident 6/12/02 with closed head injury, memory impairment, and subsequent inability to work; 3) chronic vertigo, caused by the auto accident note above; 4) type I, diabetes mellitus; 5) CVA (stroke); 6) diabetic neuropathy; 7) hypertension; 8) traumatic brain injury, as above.” Plaintiff also signed a form dated December 15,2003, which said that he had signed medical releases at the local veterans’ office to release all his medical records and asked that his claim be processed on the basis of his medical records.

Plaintiff and his wife met several times with a VA representative. Several different VA doctors examined plaintiff. Plaintiffs wife testified that plaintiffs eligibility for VA benefits arose from plaintiffs service in Vietnam and exposure to Agent Orange, which was believed to be a causative factor in plaintiffs diabetes and related circulatory problems. At some point before September 15, 2004, the VA had evidently awarded plaintiff benefits, because on that date, the VA issued a decision increasing plaintiffs disability rating as follows:

DECISION

1. Evaluation of coronary artery disease status post two myocardial infarctions; with stent placement, which is currently 60 percent disabling, is increased to 100 percent effective November 19, 2002.
*725 2. Service connection for peripheral vascular disease of the right lower extremity is granted with an evaluation of 40 percent effective November 19, 2003.
3. Service connection for peripheral vascular disease of the left lower extremity is granted with an evaluation of 20 percent effective November 19, 2003.
4. Entitlement to special monthly compensation based on Housebound criteria being met is granted from November 19, 2002.
5. Evaluation of diabetic retinopathy, which is currently 0 percent disabling, is increased to 30 percent effective November 19, 2002. Entitlement to increased evaluation is deferred.
6. A decision on entitlement to compensation for Meniere’s syndrome is deferred.

The VA decision listed the evidence on which the decision was based: (1) claims file review, (2) the medical report of Dr. Bruce R. Garretson, dated August 13, 2004, and (3) outpatient treatment reports from the VA hospital in Detroit from January 13, 2004, through July 30, 2004.

Against this background, the major issue of this case was tried: Were plaintiffs inability to work and his need for attendant care causally related to injuries he received in the June 12, 2002, rollover accident, or had he recovered from any auto-accident injuries by November 2002 and subsequently become disabled by his preexisting diabetes-related diseases that gave rise to the 100 percent VA disability rating? Defendant’s theory of the case was the latter.

Free access — add to your briefcase to read the full text and ask questions with AI

Morales v. State Farm Mutual Automobile Insurance, 761 N.W.2d 454, 279 Mich. App. 720 (Mich. Ct. App. 2008).

761 N.W.2d 454 (Morales v. State Farm Mutual Automobile Insurance) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Zegary Allen v. Joyce Bogan
Michigan Court of Appeals, 2026
Leondra Reid v. Sheila Jackson Ellout
Michigan Court of Appeals, 2026
Marian Elder v. Baker's Propane Inc
Michigan Court of Appeals, 2026
Parminder K Khabra v. Avtar S Madahar
Michigan Court of Appeals, 2025
Kaveh Esmael v. Siyavoosh Shekoohfar
Michigan Court of Appeals, 2025
Jason Middleton v. Marinos Lawn Care LLC
Michigan Court of Appeals, 2025
John Brunner v. Concentrix Corporation
Michigan Court of Appeals, 2025
20250214_C365768_59_365768.Opn.Pdf
Michigan Court of Appeals, 2025
Mandy Pecher v. Josef Gregor Habscheid
Michigan Court of Appeals, 2023
Naveen Chandra Pasupuleti v. Ashley Murdaugh
Michigan Court of Appeals, 2022