Nancy Gucwa v. Accident Fund Insurance Company of America

CourtMichigan Court of Appeals
DecidedNovember 9, 2021
Docket355501
StatusUnpublished

This text of Nancy Gucwa v. Accident Fund Insurance Company of America (Nancy Gucwa v. Accident Fund Insurance Company of America) 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
Nancy Gucwa v. Accident Fund Insurance Company of America, (Mich. Ct. App. 2021).

Opinion

If this opinion indicates that it is “FOR PUBLICATION,” it is subject to revision until final publication in the Michigan Appeals Reports.

STATE OF MICHIGAN

COURT OF APPEALS

NANCY GUCWA, Individually and as Guardian of UNPUBLISHED MARK MARUSZA, November 9, 2021

Plaintiff-Appellant,

v No. 355501 Wayne Circuit Court ACCIDENT FUND INSURANCE COMPANY OF LC No. 19-016743-NO AMERICA,

Defendant-Appellee.

Before: STEPHENS, P.J., and SAWYER and SERVITTO, JJ.

PER CURIAM.

Plaintiff, individually and as guardian of Mark Marusza, appeals as of right the trial court’s order granting summary disposition in favor of defendant in this worker’s compensation dispute. On appeal, plaintiff argues the trial court erred in dismissing plaintiff’s claims for exemplary and punitive damages after defendant breached its contractual and statutory duty by refusing to pay worker’s compensation benefits to Marusza. In addition, plaintiff argues the intentional infliction of emotional distress (IIED) claims were not barred by the statutes of limitations, and the trial court erred in concluding that the IIED claims were barred by res judicata and that plaintiff failed to establish the IIED claims. We disagree and affirm.

I. FACTS AND PROCEDURAL BACKGROUND

This case arises from a 2011 motor vehicle accident, in which a vehicle struck Marusza as he was crossing a street. At the time of the accident, Marusza was acting in the course and scope of his employment with Detroit Intermodel Transport, Inc., who had a worker’s compensation insurance policy with defendant. Marusza v Sanders, unpublished per curiam opinion of the Court of Appeals, issued on May 14, 2020 (Docket Nos. 348269; 348355), p 1. As a result of the accident, Marusza suffered a traumatic brain injury (TBI) and injuries to his shoulders, cervical spine, and ribs. Gucwa v Lawley, 731 F Appx 408, 410 (CA 6, 2018). After his release from the hospital, Marusza’s significant other, plaintiff, provided attendant care services for his injuries,

-1- and Marusza expressly agreed to pay plaintiff for her care. Id. Since the accident, defendant paid some, but not all, of Marusza’s medical expenses. The following is a description from the Sixth Circuit’s opinion in a previous suit involving defendant and is used for background purposes:

[Defendant] initially paid Marusza’s claims for Gucwa’s care but terminated payment in July 2012. [Defendant] retained the four defendant physicians—Dr. Jeffrey Lawley, Dr. Harvey Ager, Dr. W. John Baker, and Dr. Barry Rubin—[to conduct Independent Medical Evaluations (IMEs) and] to examine Marusza’s disability. Following the doctors’ reports, [defendant] refused to pay for certain treatments, including drugs to control injury-induced aggression, psychiatric hospitalization, pain medication, attendant care, physical therapy, doctors’ visits, nurse case management, and surgeries for his neck, back, and shoulders. Marusza alleged that Medicare paid $15,665.00 of [his] treatment costs which [defendant] had refused to cover. [Id. at 410-411.]

As a result, plaintiff took a number of steps seeking payment for Marusza’s medical expenses.

In 2015, plaintiff and Marusza sued defendant and the IME doctors in federal district court. Gucwa v Lawley, unpublished opinion of the United States District Court for the Eastern District of Michigan, issued January 23, 2017 (Case No. 15-10815). Plaintiff and Marusza alleged, in part, that defendant defrauded them in violation of the Racketeer Influenced and Corrupt Organizations Act (RICO), 18 USC 1960 et seq., violated the Medicare Secondary Payer Act (MSPA), 42 USC 1395y et seq., and falsely imprisoned Marusza by requiring him to attend an IME with a neuropsychologist. Id. at 3. Meanwhile, plaintiff and Marusza submitted claims to the Worker’s Compensation Board of Magistrates (WCBM). Id. at 1; Marusza, unpub op at 1. On May 23, 2016, the worker’s compensation magistrate ordered defendant to pay worker’s compensation benefits to Marusza, and any reasonable and necessary medical treatment for Marusza’s work- related injury, finding Marusza sustained a mild TBI and other injuries from the motor vehicle accident that required ongoing medical treatment. Gucwa, unpub op at 1-2. After the WCBM’s order, the federal district court dismissed plaintiff and Marusza’s complaint, which the Sixth Circuit affirmed on appeal. Gucwa, unpub op at 8; Gucwa, 731 F Appx at 417-418. Specifically, the federal courts concluded plaintiff and Marusza’s RICO claim failed because Marusza’s personal injury, underlying his worker’s compensation claim, did not “constitute an injury to business or property that is recoverable under RICO.” Gucwa, 731 F Appx at 412.

In 2017, plaintiff and Marusza’s coguardian, Jeffrey Fried, filed suit in the Wayne Circuit Court against defendant. Fried v Sanders, 783 F Appx 532, 534 (CA 6, 2019). Plaintiff and Fried alleged that Marusza suffered IIED, since 2012, because of defendant’s refusal to, at times, pay for Gucwa’s attendant care without medical evidence to the contrary, defendant’s selection of IME doctors that it knew or hoped would produce dishonest reports, which would allow defendant to deny worker’s compensation benefits to Marusza, and defendant’s refusal to pay for Marusza’s medical expenses. Plaintiff and Fried also alleged defendant violated MCL 500.2006 for a failure to timely pay the WCBM’s award or Marusza’s medical expenses and sought enforcement of the WCBM’s order. Fried, 783 F Appx at 534. Plaintiff and Fried then filed an amended complaint, adding a RICO claim against defendant for “mail and wire fraud in a pattern of racketeering.”

-2- After plaintiff and Fried amended the complaint, defendant removed the case to federal district court, alleging federal-question jurisdiction. Fried v Sanders, unpublished opinion of the United States District Court for the Eastern District of Michigan, issued November 27, 2018 (Case No. 17-14006), p 1. After denying plaintiff and Fried’s requests to amend the complaint to remove reference to federal law violations and to strengthen the IIED allegations, the federal district court dismissed the IIED claim and remanded the remaining claims to the trial court. Id. at 3-4. Relevant to this appeal, the federal district court stated:

[The parties’] theory is that the conspiracy between [defendant] and the [IME doctors] created a RICO cause of action . . . and a criminal violation of federal mail and wire fraud statutes, both of which in turn constituted sufficiently outrageous conduct as to satisfy the first prong of an IIED. The RICO claim was foreclosed by [Gucwa], however, and though the use of mail and wire may elevate fraud to a federal crime, [the parties] articulate no reason why such a federal nexus should, by itself, elevate fraud from its own tort to an element of an IIED. . . . [E]ven if [the] claim were well-pled, it would be barred by claim preclusion because [p]laintiffs Gucwa and Marusza already had opportunity to litigate their denial of benefits up to the filing of their 71-page second amended complaint on April 22, 2016. . . . To the extent the tort is continuing, it is continuing as a dispute over what constitutes “reasonable and necessary treatment of [Marusza’s] employment related injury,” pursuant to the [WCBM’s order]. [The] IIED claim is thus facially insufficient[.] [Id. at 2 (citation omitted).]

In dismissing the IIED claim, federal district court concluded it lost federal question subject-matter jurisdiction, and declined to assert supplemental jurisdiction over the worker’s compensation enforcement claims. Id. at 3. The Sixth Circuit determined the federal district court lacked jurisdiction over each of the claims and remanded to the district court “with instructions to dismiss all claims without prejudice.” Fried, 783 F Appx at 537.

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Nancy Gucwa v. Accident Fund Insurance Company of America, Counsel Stack Legal Research, https://law.counselstack.com/opinion/nancy-gucwa-v-accident-fund-insurance-company-of-america-michctapp-2021.