Oaklawn Hospital v. Auto-Owners Insurance Company

CourtMichigan Court of Appeals
DecidedJuly 30, 2019
Docket343189
StatusUnpublished

This text of Oaklawn Hospital v. Auto-Owners Insurance Company (Oaklawn Hospital v. Auto-Owners Insurance Company) 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
Oaklawn Hospital v. Auto-Owners Insurance Company, (Mich. Ct. App. 2019).

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

OAKLAWN HOSPITAL, UNPUBLISHED July 30, 2019 Plaintiff-Appellant,

v No. 343189 Calhoun Circuit Court AUTO-OWNERS INSURANCE COMPANY and LC No. 17-001283-NF HOME-OWNERS INSURANCE COMPANY,

Defendants-Appellees.

Before: O’BRIEN, P.J., and FORT HOOD and CAMERON, JJ.

PER CURIAM.

Plaintiff appeals as of right from the trial court’s order granting summary disposition in favor of defendants in this action in which plaintiff, a medical provider, seeks payment of personal protection insurance (PIP) benefits pursuant to the no-fault act, MCL 500.3101 et seq. We affirm.

I. BACKGROUND

Plaintiff filed its complaint in this case on May 8, 2017. Plaintiff alleged that defendants’1 insured, Daniel Dothsuk, was injured in a motor vehicle collision on October 2, 2004. Plaintiff further alleged that it provided professional medical services to Dothsuk during various dates in 2016 and 2017, and its charges for providing such services amounted to

1 While both Auto-Owners Insurance Company and Home-Owners Insurance Company are named as parties in this case, in its brief on appeal plaintiff states that Auto-Owners is the responsible no-fault insurer in this case, and defendants throughout their brief on appeal also refer only to Auto-Owners as the responsible party. In their renewed motion for summary disposition, defendants submitted a no-fault policy issued by defendant Auto-Owners. For purposes of clarity of analysis, we will refer to defendants in the plural, unless it is necessary to refer individually to defendant Auto-Owners.

-1- $489,209.98. After requesting that defendants pay for these medically necessary services rendered to Dothsuk, defendants refused. Alleging a claim under Michigan’s no-fault act “and the applicable insurance contract,” plaintiff sought payment of PIP benefits. In lieu of filing an answer, on June 12, 2017, defendants moved for summary disposition under MCR 2.116(C)(8), arguing that plaintiff did not have an independent cause of action against defendants under the no-fault act in light of the Michigan Supreme Court’s decision in Covenant Med Ctr v State Farm Mut Aut Ins Co, 500 Mich 191; 895 NW2d 490 (2017). The parties then engaged in discovery.

Plaintiff subsequently filed a motion seeking leave to amend its complaint on September 18, 2017. In its brief in support, plaintiff acknowledged that post-Covenant, it did not have a statutory cause of action against defendants under the no-fault act. However, plaintiff alleged that Dothsuk assigned to plaintiff the right to pursue no-fault benefits against defendants under the applicable no-fault policy. In support of its motion, plaintiff included a document entitled “Consent Upon Admission to Oaklawn Hospital for Medical Treatment” signed by Dothsuk on June 23, 2016.2

Plaintiff also requested leave to amend its complaint to allege that defendants breached a contract with Preferred Provider Organization of Michigan (PPOM), now known as Cofinity, to which defendants were parties. On the same date, plaintiff filed a response to defendants’ motion for summary disposition, acknowledging that following Covenant, it could not proceed with a direct action against defendants under the no-fault act. However, plaintiff urged the trial court to grant its motion seeking leave to amend its complaint to allege claims arising from Dothsuk’s assignment to plaintiff, as well as claims arising from the applicable Cofinity contracts. During a hearing held on September 25, 2017, the trial court granted plaintiff’s motion to amend its complaint and stated that defendants’ motion for summary disposition would be held in abeyance. On October 4, 2017, the trial court entered an order granting plaintiff’s motion for leave to amend its complaint and holding defendants’ motion for summary disposition in abeyance.

Plaintiff filed its seven-count first amended complaint on October 12, 2017, alleging one count seeking payment of PIP benefits under the no-fault act, two counts proceeding under an assignment theory, three counts alleging breach of contract and a count seeking declaratory relief pursuant to MCR 2.605. On February 2, 2018, defendants filed a renewed motion for summary disposition pursuant to MCR 2.116(C)(8) and (C)(10). Defendants argued that because Covenant clearly held that medical providers could not pursue an independent cause of action against a no-fault insurance company under the no-fault act, the counts in the first amended complaint that sought an independent cause of action against defendants should be dismissed. Defendants also contended that the consent for treatment forms that Dothsuk signed were not valid assignments authorizing plaintiff to receive payment from defendants for medical services rendered to Dothsuk.

2 Plaintiff also included identical forms signed by Dothsuk dated December 2, 2016, January 13, 2017, January 24, 2017, February 7, 2017, and February 16, 2017.

-2- Defendants also pointed out that even if the trial court were to accept plaintiff’s assertion that the consent to treatment forms were assignments, MCL 500.3143 prohibits assignments of rights to no-fault benefits payable in the future. Defendants also asserted that the alleged assignments were invalid because the no-fault insurance policy expressly prohibited the assignment of benefits without the consent of the no-fault insurer. According to defendants, the alleged assignments were also invalid because Michigan law does not allow for the splitting of a single cause of action into multiple causes of action. Finally, defendants maintained that plaintiff’s reliance on the Cofinity contracts to pursue a cause of action against defendants was unsuccessful because the documents set forth the rates that plaintiff could charge for medical services, but did not guarantee payment, and the no-fault insurer reserved the right to determine if benefits should be paid pursuant to the no-fault policy.

Plaintiff filed its response opposing defendants’ motion for summary disposition on February 21, 2018. In its brief in support, plaintiff maintained that because several counts in the first amended complaint were grounded in contract, rather than the no-fault act, defendants’ attempt to portray these claims as no-fault statutory claims was without merit. Plaintiff also pointed out that defendants’ motion for summary disposition was premature because defendants had not yet produced the Cofinity contracts at issue in spite of discovery requests concerning the contracts. Plaintiff argued that full review of the Cofinity contracts was necessary because several of the counts in the first amended complaint alleged breach of the contracts and an additional count alleged that plaintiff was a third-party beneficiary of the contracts. Plaintiff went on to contend that the trial court could not grant summary disposition on the basis of the existing record without the Cofinity contracts because the express language of the contracts required defendants to tender payment for Dothsuk’s medical treatment.

Plaintiff also argued that the counts in the first amended complaint based on an assignment theory should not be dismissed because Dothsuk executed valid assignments in favor of plaintiff allowing it to recover no-fault benefits from defendant.

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Bluebook (online)
Oaklawn Hospital v. Auto-Owners Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/oaklawn-hospital-v-auto-owners-insurance-company-michctapp-2019.