Tzvih Tinman v. Blue Cross and Blue Shield of Michigan

CourtMichigan Court of Appeals
DecidedSeptember 24, 2015
Docket322601
StatusUnpublished

This text of Tzvih Tinman v. Blue Cross and Blue Shield of Michigan (Tzvih Tinman v. Blue Cross and Blue Shield of Michigan) 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
Tzvih Tinman v. Blue Cross and Blue Shield of Michigan, (Mich. Ct. App. 2015).

Opinion

STATE OF MICHIGAN

COURT OF APPEALS

ILENE TINMAN and MICHAEL TINMAN, as UNPUBLISHED next friends of TZVIH TINMAN, September 24, 2015

Plaintiffs-Appellees/Cross Appellants,

v No. 322601 Wayne Circuit Court BLUE CROSS AND BLUE SHIELD OF LC No. 99-932051-CK MICHIGAN,

Defendant-Appellant/Cross Appellee.

Before: K. F. KELLY, P.J., and CAVANAGH and SAAD, JJ.

PER CURIAM.

Defendant-appellant/cross appellee, Blue Cross and Blue Shield of Michigan (Blue Cross or BCBSM), appeals as of right an opinion and order awarding $876,885 in attorney fees to plaintiffs-appellees/cross appellants, Ilene Tinman and Michael Tinman, as next friends of Tzvih Tinman (plaintiff). We affirm in part, reverse in part, and remand for further proceedings.

I. BASIC FACTS AND PROCEDURAL HISTORY

This attorney fee dispute arises from litigation in which plaintiff claimed that Blue Cross improperly failed to pay hospital emergency bills that incurred for Tzvih’s medical care. Though the issues that confront us on appeal are rather straight forward, the long history of this case is not. In fact, this is the fourth time this case has been before this Court. See Tinman v Blue Cross & Blue Shield of Mich, 264 Mich App 54; 692 NW2d 58 (2004) (Tinman I); Tinman v Blue Cross & Blue Shield of Mich, unpublished opinion per curiam of the Court of Appeals, issued February 14, 2008 (Docket No. 268448) (Tinman II); and Tinman v Blue Cross & Blue Shield of Mich, unpublished opinion per curiam of the Court of Appeals, issued September 6, 2012 (Docket No. 298036) (Tinman III). Because the parties are familiar with the extensive history of this case, we need not provide a detailed recitation of facts.

Plaintiff sued Blue Cross after Blue Cross refused to pay for Tzvih’s emergency room visit, claiming that Blue Cross violated MCL 550.1418 by denying coverage based on Tzvih’s “final diagnosis” as opposed to his presenting symptoms. Because plaintiff believed that Blue Cross systematically denied coverage for emergency services on the basis of an insured’s final -1- diagnosis, plaintiff brought suit on his behalf as well as other Blue Cross insureds. Blue Cross then removed the case to federal court, where the federal court dismissed some of the ERISA claims. The federal court declined to address the issue of whether plaintiff’s action was properly brought as a class action. Tinman v Blue Cross & Blue Shield of Michigan, unpublished memorandum opinion and order of the United States District Court, Eastern District of Michigan, issued January 31, 2002 (Docket No. 00-CV-72327-DT). On remand to the Wayne Circuit Court from the federal district court, former Judge Warfield Moore certified the class. However, this Court reversed that order, finding that the individual questions of each plaintiff predominated over the common questions presented. Tinman I, 264 Mich App at 564-656. On remand from this Court to the Wayne Circuit Court, Judge Moore denied plaintiff’s attempt to certify a class for declaratory and equitable relief, which this Court affirmed in Tinman II. In the meantime, Judge Moore had granted plaintiff summary disposition. Plaintiff then sought attorney fees of over $900,000. An incomplete evidentiary hearing was held and Judge Stempien awarded plaintiff $655,000 in attorney fees and $2,440 in costs.

The matter then came to this Court for a third time in Tinman III. We found that the trial court abused its discretion in refusing to complete the evidentiary hearing regarding attorney fees. Tinman III, slip op, pp 4-7. We also concluded that the trial court’s analysis was insufficient to justify the award or enable meaningful appellate review, pointing to the trial court’s failure to make adequate findings regarding “the customary fee in the locality for each attorney, the number of hours reasonably expended by each attorney on plaintiff’s individual claim as opposed to their unsuccessful class-action claim, and the use of more than one attorney on the same general tasks.” Id. at 7. The Tinman III Court ordered the trial court to, on remand, “make more specific findings, consistent with Smith [v Khouri, 481 Mich 519, 530-533; 751 NW2d 472 (2008)] and Augustine [v Allstate Ins Co, 292 Mich App 408; 807 NW2d 77 (2011)], regarding [1] the customary fee in the locality for each attorney whose fees plaintiffs seek to recover, [2] the reasonable number of hours expended by each attorney, and [3] the reasonableness of having multiple attorneys working on the same general task.” Id. at 11.

Finally, the Tinman III Court addressed defendant’s claim that the trial court improperly applied the “catalyst theory” to its fee award: “In assessing whether plaintiffs’ baseline attorney fees were excessive in light of the size of the monetary judgment, the trial court abused its discretion in considering defendant’s voluntary changes to its emergency-claims procedures.” Id. at 11. Citing Buckhannon Bd and Care Home, Inc v West Virginia Dep’t of Health and Human Resources, 532 US 598; 121 S Ct 1835; 149 L Ed 2d 855 (2001), the Tinman III Court concluded that “the results achieved should be considered in the context of the claim presented, i.e., the substantive merits of the case, rather than a change in the defendant’s conduct that the trial court did not order.” Id.

The case then returned to the trial court and Judge Stempien, where the court conducted an exhaustive evidentiary hearing.

-2- John Zuccarini of the Simon firm testified that he was primarily responsible for keeping track of the hours spent on the Tinman case and class action.1 Zuccarini had been practicing law since 1988 and was an editor for the Wayne Law Review. Zuccarini explained that Simon was the firm’s owner and decided which cases to take. Wassman and Young were the principal attorneys who had primary responsibility for the Tinman case. The case was a collaborative effort, meaning that the attorneys met and talked about trial strategy. As a general rule, they would circulate complaints and briefs for review by other attorneys. Simon made it clear that all attorneys should enter their time contemporaneously with the work performed. Zuccarini would write his time on a piece of paper and have his secretary type it. For the Tinman case, there was no monthly summary, but the case was reviewed on a quarterly basis. Zuccarini denied that there was pressure to inflate the hours worked on the case.

Zuccarini testified to the extensive case history. There were 141 docket entries while the case was in federal court. In state circuit court, the entries through July 2008 alone numbered 259. He believed that the over 400 docket entries “jived” with the complexity of the case, whose file comprised several file cabinet drawers and 30 or more boxes. At least six different judges participated in some way with the case. Contrary to defense counsel’s statement, Zuccarini testified that a principle allegation in the Tinman case was that defendant had violated MCL 550.1418(1) by denying payment based on final diagnosis.

Zuccarini testified that, in drafting the complaint, a significant amount of time was spent anticipating and preparing for possible defenses. In its answer, defendant denied withholding benefits based on illegal criteria. Defendant did not admit that they based the denial on a final diagnosis, specifically stating that “Blue Cross did not deny Plaintiff’s claim or any alleged class claims on the basis of final diagnosis.” Even after the class was decertified, defendant never admitted to wrongdoing. In light of these denials, Zuccarini believed that he had to show that the allegations in the complaint were true – that defendant was “in fact systematically denying claims on the basis of final diagnosis.”

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

Related

Smith v. Khouri
751 N.W.2d 472 (Michigan Supreme Court, 2008)
Haliw v. City of Sterling Heights
691 N.W.2d 753 (Michigan Supreme Court, 2005)
City of Marysville v. Pate, Hirn & Bogue, Inc
492 N.W.2d 481 (Michigan Court of Appeals, 1992)
Tinman v. Blue Cross and Blue Shield
692 N.W.2d 58 (Michigan Court of Appeals, 2005)
Webb v. Smith
568 N.W.2d 378 (Michigan Court of Appeals, 1997)
Olson v. Olson
671 N.W.2d 64 (Michigan Court of Appeals, 2003)
Wood v. Detroit Automobile Inter-Insurance Exchange
321 N.W.2d 653 (Michigan Supreme Court, 1982)
Schumacher v. Department of Natural Resources
737 N.W.2d 782 (Michigan Court of Appeals, 2007)
City of Kalamazoo v. Department of Corrections
580 N.W.2d 475 (Michigan Court of Appeals, 1998)
Rodriguez v. General Motors Corp.
516 N.W.2d 105 (Michigan Court of Appeals, 1994)
In Re SMNE
689 N.W.2d 235 (Michigan Court of Appeals, 2004)
Sokel v. Nickoli
97 N.W.2d 1 (Michigan Supreme Court, 1959)
Augustine v. Allstate Insurance
807 N.W.2d 77 (Michigan Court of Appeals, 2011)
KBD & Associates, Inc. v. Great Lakes Foam Technologies, Inc.
816 N.W.2d 464 (Michigan Court of Appeals, 2012)
Duncan v. State
832 N.W.2d 761 (Michigan Court of Appeals, 2013)

Cite This Page — Counsel Stack

Bluebook (online)
Tzvih Tinman v. Blue Cross and Blue Shield of Michigan, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tzvih-tinman-v-blue-cross-and-blue-shield-of-michi-michctapp-2015.