Villaflor v. State Farm Mutual Automobile Insurance

343 F. App'x 33
CourtCourt of Appeals for the Sixth Circuit
DecidedAugust 19, 2009
Docket07-1663
StatusUnpublished
Cited by1 cases

This text of 343 F. App'x 33 (Villaflor v. State Farm Mutual Automobile Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Villaflor v. State Farm Mutual Automobile Insurance, 343 F. App'x 33 (6th Cir. 2009).

Opinion

*34 OPINION

WHITE, Circuit Judge.

Defendant State Farm Mutual Automobile Insurance Company appeals the district court’s order granting plaintiff Ricardo Villaflor (Villaflor)’s post-trial request for attorney fees pursuant to section 3148 of Michigan’s No-Fault Insurance Act, Mich. Comp. Laws § 500.3148, and its denial of defendant’s motion for fees under the same provision. Finding no abuse of discretion, we AFFIRM.

BACKGROUND

On January 19, 1994, Ricardo Villaflor was involved in a serious automobile accident when he drove his car into the rear end of a semi truck that was stalled on the freeway. He was unconscious at the scene, suffered very bad facial and chest injuries, and had to be extracted from his vehicle with the jaws of life. The accident left him with a traumatic brain injury. He has been unable to return to his job working as a hibachi-style chef at a Japanese steakhouse, and is treated regularly for his continuing medical issues by a psychiatrist. Plaintiffs wife, Editha Villaflor (Mrs. Vil-laflor), previously worked at a nursing home as a licensed practical nurse, but stopped soon after her husband’s accident in order to take care of him, which she has done ever since.

At the time of the accident, plaintiff was insured under a no-fault automobile insurance policy issued by State Farm. At various times, State Farm paid attendant care benefits to Villaflor due to the injuries he suffered. 1 State Farm understood that Mrs. Villaflor was providing the attendant care for which it was paying. At other times, State Farm stopped paying benefits, requiring Villaflor to bring suit so that payments would resume. Prior to the instant suit, Villaflor filed three lawsuits against State Farm to recover overdue attendant care benefits — in 1994,1997, and 1998. Each prior suit concluded with State Farm paying Villaflor’s accrued attendant care benefits.

Between 1998 and 2003, State Farm did not ask Mrs. Villaflor to detail the services she was providing to her husband. Rather, the 1998 lawsuit was resolved with an agreement that State Farm would pay attendant care benefits at a daily rate of $250, and State Farm paid benefits accordingly. Bonnie Childs, the claims representative at State Farm who had assumed responsibility for plaintiffs claim in 1998, maintained an activity log for Villaflor’s claim as part of Villaflor’s file. A log entry dated September 5, 2002 states in pertinent part that Villaflor is “unable to work since the accident,” “his wife does [attendant] care at $250 a day” and “this was not broken down into hours since it can vary as his daily needs vary.” 2 This entry also *35 states that Villaflor “has a [closed head injury], emotional problems, increased irritability, sleep is poor, is easily disturbed by noises.... Per rec[o]rds just rec[eive]d from Dr[.] Sh[ie]ner, Ricardo continues to need [attendant] care.” The log recounted that Villaflor had suffered a “traumatic injury to the brain [and] had [loss of consciousness] of several hours” due to the accident, and that his “current medical problems and head injury are related to the injuries received in this accident.” In recounting the services Villaflor required, the entry states that “he needs [attendant] care/[supervisory] care due to his [traumatic brain injury] and emotional problems. We have a recent note from Dr[.] Sh[ie]ner that he continues to need this care for his safety.” The stated “clinical outcome” was that “he continues to need counseling and aide care. He needs someone to [supervise] him for his safety.”

In 2003, State Farm arranged for videotaped surveillance of plaintiffs activities on portions of various days. State Farm interpreted the surveillance footage as undermining plaintiffs claim for attendant care:

The surveillance videos ... revealed that Plaintiff was not, in fact, receiving 24-hour-a-day attendant care; that Plaintiff was apparently operating and performing in a music business; that Plaintiff was capable of operating a large conversion van, not owned by him prior to the accident; that Plaintiff was able to operate that van, both forward and backward, with a trailer attached; that Plaintiff could apparently direct others in activities; that Plaintiff was allowed to chauffeur his children to and from school; that Plaintiff was driving over long distances; that he was driving without his wife in the van or the Esca-lade, and that Plaintiff was engaging in recreational basketball with apparent ease and coordination. [3]

State Farm asserts that it perceived a number of “inconsistencies” between the surveillance videos and the claim file. First, it contends that State Farm was paying for care on a 24-hour per day basis, but Villaflor was not receiving such care. Second, it argues it believed plaintiff could not drive alone, but the video showed he was doing so. Third, it concluded plaintiffs playing golf, playing with a band, and going to a gym were inconsistent with a report that his I.Q. was 64.

On June 30, 2003, Childs sent a letter to Dr. Gerald Shiener, who had been treating Villaflor, to request an update regarding Villaflor’s condition and treatment. She did not disclose that surveillance had recently been conducted. In a letter to State Farm dated July 7, 2003, Dr. Shiener responded in part that “[i]n response to [the] additional request for information,” he would “remind [her] that [she] requested a copy of [his] chart very recently” and that he “ha[s] been providing [her] with regular documentation and updates regarding Mr. Villaflor’s condition.” He wrote that Villaflor “has required ongoing 24 hour attendant care for poor impulse control and poor judgement.” He further wrote that his “proposed treatment plan ... is to continue to provide him with supportive psychotherapy aimed at helping him deal with his loss of independence and loss of ability to function as a provider and breadwinner for his family. His impairments are apparent to him and he is demoralized at the prospect of ongoing dis *36 ability.” He stated that Villaflor’s “need for medical attendant care is ongoing and continuous. He needs regular supervision on a 24 hour basis daily, 7 days a week. He needs supervision while awake because his judgement is impaired. He does not know his limitations.... He will wake up in the night, wander around the house, and engage in high risk activities that are dangerous to him and the family.” Dr. Shiener concluded that Villaflor’s need for constant supervision “continues to exist,” and noted his belief that Villaflor “cannot drive alone, and is not safe spending time alone during the day because of his poor impulse control and impaired judgment.” He observed that Villaflor’s wife has provided “numerous examples of the patient’s need for supervision and the difficulty that she has in addressing his problems with irritability and impulsive behavior.” 4 Dr. Shiener’s prognosis was guarded: “I do not feel that he will get better” and “I expect that in his late 40s or early 50s his cognitive function will begin to decline and his need for attendant care, supervision, and supportive services will increase.”

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Cite This Page — Counsel Stack

Bluebook (online)
343 F. App'x 33, Counsel Stack Legal Research, https://law.counselstack.com/opinion/villaflor-v-state-farm-mutual-automobile-insurance-ca6-2009.