Michigan Court of Appeals; Docket #357617; Unpublished
Judges Cavanagh, Garrett, and Yates; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
Entitlement to PIP Benefits: Arising Out Of / Causation Requirement [§3105(1)]
In this unanimous, unpublished, per curiam decision, the Court of Appeals affirmed the trial court’s summary disposition order dismissing Plaintiff Garden City Rehab, LLC’s (“Garden City Rehab” or “Garden City”) first-party action against Defendant Integon National Insurance Company (“Integon”). The Court of Appeals held that Garden City Rehab failed to present sufficient evidence to create a question of fact as to whether Montana Sams, its patient assignor/Integon’s insured, was injured as a result of the subject motor vehicle accident for purposes of MCL 500.3105.
Montana Sams alleged that he sustained injuries in a motor vehicle accident that occurred on May 6, 2019. The day after the accident, Sams went to his doctor complaining of pain in his shoulders, right leg, lumbar spine, and thoracic spine. His doctor referred him for physical therapy at Garden City Rehab, and at some point thereafter, Sams underwent MRIs of his right knee, right hip, and spine. The MRIs revealed no injuries to Sams right knee or hip, and only a small central disc protrusion in Sams’s lumbar spine—which was also visualized in an MRI Sams underwent two weeks prior to the alleged accident. After providing phsycial therapy services to Sams, Garden City Rehab obtained an assignment from Sams and pursued no-fault PIP benefits related to its services from Integon, Sams’s no-fault insurer. Integon denied Garden City’s claim based on Sams’s failure to participate in its investigation of the accident, which it found suspicious, considering that Sams alleged to have been involved in a similar accident less than one month earlier, “which occurred in the same general location and involved one of the same vehicles and many of the same drivers or passengers.” Moreover, none of the individuals involved in either accident submitted for an examination under oath. Integon moved for summary disposition in Garden City’s resultant first-party action against it, arguing (1) that Sams (and, therefore, his assignee(s)) was ineligible for PIP benefits related to the accident based on his failure to participate in Integon’s investigation of his claim, and (2) that Garden City presented insufficient evidence to create a question of fact as to whether Sams actually sustained any injury as a result of the alleged accident. In response to Integon’s motion, Garden City submitted only a report from Sams’s physical therapy initial evaluation, which “reflect[ed] that Sams vistited his doctor on the day after [the motor vehicle accident] with complaints of severe pain [in his shoulders, right leg, and the lumbar and thoracic regions of his spine] and was referred to physical therapy.” Notably, the date of the accident on the physical therapy report was May 5, 2019, whereas the date on the police report Sams and other individuals involved in the alleged accident submitted information for was May 6, 2019. The trial court proceeded to grant Integon’s motion, relying especially on the pre- and post-accident MRI reports.
The Court of Appeals affirmed the trial court’s summary disposition order, holding that Garden City failed to present sufficient evidence to create a question of fact as to whether Sams sustained any injury arising out of the subject accident. The report from Sams’s physical therapy initial evaluation, in and of itself, was not sufficient, because its attribution of Sams’s injuries or symptoms to the accident is inadmissible hearsay. The Court also found further support for its holding in the that the negative MRI findings after the accident.
“The record evidence concerning the accident is extremely limited. The traffic-crash report submitted by defendant reflects the circumstances of the accident as described by those involved. The report states that there were no injuries, and, likewise during his deposition, the responding police officer was unable to recall anyone complaining of injuries. Responding to the motion, plaintiff brought forth a ‘Physical Therapy Initial Evaluation’ report completed on May 9, 2019. The report reflects that Sams visited his doctor on the day after a May 5, 2019,1 motor-vehicle accident with complaints of severe pain and was referred to physical therapy. The report goes on to describe Sams’s complaints of pain in his shoulders, right leg, and the lumbar and thoracic regions of his spine. As defendant argues, the report cannot be used to prove that a motor vehicle accident occurred, as such a statement would be inadmissible hearsay falling outside of the exception in MRE 803(4) (statements made for purposes of medical treatment or diagnosis), leaving as acceptable evidence on summary disposition only the portions concerning Sams’s symptoms. See Merrow v Bofferding, 458 Mich 617, 630; 581 NW2d 696 (1998).
But the implication that Sams sustained injuries in the alleged May 6, 2019, accident is negated by the MRI imaging reports produced by defendant. The MRIs taken after the accident reflect no evidence of injury to Sams’s right knee or hip, and only a small central disc protrusion in his lumbar spine. The same disc protrusion was also visualized in an MRI of the same area from April 17, 2019—approximately two weeks before the May 6, 2019, accident. An additional MRI from April 17, 2019, also identified a hernia in Sams’s cervical spine. These records sufficiently rebut the implication that the injuries for which plaintiff provided treatment were caused by the May 6, 2019, accident. Accordingly, the trial court did not err by determining that plaintiff failed to create a genuine issue of material fact as to whether Sams’s injuries arose from the May 6 accident and, therefore, that plaintiff’s treatment of those injuries lacked the required causal connection to establish defendant’s liability. Lowrey, 500 Mich at 5; Griffith, 472 Mich at 531.”