Michigan Court of Appeals; Docket #358272; Unpublished
Judges Murray, Riordan, and Yates; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
Lawfully Rendered Treatment [§3157]
In this unanimous, unpublished, per curiam decision, the Court of Appeals reversed the trial court’s summary disposition order dismissing Plaintiffs Maple Manor Rehab Center of Novi, Inc. (“Maple Manor Rehab Center”) and Maple Manor Neuro Center, Inc.’s (“Maple Manor Neuro Center”) action for unpaid No-Fault PIP benefits against Defendant Allstate Insurance Company (“Allstate”). The Court of Appeals held that a question of fact existed as to whether the treatment at issue was provided by Maple Manor Rehab Center—a licensed health care provider—or Maple Manor Neuro Center—which was not a licensed health care provider and held itself out as merely the billing agent for Maple Manor Rehab Center. If provided by Maple Manor Rehab Center, the services would have been “lawfully rendered” for purposes of MCL 500.3157.
Drew Newell was injured in a motor vehicle accident, after which he received treatment from Maple Manor Rehab Center. Maple Manor Neuro Center was Maple Manor Rehab Center’s billing agent and submitted bills for Newell’s treatment to Allstate. Allstate refused to pay for Newell’s treatment, arguing that Maple Manor Neuro Center was the one rendering actual treatment to Newell, and since Maple Manor Neuro Center was not a licensed healthcare provider like Maple Manor Rehab Center, Newell’s treatment was not “lawfully rendered” for purposes of MCL 500.3157(1). Maple Manor Rehab Center and Maple Manor Neuro Center proceeded to jointly file suit against Allstate, and Allstate moved for summary disposition, arguing that there was no question of fact that Maple Manor Neuro Center was Newell’s treatment provider and that Maple Manor Rehab Center merely the location where the treatment was provided. In opposition to the motion, Maple Manor Rehab Center and Maple Manor Neuro Center presented (1) a copy of Newell’s admission agreement, which was signed by Newell and Maple Manor Rehab Center, (2) a health insurance claim form, which listed Maple Manor Neuro Center as both the billing agent and the service provider, and (3) an affidavit from Maple Manor Rehab Center’s HR director, Sheryl Villarose-Missaoui, in which she averred that “Maple Manor Rehab Center employed approximately 230 employees that provide the direct care and treatment of its patients, that Maple Manor Neuro Center had no employees or payroll to process, and that Maple Manor Neuro Center ‘cannot and does not provide any direct care or direct treatment to patients.’ ” Despite this evidence, trial court ruled that there was no question of fact that Maple Manor Neuro Center had provided Newell’s treatment and thus, granted Allstate’s motion.
The Court of Appeals reversed the trial court’s summary disposition order, holding that the evidence discussed above was more than sufficient to create was a question of fact as to which of the two entities—Rehab Center or Neuro Center—provided Newell’s treatment.
“Even if the trial court properly concluded that Allstate met its summary disposition burden by submitting evidence showing that Neuro Center was the rendering medical provider, the record reveals that Maple Manor did not ‘rest upon the mere allegations or denials,’ but by affidavits and other evidence ‘set forth specific facts showing that,’ at a minimum, ‘there [wa]s a genuine issue for trial.’ MCR 2.116(G)(4); see also Barnard, 285 Mich App at 377. In that regard, Maple Manor argued that the name on a medical record was not necessarily the legal provider and referred to the HR director’s affidavit, which stated that the provider was Rehab Center. Additionally, the medical records and invoices submitted by Allstate were at least in part contradicted by the admission agreement, the health insurance claim form, and Villarosa-Missaoui’s affidavit. With this conflicting evidence on this precise issue, we conclude that, at a minimum, there was a genuine issue of material fact regarding whether Neuro Center or Rehab Center provided the care to Newell.”
The Court further explained that if it was determined through trial that the services were actually provided by the licensed health care provider, Maple Manor Rehab Center, the service would not be unlawfully rendered for purposes of MCL 500.3157.