Michigan Court of Appeals; Docket #360172; Unpublished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In this unanimous, unpublished, per curiam decision, the Court of Appeals reversed the trial court’s summary disposition order dismissing Plaintiffs Maple Manor Rehab Center of Novi, Inc.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 Progressive Michigan Insurance (“Progressive”). 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.
Shirly Soifer was injured in a motor vehicle accident, after which she 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 Progressive. Progressive refused to pay for Soifer’s treatment, arguing that Maple Manor Neuro Center was the one rendering actual treatment to Soifer, and since Maple Manor Neuro Center was not a licensed healthcare provider like Maple Manor Rehab Center, Soifer’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 Progressive, and Progressive moved for summary disposition, arguing that there was no question of fact that Maple Manor Neuro Center was Soifer’s treatment provider, and Maple Manor Rehab Center merely the location where the treatment was provided. Progressive supported its motion with (1) “a multipage report from Maple Manor . . . showing Neuro Center as the ‘Rendering Provider’ and Rehab Center as the ‘Location Name’”; and (2) the trial court’s decision in a similar case involving Maple Manor Rehab Center, Maple Manor Neuro Center, and Allstate. In opposition to the motion, Maple Manor Rehab Center and Maple Manor Neuro Center presented (1) an affidavit from Maple Manor’s administrator/medical director regarding a different patient, in which the administrator/medical director referenced ‘charges submitted by Maple Manor Neuro on behalf of Maple Manor Rehab’; and (2) 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 Soifer’s treatment, and granted Progressive’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— Maple Manor Rehab Center or Maple Manor Neuro Center—provided Soifer’s treatment.
“In light of this record, we hold that although Progressive met its initial burden by providing evidence to support its argument that Neuro Center was the rendering 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 as to any material fact” on the issue. MCR 2.116(G)(4); see also Barnard, 285 Mich App at 377. As recounted above, the parties created a record that contains conflicting evidence on the dispositive issue, and therefore, at a minimum, there was a genuine issue of material fact regarding whether Neuro Center or Rehab Center provided medical services to Soifer.”
The Court explained that if it was determined through trial that the services were actually provided by the licensed health care provider, Maple Manor Rehab Center, they would not be unlawfully rendered for purposes of MCL 500.3157.