Michigan Court of Appeals; Docket #361090; Unpublished
Judges Redford, O’Brien, and Feeney; Per Curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion
STATUTORY INDEXING:
Entitlement to PIP Benefits: Arising Out of / Causation Requirement [§3105(1)]
Work Loss Benefits: Nature of the Benefit [§3107(1)(b)]
TOPICAL INDEXING:
Not Applicable
SUMMARY:
In this unanimous, unpublished, per curiam decision, the Court of Appeals reversed the trial court’s summary disposition order dismissing Plaintiff Felicia Edison’s action for no-fault PIP benefits against Defendant Nationwide General Insurance Company (“Nationwide”). Approximately one and a half months after Edison was injured in a motor vehicle accident, she developed atrial fibrillation unrelated to the accident. The Court of Appeals held that a question of fact existed as to whether Edison’s work loss and need for replacement services following her diagnosis of atrial fibriliation were attributable to the injuries she sustained in the accident, or whether they were attributable to her atrial fibrillation—in other words, whether Edison’s atrial fibrillation was an “independent superseding disability that extinguished her eligibility for PIP benefits” pursuant to MacDonald v State Farm Mut Ins Co, 419 Mich 146 (1984).
Felicia Edison was involved in a motor vehicle accident on July 2, 2019. The day of the accident, Edison received treatment at the emergency room and was diagnosed with injuries to her chest, abdomen, and pelvis. She received a disability certificate following the accident indicating that she was disabled from employment and household work due to “knee pain, neck pain, and lower back pain,” but she returned to work at her two jobs nonetheless, albeit taking off a few days due to pain. On August 24, 2019, Edison was hospitalized and diagnosed with atrial fibrillation unrelated to the accident, after which she stopped working both her jobs. She received disability certificates in August and September 2019 in which her doctor stated that she was disabled from employment and household work as a result of ‘multiple disc herniations cervical,’ ‘lumbar spine, and ‘complex tears in the meniscus, left knee’—all of which were accident related—but the first day she claimed work loss benefits, August 26th, was the third day of her hospitalization from atrial fibrillation. Edison remained off work and was hospitalized three more times between September 2019 and October 2020, by which time Nationwide stopped paying her work loss and replacement services benefits, claiming that her atrial fibrillation was an independent superseding disability pursuant to MacDonald v State Farm Mut Ins Co, 419 Mich 146. Edison proceeded to file suit against Nationwide, and during the course of litigation, she underwent an insurance medical examination in which the examiner concluded that Edison had suffered a meniscus tear as a result of the accident and that she should be restricted from “some potential work activities, ‘including lifting above 20-30 pounds or [a] significant amount of walking (more than 1000-2000 steps) secondary to her knee pain.’” In March 2021, Edison underwent a cardiac ablation surgery for her atrial fibrillation, through which time—and after which—she continued to claim work loss benefits from Nationwide. She continued to receive disability certificates as recently as September 2021 that indicated disability from employment and household work as a result of “knee pain, neck pain, and lower back pain.” Nationwide eventually moved for summary disposition with respect to Edison’s work loss and replacement services claims, and the trial court granted its motion, ruling that Edison’s atrial fibrillation was an independent superseding disability as a matter of law.
The Court of Appeals reversed the trial court’s summary disposition order, holding that a question of fact existed as to whether Edison’s atrial fibrillation was a true independent superseding disability or whether her disability from employment and household work (during the periods in which she was not hospitalized specifically for her atrial fibrillation) was attributable, instead, to her accident-related knee, back, and neck injuries. The Court noted that the record was “far from conclusive” on the issue of whether Edison’s atrial fibrillation was totally disabling, and also that there was considerable evidence to suggest that, outside of the periods during which she was actually hospitalized for her atrial fibrillation, the reasons for her disability from employment and household work were her other, accident-related injuries.
Here, Nationwide contends that plaintiff’s atrial fibrillation condition was completely disabling, terminating any eligibility for PIP disability benefits resulting from plaintiff’s accident injuries. However, the record is far from conclusive in establishing this contention. Though plaintiff returned to work in the period between the accident and the onset of her atrial fibrillation, she has testified that she was in pain at work during this period and took some days off. Plaintiff has also stated that her physical limitations, specifically her inability to lift and use stairs, prevented her from managing the rental properties associated with F&Q.
Though the sequence of events and some additional testimony by plaintiff suggest that atrial fibrillation independently established plaintiff’s disability, the record contains medical documentation which refutes this, including: (1) several disability certificates indicating disability from work and household chores as early as mid-July 2019, based specifically on the diagnoses of knee pain, neck pain, and lower back pain, with no mention of atrial fibrillation; (2) FMLA paperwork completed after the onset of atrial fibrillation, documenting plaintiff’s disability from work activities caused by plaintiff’s neck, back, and knee injuries, and not listing atrial fibrillation as a cause; and (3) the IME paperwork indicating lifting and walking restrictions because of plaintiff’s knee pain, but not mentioning any disability from her atrial fibrillation. Though plaintiff cannot establish a disability until she was actually unable to work, MacDonald, 419 Mich at 152, considering the evidence in the light most favorable to plaintiff, a question of fact remains whether there were periods of disability caused by the accident injuries alone, even after the onset of plaintiff’s atrial fibrillation condition, and whether the atrial fibrillation was an independent or unrelated occurrence causing a superseding disability under MacDonald.
As highlighted by plaintiff on appeal, it seems that the trial court’s review of the documentary evidence submitted by the parties was incomplete. For instance, the trial court’s statement that plaintiff’s initial disability certificate ‘was devoid of any indication of the reason for the disability (e.g., knee, chest bruising, etc.)’ ignores that the diagnostic codes on that
certificate listed the reasons for plaintiff’s disability as knee pain, neck pain, and lower back pain.4 The more fundamental error in the trial court’s opinion, however, is its conclusion that plaintiff’s disability was caused by the atrial fibrillation, such that plaintiff had to produce evidence showing that the atrial fibrillation was caused by the accident in order to receive PIP benefits. As explained, while there is evidence in the record to support this conclusion, plaintiff has produced numerous medical records showing that plaintiff’s disability is attributable to her neck, back, and knee injuries, not atrial fibrillation. When all of the evidence is viewed in the light most favorable to plaintiff, a question of fact remains as to the cause of plaintiff’s disability.
At the conclusion of its analysis, the Court emphasized that even if Edison was temporarily disabled as a result of her atrial fibrillation, that would not necessarily preclude her eligibility for PIP benefits. As the Supreme Court held in Marquis v Hartford Accident & Indemnity, 444 Mich 638 (1994), “some superseding causes only suspend eligibility for work-loss benefits (emphasis added”—as opposed to permanently cutting off eligibility for work-loss benefits.
“Plaintiff further argues that the fact that her atrial fibrillation temporarily disabled her does not necessarily preclude her eligibility for PIP. We agree. Our Supreme Court addressed the temporary effects of some superseding events in Marquis v Hartford Accident & Indemnity, 444 Mich 638; 513 NW2d 799 (1994). Notably, the Michigan Supreme Court recognized in its legal analysis that some superseding causes only suspend eligibility for work-loss benefits; one example recognized in previous caselaw being incarceration. Id. at 649. Here, there are no medical records indicating that atrial fibrillation was permanently disabling by itself, or even disabling for periods of time beyond the specific occurrences and hospitalizations which resulted from the condition. Medical records show that plaintiff was: (1) hospitalized for the condition for three days in August 2019; (2) had to visit the hospital again in December 2019, for an allergic reaction to the loop recorder implanted to monitor the fibrillation; (3) had another atrial fibrillation episode in February 2020 for which she was admitted to the hospital; (4) had two emergency room visits for the condition between February 2020 and October 2020; and (5) underwent cardiac ablation in March 2021. Though this is evidence that plaintiff suffered from a serious medical condition during this period, plaintiff’s medical records do not contain any statements regarding any activity restrictions or other disability caused by her atrial fibrillation. Even the IME did not result in any finding of disability from plaintiff’s atrial fibrillation; it found that plaintiff’s lifting and walking restrictions were because of plaintiff’s knee pain. Thus, there is support in the record for plaintiff’s contention that her atrial fibrillation was episodic in nature, lending itself to the framework of a potential temporary interruption for no-fault benefit eligibility, and not the complete termination of this eligibility.”
