United States District Court, Eastern District of Michigan; Case #13-cv-13045
Hon. Matthew F. Leitman
Official Michigan Reporter Citation: Not Applicable; Opinion Not Available 
STATUTORY INDEXING:
Allowable Expenses for Attendant Care [§3107(1)(a)]
Work Loss Benefits: Nature of the Benefit [§3107(1)(b)]
Replacement Service Expense Benefits: Nature of the Benefit [§3107(1)(c)]
Reasonable Proof Requirement [§3142(2)]
Requirement That Benefits Were Overdue [§3148(1)]
TOPICAL INDEXING:
Not Applicable
CASE SUMMARY:
In this Federal written Opinion, Judge Matthew F. Leitman held that plaintiff presented sufficient evidence to support his claims for: 1) family-provided attendant care; 2) commercially-provided attendant care; 3) work loss benefits; and 4) household replacement services, and therefore plaintiff was entitled to partial summary judgment on these claims. Judge Leitman further held that defendant’s failure to pay these benefits within 30 days rendered them overdue pursuant to MCL 500.3142(2), and also that defendant’s refusal to pay was “unreasonable” such that plaintiff was entitled to penalty attorney fees under MCL 500.3148(1).
Plaintiff in this case was ejected from a vehicle and suffered serious spinal injuries that resulted in permanent quadriplegia. After the accident, family members (mainly plaintiff’s mother) provided plaintiff attendant care services, as well as a commercial home health-care services provider. Plaintiff sought no-fault benefits from defendant QBE Insurance. Plaintiff’s claims included amounts for family-provided attendant care; commercially-provided attendant care; work loss; and household replacement services. QBE objected to the amounts that plaintiff claimed for these benefits, arguing the benefits were duplicative and lacked evidentiary support. However, Judge Leitman rejected these arguments and concluded as a matter of law that plaintiff was entitled to these benefits for the reasons stated below.
Attendant Care
QBE claimed it did not pay plaintiff’s claim for attendant care benefits because the services were duplicative of the replacement services that plaintiff also claimed. QBE further asserted that plaintiff never asked for a particular hourly rate.
Judge Leitman rejected QBE’s arguments in this regard, finding that plaintiff submitted sufficient evidence that he requested benefits more than once, and completed the appropriate claim forms.
Regarding family-provided attendant care services, QBE acknowledged that plaintiff’s mother provided a portion of his care. By not paying plaintiff benefits that were owing within 30 days, Judge Leitman said the benefits were deemed overdue. He explained:
“The Court concludes that [plaintiff] has complied with his obligation pursuant to the No-Fault Act to provide ‘reasonable proof of the fact and of the amount of loss sustained’ with respect to the attendant care services [his mother] has provided. … The Court further concludes that because QBE has not paid [plaintiff] these due and owing attendant care benefits within 30 days of its receipt of ‘reasonable proof,’ the benefits are ‘overdue.’ … The Court therefore GRANTS [plaintiff] partial summary judmtgnet on his claim for PIP benefits for family-provided attendant care services.”
As for the attendant care services provided by the home health-care agency, QBE asserted it did not pay these benefits because it was concerned that the services provided by plaintiff’s mother were duplicative of the services provided by the home health-care agency. Judge Leitman rejected this argument and said:
“Simply put, QBE has provided no evidence to justify its failure to timely pay these invoices nor to explain why these invoices remain unpaid more than six months after the depositions. The Court concludes that [plaintiff] has complied with his obligation pursuant to the No-Fault Act to provide ‘reasonable proof of the fact and of the amount of loss sustained’ with respect to the attendant care services provided by Health Partners. … The Court further concludes that because QBE has not paid [plaintiff] these due and owing attendant care benefits within 30 days of its receipt of ‘reasonable proof,’ the benefits are ‘overdue.’ … The Court therefore GRANTS [plaintiff] partial summary judgment on his claim for PIP benefits for attendant care services provided by Health Partners.”
Work Loss
QBE asserted it was not obligated to pay work loss because: 1) it needed additional medical records to determine whether plaintiff remained disabled from any type of employment, and 2) plaintiff did not provide reasonable proof of the amount of his wage loss.
Rejecting these arguments, Judge Leitman held that plaintiff presented sufficient evidence that QBE failed to pay work loss benefits. The judge noted that plaintiff only sought benefits for his previous job at Petoskey Plastics, and not for a second job he had at a construction company. The judge stated:
“The Court concludes that [plaintiff] has complied with his obligation pursuant to [the] No-Fault Act to provide ‘reasonable proof of the fact and of the amount of loss sustained’ with respect to his work loss from his job at Petoskey Plastics. … The Court has further concluded that because QBE has not paid [plaintiff] these due and owing work-loss benefits within 30 days of its receipt of ‘reasonable proof,’ the benefits are ‘overdue.’”
Replacement Services
QBE claimed it was not obligated to pay replacement services because there was an overlap between these services and the attendant care benefits. Judge Leitman rejected this argument and reasoned:
“QBE has failed to provide any evidence of double billing. It has simply made a bald claim that [plaintiff] … may be attempting to double bill …. That is not enough to withstand summary judgment. The Court concludes that [plaintiff] has complied with his obligation pursuant to [the] No-Fault Act to provide ‘reasonable proof of the fact and of the amount of loss sustained’ with respect to household-replacement services. The Court further concludes that because QBE has not paid [plaintiff] these due and owing household-replacement benefits within 30 days of its receipt of ‘reasonable proof,’ the benefits are ‘overdue.’”
Penalty Interest and Attorney Fees
After finding that plaintiff was entitled to benefits, Judge Leitman further held that plaintiff was entitled to penalty interest under §3142(2) and to attorney fees under §3148(1) because the benefits to which plaintiff was entitled were all overdue.
Regarding §3142(2) penalty interest, Judge Leitman said:
“Where a claimant is rightly entitled to benefits, as [plaintiff] is here, an insurer has 30 days, not ‘2-3 months’ to pay those benefits before it is liable for penalty interest. Here, the Court has determined that QBE is liable for unpaid benefits and that [plaintiff] provided reasonable proof of his right to these benefits more than 30 days ago. The Court therefore concludes that [plaintiff] is entitled to penalty interest on the past-due attendant care, work loss, and household replacement services benefits.”
Regarding §3148(1) penalty attorney fees, Judge Leitman concluded:
“QBE’s refusals to pay on all of the above-described grounds, and QBE’s treatment of [plaintiff] — a vulnerable quadriplegic who is plainly entitled to substantial benefits under the No-Fault Act — were patently unreasonable and, indeed, indefensible. For all of these reasons, the Court concludes that [plaintiff] is entitled to penalty attorney fees in an amount to be determined in future proceedings.”
