United States District Court, Eastern District of Michigan; Case #14-12175
Hon. Avern Cohn
Official Michigan Reporter Citation: Not Applicable; Opinion Not Available 
STATUTORY INDEXING:
Catastrophic Claims Association [§3104]
Personal Protection Insurance (PIP) Benefits Entitlement [§3105]
Allowable Expenses for Attendant Care [§3107(1)(a)]
Future Benefit Assignment [§3143]
Reasonable and Customary Provider Charges [§3157]
TOPICAL INDEXING:
Collateral Estoppel or Res Judicata
CASE SUMMARY:
In this Federal written Opinion, Judge Avern Cohn denied an attendant care provider’s request for summary judgment seeking the dismissal of defendant-Amica Mutual’s counterclaims. In requesting summary judgment, the attendant care provider advanced several arguments — all of which were rejected by Judge Cohn — and the judge issued several holdings:
1) defendant-Amica had standing to pursue its counterclaims because the claims involved monies it had paid on behalf of the claimant, and
2) defendant-Amica’s counterclaims were not barred by the doctrines of res judicata or collateral estoppel, notwithstanding a prior settlement and arbitration award, because the issues and controversies associated with the previous settlement and arbitration award did not involve the issues presently before the court.
Plaintiff-EDS Care Management brought this action against defendant-Amica seeking to recover PIP benefits for attendant care services provided to Stephanie Rudd, who suffered a traumatic brain injury in an auto accident. Two prior actions had been filed relating to Rudd’s care, resulting in one being settled and the other being arbitrated. After this action commenced, defendant asserted counterclaims against plaintiff, alleging payment under mistake of fact, unjust enrichment, and breach of fiduciary duty. Plaintiff sought summary judgment and the dismissal of defendant’s counterclaims, arguing that defendant did not have standing because it had been reimbursed by the Michigan Catastrophic Claims Association, and that defendant’s claims were barred by res judicata or collateral estoppel because of the prior settlement and arbitration.
Judge Cohn rejected plaintiff’s arguments and found that summary judgment was improper.
In so holding, Judge Cohen said that defendant did have standing even though it had been compensated by MCCA. In this regard, the judge said:
“EDS says that Amica has not suffered an injury in fact because it was fully reimbursed for the payments it made to EDS. This argument is not well-taken. Notably, EDS cites no case law in support of its position nor does research reveal any case law. Further, Amica did suffer an injury - having to pay for PIP benefits that it says were improper. The fact that MCCA reimbursed Amica does not change the matter. … In other words, that fact that Amica was reimbursed from MCCA does not impair its ability to seek monies it paid. Any monies Amica obtains must be turned over to MCCA. … EDS relatedly argues that Amica is not the real party of interest because once MCCA reimbursed Amica for payments it made, MCCA assumed Amica’s liability. This argument has no merit. … Here, as in Farmers [Ins Exchange v Titan Ins Co, 251 Mich App 454 (2002)], Amica is looking to be recoup monies paid to EDS for Rudd’s care. Amica is, therefore, a party in interest.”
Regarding the argument that defendant’s counterclaim was barred because of the prior settlement, Judge Cohn said defendant was not “locked in” simply because it had paid some monies as part of a previous settlement. The judge said:
“EDS says that based on Amica’s settlement payment in May 2008, Amica’s
liability is conclusively established and Amica cannot now seek recoupment. Not so. Courts have held that the fact that an insurer has made some payment to or on behalf of an insured does not establish liability for an injury and does not preclude an insurer from later asserting that it owes nothing. … [A]t most the May 2008 settlement between Amica and Rudd resolved Rudd’s right to PIP benefits up until April 2008. … Amica is not precluded by res judicata or collaterally estopped from challenging Rudd’s entitlement to PIP benefits after that date.”
Judge Cohn went on to reject plaintiff’s argument that the prior arbitration award also barred defendant’s counterclaim. The judge said:
“Res judicata simply does not bar Amica from bringing a counterclaim to recoup benefits after October 2011. EDS’s argument that the arbitration award conclusively establishes that Rudd is injured and entitled to benefits reads too much into the arbitration award. … Here, the 2011 arbitration panel did not make a finding that Rudd sustained a traumatic brain injury or that any particular injury resulted from the accident. The specific findings that [plaintiff] believes should be given collateral estoppel effect — regarding Rudd’s injury — simply cannot be deduced from the arbitration award. … EDS has not shown as a matter of law that there is a causal connection with the arbitration award and Amica’s counterclaim to recoup benefits it paid to EDS for Rudd’s care after the arbitration award.”
Accordingly, Judge Cohn denied plaintiff’s motion for summary judgment.
