Filed: Apr. 28, 2017
Latest Update: Apr. 28, 2017
Summary: ORDER DENYING WITHOUT PREJUDICE DEFENDANT'S AMENDED MOTION FOR SUMMARY JUDGMENT, (Doc. 70) AVERN COHN , District Judge . This is a no-fault benefits case. Plaintiffs include the driver—the insured—and medical providers. The accident took place on March 4, 2013. The claim consists of: • medical services and expenses, • replacement services, • attendant care, and • work loss Exhibit A reflects the chronology of the accident and medical services and expenses. There is in the record no do
Summary: ORDER DENYING WITHOUT PREJUDICE DEFENDANT'S AMENDED MOTION FOR SUMMARY JUDGMENT, (Doc. 70) AVERN COHN , District Judge . This is a no-fault benefits case. Plaintiffs include the driver—the insured—and medical providers. The accident took place on March 4, 2013. The claim consists of: • medical services and expenses, • replacement services, • attendant care, and • work loss Exhibit A reflects the chronology of the accident and medical services and expenses. There is in the record no doc..
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ORDER DENYING WITHOUT PREJUDICE DEFENDANT'S AMENDED MOTION FOR SUMMARY JUDGMENT, (Doc. 70)
AVERN COHN, District Judge.
This is a no-fault benefits case. Plaintiffs include the driver—the insured—and medical providers. The accident took place on March 4, 2013. The claim consists of:
• medical services and expenses,
• replacement services,
• attendant care, and
• work loss
Exhibit A reflects the chronology of the accident and medical services and expenses. There is in the record no documentation of replacement services, work loss or attendant care.
Defendant insurance company denies liability on several grounds including lack of causation, lack of documentation and fraud.
On May 26, 2015, plaintiff was videod engaged in activities which may challenge any claim she suffered from a physical condition that disabled her. A claim for benefits that is legitimate at its inception may lose its legitimacy at some point. The evidence as to fraudulent conduct vitiating the legitimacy of plaintiff's claim is ambiguous. If there is evidence of fraud, the date that the claim changed from a legitimate right to benefits to a fraudulent claim of benefits is uncertain.
The record is long and complex, including contradictory medical opinions and representations of the parties as to documentary support for the claims made by plaintiff and third-party medical providers.
The Court cannot say there is no genuine issue of material fact over various items of damages or the condition of plaintiff on various dates forward from the accident. Accordingly, the record is not ripe for summary judgment in defendant's favor as to any particular item of insurable damages suffered by plaintiff or any third-party plaintiff.
SO ORDERED.
Exhibit A
CHRONOLOGY OF RELEVANT EVENTS
Grimmett, 14-14646
(Amount
Date Event/Service Charged)
3/4/13 Accident
3/15/13 Application for no-fault benefits
3/20/14 X-ray of spine (OMRI) $575
3/22/14 MRI (brain and spine) and CT scan; blood
and urine tests (OMRI) $25,000
5/2/14 Complaint filed
5/15/14 Blood draw (OMRI) $15
5/19/14 Pre-op lab for cervical surgery (SE Mich.) $500
5/20/14 Cervical surgery (SE Mich.) $80,200
5/29/14 MRI (spine) and blood draw/test (OMRI) $8,700
6/17/14 X-ray of spine (OMRI) $220
X-ray and MRI of spine and CT scan
10/23/14 (OMRI) $7,175
[no claim form to Encompass attached for
this service]
5/26/15 Surveillance video taken
6/18/15 Independent medical examination
8/1/15 Lumbar surgery (MASc) $164,800
** Service description based on claim form codes and billing statements. Medical
providers did not provide a narrative accounting of services rendered.
** OMRI numbers add up to $41,600, slightly more than the $40,900 requested.
