Injured? Contact Sinas Dramis for a free consultation.

   

Southeast Michigan Surgical Hospital v. Home-Owners Ins. Co. (COA – UNP 9/19/2019; RB #3970)

Michigan Court of Appeals; Docket # 342443; Unpublished
Judges O’Brien, Beckering, and Letica; Per curiam
Official Michigan Reporter Citation: Not Applicable; Link to Opinion


STATUTORY INDEXING:
Not Applicable

TOPICAL INDEXING:
Case Evaluaion—Accept/Reject in PIP Cases


SUMMARY:

In this unanimous unpublished per curiam decision, following a jury trial in which a judgment of no cause of action was entered in favor of the defendant, the Court of Appeals affirmed the trial court’s decision to grant the defendant’s motion for a directed verdict as to the plaintiff’s claims for replacement services and reversed the trial court’s order denying the defendant’s motion for case evaluation sanctions under MCR 2.403(O).  The Court of Appeals determined that the directed verdict was a harmless error, because it was apparent, based on the jury’s determination that none of the plaintiff’s other claims for no-fault PIP benefits were related to injuries she suffered in the subject motor vehicle collision, that the jury would have also concluded that the plaintiff did not need replacement services either.  As to defendant’s motion for case evaluation sanctions, the Court of Appeals determined that the defendant did present sufficient evidence that the award was unanimous, despite not submitting any actual documentation from the case evaluation panel.  Thus, the defendant was entitled to case evaluation sanctions, and the Court of Appeals remanded for a determination of taxable costs and reasonable attorney fees.

Connie Sarazin was injured in a motor vehicle collision on February 20, 2014, and sought no-fault PIP benefits from the defendant, Home-Owners Insurance Company, including medical expenses, work loss, replacement services, and other allowable expenses.  After Sarazin returned to work on September 1, 2014, Home-Owners discontinued paying her benefits, including those related to treatments Sarazin received in June 2016, prompting Sarazin and her treatment providers to file the instant action for expenses incurred after September 1, 2014.  At trial, Home-Owners successfully moved for a directed verdict on Sarazin’s claims for replacement services, arguing that Sarazin “failed to offer proof that she actually incurred expenses for household services provided by family members and friends”—i.e. that those who performed the replacement services expected reimbursement.  All Sarazin’s other claims for PIP benefits were submitted to the jury, who ultimately determined that none of the allowable expenses Sarazin incurred after September 1, 2014 were related to the motor vehicle collision.  Home-Owners subsequently filed a motion for case evaluation sanctions under MCR 2.403(O), but the trial court denied the motion, finding that MCR 2.403(O)(7) barred Home-Owners from receiving such sanctions because it failed to show that the case evaluation award was unanimous.

Sarazin appealed the trial court’s decision to grant Home-Owners motion for a directed verdict as to her claims for replacement services, and the Court of Appeals agreed with Sarazin that that decision was, in fact, erroneous.  Sarazin introduced sufficient evidence to prove that the individuals who performed her replacement services did expect compensation.

Plaintiff introduced into evidence the forms that her service providers completed, signed, and submitted to the insurer. The service providers completed the forms using defendant’s codes to identify the tasks that they performed. Defendant paid replacement-service benefits pursuant to these forms until plaintiff’s return to work on September 1, 2014. Evidence that plaintiff’s providers completed and submitted reimbursement forms supports an inference that they had an expectation of reimbursement, especially when they obtained reimbursement through this procedure before. By previously reimbursing plaintiff’s replacement-service providers, defendant implicitly acknowledged that this expense was “incurred.” Although plaintiff did not directly testify that the service providers expected payment, she did testify that (1) she and her helpers completed and signed forms to document the services provided, (2) the reimbursement forms were supplied by defendant, and (3) they believed that defendant should pay for the services. This constitutes “some evidence that the family member expected compensation,” and “some basis for a fact-finder to conclude that the caregiver had some expectation of compensation from the insurer . . . .” Douglas, 492 Mich at 268 n 56. Accordingly, the trial court erred by granting defendant’s motion for a directed verdict on plaintiff’s replacement-services claim.

However, the Court of Appeals held that the trial court’s error was harmless, considering the jury’s determination that none of Sarazin’s other claims for no-fault PIP benefits arose from the injuries she suffered in the subject motor vehicle collision.  Had the claims for replacement services also been submitted to the jury, the Court reasoned that they, too, would have been deemed unrelated to the collision.

Although the jury found that plaintiff suffered injuries arising from the February 20, 2014 accident, it found that she did not incur any allowable expenses, including medical expenses and attendant care, on or after September 1, 2014. Based on the verdict rendered, the jury determined that if plaintiff had a need for medical treatment and attendant care after September 1, 2014, that need did not arise from injuries sustained in the February 20, 2014 accident. From this, it is apparent that the jury would have also concluded that if plaintiff needed replacement services after September 1, 2014, those, too, were not related to the accident. The crucial question for all of plaintiff’s claims was whether her need for benefits after September 1, 2014, arose from her injuries. This question was fairly submitted to the jury, and the jury concluded that it did not. There is simply no basis for finding that plaintiff had a need for replacement services that arose from her accident injury that outlasted her need for medical treatment and attendant care related to the accident. Accordingly, the trial court’s error in granting defendant a directed verdict with respect to replacement services was harmless. See Eberbach, 232 Mich at 397-398.

Home-Owners appealed the trial court’s denial of its motion for case evaluation sanctions and taxable costs under MCR 2.403 and MCR 2.625, in which the trial court ruled that Home-Owners did not present sufficient evidence to prove that the case evaluation award was unanimous.  Home-Owners did not submit any documentation from the actual case evaluation panel, but it did submit an affidavit from its lead attorney explicitly averring that the award was unanimous and, moreover, the plaintiff never disputed that the award was unanimous.  The Court of Appeals thus reversed the trial court’s ruling and remanded for a determination of taxable costs and attorney fees.

Although defendant did not submit documentation from the case evaluation panel showing that the award was unanimous, it submitted an affidavit from its lead attorney, who explicitly averred that the award was unanimous. The court rule does not specify how the moving party must prove unanimity. Indeed, the rule’s passive-voice phrasing—“[c]osts shall not be awarded if the case evaluation award was not unanimous”—suggests that a non- unanimous award is a disqualifier left to the opposing party to assert. Plaintiff never disputed that the award was unanimous. We therefore conclude that the trial court erred by denying sanctions under MCR 2.403(O)(7) because (1) defendant’s motion was supported by an affidavit representing that the case evaluation award was unanimous, (2) plaintiff never countered or otherwise disputed that assertion, and (3) the trial court had no factual basis for finding that the award was not unanimous.

As a peripheral matter, but worth noting, the Court of Appeals also dispensed with the trial court’s questioning of “the justice of imposing case evaluation sanctions on a plaintiff-insured where a plaintiff-medical provider’s direct claim was required to be dismissed by Covenant,” holding that the trial court “did not have discretion to deny sanctions under the interest-of-justice exception [in MCR 2.403(O)(11)].”


Lansing car accident lawyer Stephen Sinas is the lead editor of the appellate case summaries published on this site regarding the Michigan auto insurance law. To learn more about how Stephen Sinas and how the Sinas Dramis Law Firm can help you if you have been injured in a Michigan auto accident, visit SinasDramis.com.

Copyright © 2021 Sinas Dramis Law Firm, George Sinas, Stephen Sinas.
All Rights Reserved.
Login (Publishers Only)

FacebookTwitterInstagram