United States District Court, E.D. Michigan, Southern Division
Anthony P. Patti U.S. Magistrate Judge.
OPINION AND ORDER GRANTING DEFENDANTS' MOTIONS TO
DISMISS; DENYING DEFENDANT DR. BARRY RUBIN'S MOTION FOR
SANCTIONS; AND DENYING PLAINTIFFS' MOTION FOR LEAVE TO
FILE AN AMENDMENT TO THE SECOND AMENDED
J. TARNOW SENIOR UNITED STATES DISTRICT JUDGE.
October 2011, Mark Marusza suffered severe injuries to, among
other things, his brain, shoulders, cervical spine, and ribs,
when he was struck by an SUV while walking through an
intersection during the course and scope of his employment.
Accident Fund Insurance Company, the workers'
compensation administrator, refused to pay for some of
Marusza's treatment, and for attendant care services
provided by Marusza's girlfriend, Nancy Gucwa, after it
reviewed a series of evaluation reports written by Doctors
Ager, Baker, Rubin, and Lawley. After the Workers'
Compensation Board Magistrate ordered Accident Fund to pay
Marusza, Plaintiffs filed this lawsuit against Accident Fund
and the five doctor defendants, alleging a conspiracy,
pursuant to which Accident Fund hired the doctors to write
fraudulent reports for the purpose of denying claimants
workers' compensation benefits, in violation of the
Racketeer Influenced and Corrupt Organizations
(“RICO”) Act. Plaintiffs also bring claims of
tortious interference with contract or expectancy; liability
under the Medicare Secondary Payer Act (“MSPA”);
and the tort of false imprisonment.
reasons discussed in depth below, the Court will GRANT
Defendants' Motions to Dismiss. The Court will DENY both
Defendant Rubin's Motion for Sanctions and
Plaintiffs' Request for Sanctions against Defendant
Rubin, and will DENY Plaintiffs' Motion for Leave to File
an Amendment to the Second Amended Complaint.
the nature of Defendants' motions, the Court will accept
the complaint's factual allegations as true and draw all
reasonable inferences in the plaintiffs' favor. Ohio
Police & Fire Pension Fund v. Standard & Poor's
Fin. Servs. LLC, 700 F.3d 829, 835 (6th Cir. 2012).
Marusza was struck by a car while on the job in October 2011.
The accident caused him to suffer a traumatic brain injury
(“TBI”) and injuries to his spine and shoulder.
Plaintiff Gucwa, Marusza's girlfriend, provided attendant
care services for his brain and spine injuries.
Accident Fund Insurance Company (“AF”)
administered workers' compensation insurance under a
contract of insurance through Marusza's employer.
Plaintiffs allege that AF hired the doctor defendants for the
purpose of obtaining fraudulent reports supporting the denial
of benefits, and that the doctor defendants consistently
wrote biased reports favorable to AF. Relying on reports
prepared by Doctors Ager, Baker, Rubin, and Lawley, AF
refused to pay for attendant care services provided by Gucwa
and for treatment Marusza received for his shoulder injuries.
Medicare paid for some of the treatment costs that AF refused
submitted claims to the workers' compensation agency.
After a series of hearings held in October-December of 2015,
Magistrate Beatrice B. Logan, of the Workers'
Compensation Board, made the following relevant factual
findings as to Mr. Marusza:
. Plaintiff sustained a mild traumatic brain
injury, injury to his neck, left and right shoulders, lower
back, and vision problems as a result of the October 2011
motor vehicle accident;
. Plaintiff returning to useful work is
probably not practical;
. Plaintiff lost all wage earning capacity
due to the injuries he sustained; .
Plaintiffs treatment was needed for the problems related to
the TBI and orthopedic injuries Plaintiff sustained as a
result of the motor vehicle accident;
. Defendant Accident Fund is responsible for
the reasonable and necessary medical treatment, including the
residual TBI treatment and the orthopedic injuries;
. Accident Fund shall pay for reasonable and
necessary medical treatment of Plaintiff s employment-related
condition of the TBI, the convergence insufficiency,
hyperphoria, ptosis, end point nystagmus, and the orthopedic
injuries Plaintiff sustained as a result of the accident;
. Plaintiff cannot return to his former job
with Defendant, any of his past jobs, or any employment other
than a sheltered workshop;
(Dkt. 79, Pg. ID 1220-25).
Magistrate ordered Accident Fund to pay Plaintiff Marusza
worker's compensation benefits at the rate of $592.88 per
week from October 19, 2011 until otherwise ordered and to pay
for reasonable and necessary medical treatment for Plaintiffs
employment related injury. Accident Fund paid Plaintiff
Marusza $74, 382.00 on August 12, 2016. (Dkt. 102-1, Pg. ID
Court will recite only the pertinent parts of the procedural
history of this case. After Plaintiffs filed their Amended
Complaint [Dkt. 2] in March 2015, the Defendants filed their
Motions to Dismiss [Dkt. 27, 32-34, 36] in April and May
2015. Further briefing on these motions followed, and in lieu
of a hearing, the Court met with counsel for a status
conference in November 2015. The Court adjourned the hearing
until after the Workers' Compensation Board issued a
written decision in Marusza's case.
filed their Second Amended Complaint [Dkt. 75] in April 2016.
The Workers' Compensation Board Magistrate issued an
Opinion and Order [Dkt. 79] on May 23, 2016. Thereafter,
Defendants filed their Motions to Dismiss the Second Amended
Complaint [Dkt. 81, 83-86] in late July 2016. Both parties
timely briefed their Responses [Dkt. 93-97] and Replies [Dkt.
98-102] by October 2016.
Dr. Barry Rubin filed a Motion for Sanctions (Dkt. 104) on
November 8, 2016. Plaintiffs then filed a Motion for Leave to
File an Amendment to the Second Amended Complaint [Dkt. 106]
on November 21, 2016. After a hearing on December 2, 2016,
the Court took all motions under advisement.
Defendants' Motions to Dismiss
Defendants move to dismiss Plaintiffs' complaint pursuant
to Federal Rules of Civil Procedure 12(b)(6) for failure to
state a claim upon which relief can be granted. To survive
such a motion, Plaintiffs must plead factual content that
allows the court to draw a reasonable inference that the
defendant is liable for the misconduct alleged. Ashcroft
v. Iqbal, 556 U.S. 662, 678 (2009). “A
plaintiff's complaint must provide ‘more than
labels and conclusions, and a formulaic recitation of the
elements of a cause of action will not do.'”
Iqbal, 556 U.S. at 678 (quoting Bell Atl. Corp.
v. Twombly,550 U.S. 544, 555 (2007)). Courts are not
required to accept as true legal conclusions framed as
factual allegations. See Twombly, 550 U.S. at 555.
“Factual allegations must be enough to raise a right to
relief above the speculative level on the assumption that all
the allegations in the complaint are true (even if doubtful
in fact).” Id. (internal citations omitted).
“[W]here the ...