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Gucwa v. Lawley

United States District Court, E.D. Michigan, Southern Division

January 23, 2017

Nancy Gucwa and Mark Marusza, Plaintiffs,
v.
Dr. Jeffrey Lawley, et al., Defendants.

          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 COMPLAINT

          ARTHUR J. TARNOW SENIOR UNITED STATES DISTRICT JUDGE.

         In 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.

         For the 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.

         Factual Background

         Given 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).

         Plaintiff 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.

         Defendant 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 to cover.

         Plaintiffs 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).

         The 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 1846).

         Procedural History

         The 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.

         Plaintiffs 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.

         Defendant 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.

         I. Defendants' Motions to Dismiss

         Standard of Review

         All 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 ...


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