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Dean v. Allstate Insurance Co.

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

September 19, 2017

Deseon Dean, Plaintiffs,
v.
Allstate Insurance Company, Defendant.

          ELIZABETH A. STAFFORD U.S. MAGISTRATE JUDGE

          OPINION AND ORDER GRANTING IN PART AND DENYING IN PART DEFENDANT'S MOTION FOR SUMMARY JUDGMENT [12] AND DENYING DEFENDANT'S REQUEST FOR SANCTIONS

          ARTHUR J. TARNOW SENIOR UNITED STATES DISTRICT JUDGE

         After being hit by a car on the night of September 5, 2015, Plaintiff DeSeon Dean filed a claim for No-Fault Personal Injury Protection (“PIP”) Benefits with the Michigan Assigned Claims Plan (“MACP”). The MACP assigned Plaintiff's claim to Defendant Allstate Insurance Company on December 29, 2015. After reviewing Plaintiff's application, supporting documentation, and medical records, Allstate requested that Plaintiff undergo an Examination Under Oath (“EUO”). Plaintiff's counsel denied the EUO.

         On May 31, 2016, Plaintiff filed this action in Wayne County Circuit Court, alleging breach of contract and seeking declaratory relief. Plaintiff claims that he incurred expenses for care, recovery, and/or rehabilitation; necessary replacement services; and other personal protection benefits, and that Defendant unreasonably refused to pay these benefits.

         Defendant timely removed the case to this Court on June 17, 2016 [Dkt. 1]. Defendant then filed its Motion for Summary Judgment [12] on February 21, 2017. Defendant requested that the Court either dismiss the entirety of Plaintiff's case or dismiss the claims pertaining to the fees charged by Orthopedic P.C. and Greater Lakes Ambulatory Surgical Center, where Plaintiff treated after the accident. A hearing on the motion took place on July 12, 2017.

         The Court will GRANT IN PART and DENY IN PART Defendant's Motion for Summary Judgment. Given the myriad serious issues with Plaintiff's case - including the fact that he treated with a doctor whose license was revoked due to the deceitful practice of medicine - no reasonable trier of fact could return a verdict in Plaintiff's favor, at least as it pertains to the approximately $90, 000 in fees charged by Orthopedic P.C. and Greater Lakes Ambulatory Surgical Center. Therefore, to the extent Defendant seeks dismissal of those claims, the motion for summary judgment is GRANTED, and those claim against Defendant are dismissed. However, Defendant's Motion is DENIED to the extent that it seeks dismissal of Plaintiff's claims for household services, attendant care, and wage loss.

         The Court will also DENY Defendant's request for sanctions. This request is based on a screenshot of Plaintiff's PIP benefits application that appears in Plaintiff's response brief. The screenshot shows a modified version of Plaintiff's application, as compared to the version of the application submitted as an exhibit to both parties' briefs. It is clear that Plaintiff's counsel's error was unintentional and not done in bad faith. See Danese v. City of Roseville, 757 F.Supp. 827, 829 n.2 (E.D. Mich. 1991) (sanctions are inappropriate where the misrepresentations “may very well have resulted from mistake or inadvertence, ” and movants did not prove “that the alleged misrepresentations were intentional.”).

         Factual Background

         I. Plaintiff's Injuries

         On September 5, 2015, at approximately 9 PM, a Chevrolet Suburban struck Plaintiff while he was standing on a sidewalk at the intersection of Collingwood and Dexter in Detroit. Plaintiff was taken to Henry Ford Hospital, where he reported pain in his left arm, left leg, left hip, knees, and left elbow. (Pl.'s Ex. B). He also exhibited bruises, and an abrasion over the left lower anterior abdomen. Id. A physical examination revealed that Plaintiff was oriented to person, place, and time. Plaintiff had mild degenerative disc disease, but otherwise suffered no significant spinal or neuroforaminal stenosis. Id. The doctor further noted that “structures in the pelvis appear intact. Hip joints are normal.” Id. No fractures were evident. Id. CT scans of Plaintiff's head and cervical spine were negative and revealed no major problems.

         II. Plaintiff's Application for PIP Benefits

         Because Plaintiff did not have a policy of insurance at the time of the accident, he submitted his application for PIP Benefits to the Michigan Assigned Claims Plan (“MACP”)[1] in October 2015. According to the application, Dr. Mohamed Saleh treated Plaintiff.[2] (Def.'s Ex. D). Plaintiff also indicated that he was not taking any medications prior to this incident and that he was not treated in a hospital. Id. Curiously, Plaintiff also stated that he received outpatient hospital treatment. Id. Plaintiff also claimed that he did not have any kind of health insurance. Id.

         In October and December of 2015, the MACP informed Plaintiff that it could not process his claim without a completed PIP application and automobile insurance information from the owner of the vehicle involved in the accident. (Def.'s Ex. E, G). On December 17, 2015, Plaintiff's counsel informed MACP that Plaintiff could not reach the owner of the vehicle involved in the accident. MACP assigned Plaintiff's PIP Benefits claim to Allstate on December 29, 2015. (Def.'s Ex. I).

         Under the MACP, “[a] servicing insurer . . . shall investigate the claim for benefits under the Plan.” (Def.'s Ex. J at 4). According to the Plan, the servicing insurer may require the claimant to submit additional documentation or submit “to an examination under oath.” Id. Defendant asked Plaintiff to undergo an Examination Under Oath (“EOU”) in May 2016. Plaintiff's counsel ...


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