United States District Court, E.D. Michigan, Southern Division
OPINION AND ORDER GRANTING IN PART AND DENYING IN
PART PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT
F. Cox United States District Court Judge.
a suit seeking no-fault benefits from the defendant insurance
company for injuries sustained by Plaintiff's decedent in
a 2013 automobile accident. Discovery has concluded and
Plaintiff has moved for summary judgment. For the reasons
below, the Court shall grant the motion in part and deny it
in part. The Court shall grant the motion as to
Plaintiff's medical payments claim because Defendant does
not object to the requested payment of $43, 891.61 in medical
benefits. But the Court shall deny Plaintiff's motion in
all other respects because genuine issues of material fact
exist for trial.
September 9, 2013, Frederick Rode was involved in an
automobile accident. Pl. Stmt. of Material Facts, ¶ 1.
Rode, who maintained an automobile insurance policy with
Defendant Citizens Insurance Company, notified Defendant the
next day of a claim for first-party no-fault benefits and
underinsured motorist benefits. Id. at ¶ 12,
18-19. But aside from paying for Rode's initial
hospitalization, Defendant denied Rode's request for
benefits, attesting that the injuries he sustained did not
result from the accident. Id. at ¶ 13.
were those injuries? Per Rode, immediately after the accident
he began experiencing burning in his torso, an
electric-shock-like sensation in his lower extremities, and
cervical spine pain. Id. at ¶ 2. Two months
later, he visited an orthopaedic surgeon, Dr. Sidhu,
complaining of pain in his neck, mid-back, and lower back,
which also radiated to his extremities. Id. at
¶ 3. A January 2014 MRI revealed that Rode had disc
bulges at the C5-6 and C6-7 levels of his cervical spine. Pl.
Ex. 5. Two months later, because an MRI showed a large
herniated disc, Dr. Sidhu proposed that Rode undergo a
cervical discectomy surgery and Rode did so the next month.
Pl. Stmt., ¶ 7-8, 10. Defendant's own evaluating
doctor would later opine that the accident had caused Rode to
develop the C6-7 herniated disc that prompted the surgery.
Def. Ex. 3, p. 9.
couple years later, in a September 2016 deposition, Rode
discussed the effect that his injuries had allegedly had on
his quality of life. Three months prior, Rode had started
going to physical therapy due to pain in his neck that
radiated throughout his body. Pl. Dep., p. 88. During those
next few months, Rode also had difficulty controlling his
hand; for instance, he would drop his cellphone while trying
to carry it. Id. at 88, 96. Rode also needed help
with chores around the house as he had difficulty lifting
large loads of laundry, putting dishes away on upper shelves,
cutting grass, shoveling snow, and raking leaves.
Id. at 90-92. Basic hygiene was also an issue; Rode
had difficulty getting dressed, going to the bathroom, and
showering. Id. at 107-08. Unsurprisingly, many of
his leisure activities had also been limited, such as
boating, skiing, and driving his sport's car.
Id. at 109-114.
September 2013 accident was not the beginning of Rode's
troubles. Before the accident, in early 2013, he had applied
for Social Security Disability Benefits. Def. Ex. 7. In his
application, he reported a litany of issues relating to pain
in his back, including: lifting, squatting, bending,
standing, walking, sitting, kneeling, climbing stairs, and
completing household chores. Id. at 4. Rode also
noted that he had numbness and weakness in both hands,
leading to difficulty grasping and holding items.
Id. These physical problems led to issues in
Rode's daily life; he noted that he had difficulty
standing and completing tasks. Id. at 1. And along
with these problems, Rode's application also detailed
numerous social limitations. He reported engaging in few
daily activities, having difficulties with memory and
concentration, and having a reluctance to go out in public.
Id. at 4.
problems persisted. Medical records from February 2013 show
that Rode had been attending physical therapy for lower back,
left shoulder, and hip pain. Def. Ex. 12, p. 1. At that time,
he also reported pain in his cervical spine that radiated
down his back and decreased range of motion and pain in his
left shoulder. Id. at 1-2. For this, his treating
physician recommended that Rode continue with physical
therapy. Id. at 2.
next month, Rode underwent a psychological assessment for his
disability application. Def. Ex. 8, p. 1. Rode reported to
the examiner that on most days he did not get out of bed and
that he isolated himself from others, noting that he had no
friends or people that he socialized with. Id. at
1-2. He also mentioned that he had previously been hit by a
car, leading to trouble with his hips, neck, and back that
caused him to refrain from much activity. Id. at 3.
The resulting diagnostic impression from the assessment was
major depressive disorder, generalized anxiety disorder, and
panic disorder without agoraphobia. Id. at 4. Other
medical records from this time frame also indicate that Rode
had not been driving due to his medical issues. Def. Ex. 11,
April 2013, the Social Security Administration determined
that Rode was totally disabled from working as of December 2,
2011 and that medical improvement was not expected. Def. Ex.
9, p. 16. Rode then began receiving disability benefits.
Id. at 17.
months later, the accident at issue here occurred. Rode
sought medical care for his resulting injuries and, from
February 2014 through September 2014, he was billed $43,
891.61 for various medical treatments relating to the
accident. Id. at ¶ 22-31. Although Defendant
had denied coverage for certain no-fault benefits, it did
issue checks to Rode for these treatments under his
policy's medical payments coverage. But although
Defendant issued Rode a check for the billed amount of each
treatment, those checks were never cashed. Id. The
reason for this is disputed; Plaintiff contends the checks
were unable to be cashed, Defendant states Rode never cashed
them and allowed them to go stale. In any event, Defendant
presently does not object to the payment of $43, 891.61 in
medical benefits. Def. Counter-Statement of Material Facts,
October 2014, Defendant had Rode undergo an independent
medical examination. Id. at ¶ 14. At the time,
Rode complained of neck pain and numbness in his limbs,
hands, and face. Def. Ex. 10, p. 2. The evaluating doctor,
Dr. Nikpour, noted that these same complaints-such as the
neck and back pain-were present after Rode was in car
accidents in 2004 and 2012. Id. at 4. Dr. Nikpour
noted, however, that the “abnormality that was positive
in the recent accident” was the spurring and disc
complex at Rode's C5-C6 and C6-C7 discs. Id. And
he acknowledged that the accident led to the C6-7 damage that
required surgery. Id. at 9. But he was unsure
whether the September accident contributed to the continued
numbness Rode was experiencing. Id.
Nikpour also painted a rosier picture of Rode's physical
capabilities. He stated: “I do not see at present any
neurological problem or deficit with him or physical deficit
with him that he could not go back to work and perform his
job at GM. He is physically capable of doing so.”
Id. He also felt similarly about Rode's personal
life: “It seems to me that he is a physically strong
young man that he can perform all his personal care and
personal duty without any difficulty.” Id.
record contains scant information about the next two years.
Eventually, in March 2016, Rode displayed some complications,
leading to Dr. Sidhu giving him the option of a revision
surgery for pseudoarthrosis repair. Pl. Ex. 7. Yet this