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Estate of Rode v. Citizens Insurance Co.

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

June 15, 2018

Estate of Frederick Rode, Plaintiff,
v.
Citizens Insurance Company, Defendant.

          OPINION AND ORDER GRANTING IN PART AND DENYING IN PART PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT

          Sean F. Cox United States District Court Judge.

         This is 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.

         BACKGROUND

         On 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.

         What 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.

         A 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.

         Yet the 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.

         These 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.

         The 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, p. 4.

         In 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.

         Five 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, ¶ 31.

         In 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.

         Dr. 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.

         The 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 ...


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