Exec. Ambulatory Surgical Ctr., LLC v. State Farm Mut. Auto. Ins. Co.
| Decision Date | 03 March 2020 |
| Docket Number | Case No. 18-cv-14094 |
| Citation | 442 F.Supp.3d 998 |
| Parties | EXECUTIVE AMBULATORY SURGICAL CENTER, LLC, as assignee of Tamika Burrell, Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. |
| Court | U.S. District Court — Eastern District of Michigan |
Gary R. Blumberg, Dearborn, MI, for Plaintiff.
Kevin J. Bacon, Julie A. Taylor & Associates, Southfield, MI, for Defendant.
This case involves a medical provider's claims for the payment of no-fault insurance benefits stemming from an August 19, 2014 motor vehicle accident in which a car driven by Tamika R. Burrell ("Burrell") was struck in the rear by a hit and run driver and then pushed into a pickup truck in front of her and she sustained bodily injuries. Following the accident, Burrell sought treatment from a number of medical providers, including Plaintiff Executive Ambulatory Surgical Center, LLC ("Executive Ambulatory"). During the course of that treatment, Burrell assigned her statutory rights to collect no-fault benefits to several of her providers, including Executive Ambulatory, who now attempts to recover no-fault insurance benefits from Burrell's insurance company, Defendant State Farm Mutual Automobile Insurance Company ("State Farm"). Defendant now moves for summary judgment, arguing that Plaintiff's claims are barred under the doctrines of res judicata and collateral estoppel. The matter is fully briefed and the Court held a hearing on February 6, 2020. For the reasons that follow, the Court DENIES the Defendant's motion for summary judgment.
On August 19, 2014, Burrell was involved in a motor vehicle accident in which she claims to have sustained accidental bodily injuries. Burrell alleges she was struck from behind by a vehicle that fled the scene and was pushed into a 2013 Ram pickup truck driven by Christopher Wujeck. (ECF No. 9-3, State of Michigan Traffic Crash Report ("Crash Report").) Mr. Wujeck was not injured, but Burrell claimed injuries as a result of the accident and was taken to Southfield Providence Hospital. (Id. ) Emergency room records indicate that Burrell was transported from the scene of the collision "with full C-Spine precaution" and examination revealed complaints of "pain along the entire cervical spine without focality" and "tenderness" along the thoracic and lumbar spine and left lateral hip. (ECF No. 13-5, Providence Emergency Room Records, PgID 358-59.) She was subsequently discharged home that same day with prescriptions for Bactrim and Motrin and given a note that she could return to work the next day. (Id. PgID 357.)
Burrell was insured with Defendant State Farm under a no-fault insurance policy at the time of the accident. (Compl. ¶¶ 9-10, PgID 9.) She sought to recover no-fault personal injury protection ("PIP") benefits from State Farm as a result of the accident.
Following the accident, Burrell sought treatment from a number of medical providers, including, but not limited to, Michigan Rehabilitation Specialists of Fowlerville LLC, d/b/a ATI Physical Therapy ("ATI") and Plaintiff Executive Ambulatory. (See ECF Nos. 13-6 to 13-12, Burrell's Medical Records.) Dr. Lucia Zamorano, a Board Certified neurosurgeon, treated Burrell and performed three surgeries on her: (1) on February 9, 2016, anterior cervical disc fusion and decompression of the spinal cord at the C4-C5 and C5-C6 levels; (2) on September 18, 2018, anterior disc fusion and decompression of the nerve root at C3-C4 with a revision of the previous disc fusion from C4 to C6; and (3) on March 11, 2019, discectomy and fusion of the L3-L4 level of her lumbar spine, with decompression of the nerve root. (ECF Nos. 13-10 to 13-12.) Plaintiff asserts that the latter two procedures were performed at Executive Ambulatory and are the subject of the present claim before the Court. (Pl.'s Resp. at 6, PgID 318.)
During the course of her treatment, Burrell assigned her statutory rights to collect no-fault benefits to several of her providers, including to ATI and Plaintiff Executive Ambulatory, for the services they rendered. (ECF No. 9-5, Assignments.)
On February 1, 2017, ATI filed a lawsuit against State Farm in the 46th District Court in Oakland County arising out of the August 19, 2014 motor vehicle accident and seeking to collect payment of no-fault PIP benefits for the physical therapy services it rendered to Burrell. On May 25, 2017, the Michigan Supreme Court issued its opinion in Covenant Medical Center, Inc. v. State Farm Mutual Automobile Insurance Company , 500 Mich. 191, 895 N.W.2d 490 (2017), holding "that healthcare providers do not possess a statutory cause of action against no-fault insurers for recovery of personal protection insurance benefits under the no-fault act." Id. at 217-18, 895 N.W.2d 490. The Court clarified, however, that its decision "is not intended to alter an insured's ability to assign his or her right to past or presently due benefits to a healthcare provider." Id. at 217 n.40, 895 N.W.2d 490. (citations omitted). State Farm then filed a motion for summary disposition and argued that ATI did not have a direct cause of action against it pursuant to Covenant . In response to State Farm's motion, ATI produced several assignments of rights signed by Burrell. The trial court held that the language of the assignments was insufficient to allow ATI to proceed with the case and granted summary disposition in favor of State Farm. (ECF No. 9-6, ATI Trial Court Order Granting MSD.)
ATI appealed the ruling to the Oakland County Circuit Court, which reversed the trial court's ruling and held that the assignments were valid and that ATI was permitted to pursue its case as assignee of Burrell. (ECF No. 9-7, ATI Appellate Order.) ATI then filed an amended complaint on August 24, 2018, based upon the assignment of rights previously provided by Burrell. (ECF No. 9-8, ATI Amended Compl.) On March 19 and 20, 2019, ATI, as assignee of Burrell, took its case against State Farm to trial in the 46th District Court, and on March 20, 2019, the jury returned a verdict of no-cause of action in favor of State Farm, finding that Burrell did not sustain an injury in the August 19, 2014 automobile accident. (ECF No. 9-9, ATI Judgment of No Cause of Action.) Specifically, the jury form read as follows:
(Id. at PgID 164.)
On August 10, 2018, Burrell filed her own lawsuit against State Farm arising out of the August 19, 2014 automobile accident in the Wayne County Circuit Court, broadly seeking PIP benefits, including wage loss benefits, replacement service expenses, medical expenses, and attendant care services, without any further identification of what those expenses are or the amount of those expenses. (ECF No. 9-10, Burrell Compl.)1 On April 22, 2019, following the no-cause verdict in the ATI lawsuit, State Farm filed a motion for summary disposition based upon the doctrines of collateral estoppel and res judicata. (ECF No. 9-11, Defendant's MSD.) State Farm argued that the finding of no injury in the ATI case was a collateral estoppel or res judicata bar to Burrell's claims for no-fault benefits related to the August 19, 2014 motor vehicle accident. (Id. ) The Wayne County Circuit Judge heard oral arguments on June 24, 2019, and on June 27, 2019 entered an order granting State Farm's motion "for the reasons set forth by the Court on the record at the hearing of the motion" and dismissing Burrell's case with prejudice. (ECF No. 9-12, Order Granting Def.'s MSD.)
On November 21, 2018, Plaintiff Executive Ambulatory filed the present action against Defendant State Farm in the Oakland County Circuit Court. (Compl.) This action was removed to this Court on December 31, 2018. (ECF No. 1, Notice of Removal.)
On September 19, 2019, Defendant State Farm filed its motion for summary judgment, arguing that the ATI jury verdict and judgment of no-cause of action, as well as the summary disposition order in the Burrell action, serve as a res judicata and collateral estoppel bar to Plaintiff's claims in this lawsuit against it. (ECF No. 9, Def.'s Mot. S.J.)
Plaintiff responded to Defendant's motion on October 31, 2019, asserting that the central issue in this lawsuit is whether the services it provided were reasonable and necessary for the treatment of injuries Burrell sustained in the August 19, 2014 accident, and that this claim "belongs exclusively and solely to Plaintiff, and was not, and could not have been, litigated in either the ATI Physical Therapy lawsuit," which "concerned only the reasonableness and necessity of physical therapy services rendered to Burrell" or "Burrell's second generation suit filed in 2018." (Id. (emphasis in original).) Plaintiff contends that no evidence regarding the surgeries at issue here was presented in the ATI lawsuit, and that thus its "claim here is entirely separate, distinct, and distinguishable from the claim ATI presented in the 46th District Court." (Id. at 2, PgID 314.)
Defendant filed a reply brief on November 13, 2019, re-asserting its arguments that it has established all required elements of both res judicata and collateral estoppel, and that its previous settlement with Burrell is not an admission that Burrell was injured or otherwise a bar to its motion. (ECF No. 16, Def.'s Reply.)
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Exec. Ambulatory Surgical Ctr., LLC v. State Farm Mut. Auto. Ins. Co.
...an Opinion and Order denying Defendant's Motion for Summary Judgment (ECF No. 9). Executive Ambulatory Surgical Ctr., LLC v. State Farm Mut. Auto. Ins. Co. , 442 F. Supp. 3d 998 (E.D. Mich. 2020) (ECF No. 22.) In the Opinion and Order, the Court held that Plaintiff Executive Ambulatory Surg......
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Exec. Ambulatory Surgical Ctr. v. State Farm Mut. Auto. Ins. Co.
...not barred under the doctrines of res judicata or collateral estoppel. (ECF No. 22.) Executive Ambulatory Surgical Ctr., LLC v. State Farm Mut. Auto. Ins. Co., 442 F. Supp. 3d 998 (E.D. Mich. 2020). This Court found that the two prior state court actions between ATI and State Farm, and betw......