Where a plaintiff sought PIP benefits, summary judgment is unwarranted because a jury question remains about whether the expenses the plaintiff alleges were incurred.
“Plaintiff Heavenly Hands Physical Therapy, LLC, seeks repayment of first party no-fault benefits from Defendant Allstate Fire and Casualty Insurance Company for rehabilitative services provided to Khattar Zalghout for his injuries from a motor vehicle accident.
“Heavenly Hands moves for partial summary judgment, asking the Court to strike Allstate's affirmative defenses, hold an evidentiary hearing to determine a fee schedule rate, and award penalty interest and attorney's fees.
“First, Heavenly Hands says that the Court should strike the affirmative defenses because Allstate has no independent medical examinations (IMEs), expert opinions, or surveillance logs to support the denial of bills. ... But Heavenly Hands does not specify any affirmative defenses nor set forth legal authority showing that the affirmative defenses require such evidence.
“Heavenly Hands also argues that Allstate never paid it any benefits and now owes penalty interest for the overdue payment. ... Under the Michigan No-Fault Act, ‘an insurer is liable to pay benefits for accidental bodily injury arising out of' an automobile accident. Mich. Comp. Laws. 500.3105(1). Benefits are payable for ‘allowable expenses consisting of reasonable charges incurred for reasonably necessary products, services and accommodations for an injured person's care, recovery, or rehabilitation.’ ... In other words, to hold a no-fault insurer responsible for benefits, the expense must have been (1) incurred; (2) reasonably necessary for the injured person's care, recovery, or rehabilitation; and (3) a reasonable amount.
“Heavenly Hands argues that it provided reasonable treatment to Zalghout and submitted medical documentation, so Allstate should have paid the benefits. ... It also says that the Court should award it penalty interest for the overdue payment of benefits, citing an Allstate doctor's opinion to show that physical therapy was reasonable and necessary for at least three months. ... And Heavenly Hands states that a fee schedule applies to the medical bills so that ‘there can be very little dispute over the amount owed.’
“But a jury question remains about whether the expenses Heavenly Hands alleges were incurred. Though Allstate's motion for summary judgment on that issue is denied, there is insufficient evidence for the Court to decide as a matter of law that Heavenly Hands' billing was accurate. And though Allstate's expert found that Zalghout needed reasonable treatment for three months following the accident, that does not mean that Heavenly Hands has met its burden of showing that the treatment it provided was entirely reasonable.
“In sum, Heavenly Hands points to weaknesses in Allstate's case, but it has not shown that no genuine issues of material fact exist.”
Heavenly Hands Physical Therapy LLC v. Allstate Fire & Cas. Ins. Co.; MiLW 02-108143, 9 pages; U.S. District Court for the Eastern District of Michigan; Stafford, J.
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