First Party (PIP)

Court/Case No: Wayne County Circuit Court, 16-002846-NF

Tried/Argued Before: Judge

Demand: 

Verdict: $0

Name of Judge(s): Honorable Susan L. Hubbard

Keys to the Case:

Ms. David obtained a dismissal of a catastrophic claim where more than $400,000 in first-party benefits were paid pre-suit. Plaintiff filed suit seeking various first-party benefits under the Michigan No-Fault Act, including medical expenses and attendant care provided by an agency formed by her husband following the accident. Plaintiff’s agency care providers (Plaintiff’s children and sister) allegedly provided care for 10 hours per day, 7 days per week. The family-formed company charged Defendant Progressive an agency rate of $22/hour for services rendered. However, its only employees were Plaintiff’s family members who had no medical training or experience. Further, Plaintiff’s family members were paid $10 per hour and did not receive any employee benefits, health insurance, or 401k contributions. Finally, the agency had no overhead expenses aside from paying the care providers $10/hour. Plaintiff’s husband and, presumably Plaintiff, were pocketing $12/hour for doing absolutely nothing.

Although Plaintiff sought payment for 10 hours of attendant care per day, 7 days per week, and represented that she required such care due to difficulty ambulating, Plaintiff traveled to Florida and participated in the Disney Princess Half Marathon Run in February 2017. Plaintiff completed the 13 mile run in 2 hours and 41 minutes, averaging a 12 minute mile. Moreover, Plaintiff submitted claims for payment of services by her caregiver for the dates of the half marathon run. Plaintiff’s caregiver testified that she did not travel to Florida with Plaintiff on the dates claims for services were submitted.

Moreover, Defendant obtained surveillance of Plaintiff showing her performing extensive yardwork and lifting numerous heavy objects. Ultimately, Ms. David filed a dispositive motion on behalf of Defendant Progressive on the basis of Bahri v. IDS Prop. Cas. Ins. Co., 308 Mich. App. 420 (2014). Ms. David argued that Plaintiff committed fraud on multiple occasions and, although she sustained catastrophic injuries in the accident, she made material misrepresentations about her functional abilities with the intent to defraud Progressive.

Judge Hubbard granted Defendant’s dispositive motion, dismissing Plaintiff’s claims with prejudice and deeming the policy of insurance void ab initio.

Defense SW attorney(s) Involved in Case: