Personal protection insurance (PIP) benefits claim; Proof of damages; Motion for a directed verdict; Reasonableness of medical providers’ charges; MCL 500.3107(1)(a); Kallabat v State Farm Mut Auto Ins Co; Admission of post-accident medical bills, health insurer’s explanations of benefits (EOBs), & defendant-insurer’s explanations of review (EORs); MCR 2.313(C)(1); Exclusion of pre-accident medical bills; Motion to strike an expert’s causation testimony; MRE 702; Penalty interest; MCL 500.3142(2); Attorney fees & costs; MCL 500.3148(1); Motion for JNOV or a new trial; Improper enlargement of the record on appeal
The court held that “plaintiff presented a question of material fact as to her having suffered damages compensable as PIP benefits” and as to the reasonableness of her medical providers’ charges. The court rejected State Farm’s challenges to the admission of some documents and the exclusion of others, and held that the trial court did not abuse its discretion in refusing to strike a treating doctor’s causation testimony. It also upheld the awards of no-fault penalty interest and attorney fees, and the denial of State Farm’s motion for JNOV or a new trial. But it vacated the award of $6,000 in costs and directed that the amount be amended to $3,768.40. State Farm’s summary disposition motion asserted “plaintiff failed to produce any proof of damages supporting” her PIP claim. However, plaintiff provided “wage information to establish her wage loss and outstanding medical bills in discovery, along with additional, supplemental records; testified at her deposition that her brother provides sporadic compensable assistance with her household services; likewise provided signed authorizations in response to State Farm’s discovery requests enabling it to obtain any and all records supporting her claim for PIP benefits; and memorialized benefits she was seeking (at that time) in a” letter. Thus, the trial court properly denied State Farm’s summary disposition motion. As to the reasonableness of medical provider charges, during the trial, plaintiff’s physical medicine and rehabilitation specialist physician (Dr. G) and her neurosurgeon (Dr. E) testified that the amount their offices bill “does not vary based upon the patient’s ability to pay via insurance or otherwise, but rather reflects the services rendered and, as [E] testified, are not simply a product of seeking payment and profit, ‘because we treat patients with all insurances, all-comers, including even uninsured.’ Further, [G] referred plaintiff to [E] for potential surgical intervention of the cervical and lumbar spine and testified that the procedures that [E] performed were consistent with his diagnosis of the plaintiff’s need.” The jury was also “provided with plaintiff’s medical bills and records (including those of Drs. [G] and [E]), BCN’s EOBs, and State Farm’s EORs for their scrutiny of the reasonableness of those expenses . . . .” Thus, the trial court properly denied State Farm’s motion for a directed verdict.
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