Synergy Spine & Orthopedic Surgery Ctr LLC v. American Country Ins
350549
Mich. Ct. App.Jul 15, 2021Background:
- Synergy Spine and Silver Pine assigned PIP claims from Laquita Jackson‑Davis for injuries from a March 19, 2017 motor‑vehicle accident; they sued American Country after it refused payment of medical bills.
- Case evaluation awarded plaintiffs $160,000 (Synergy) and $37,000 (Silver Pine); defendant rejected and proceeded to trial.
- Pretrial: defendant relied on an IME finding no acute injury from the March 2017 accident and discovered (after a deposition) an April 5, 2017 hospitalization and a prior 2015 claim dismissed for fraud.
- Trial issues included causation (whether the March 2017 accident was a cause of Jackson’s treatment), admissibility of a March 2019 shoulder‑surgery bill disclosed the day before trial, and whether defendant could question Jackson about prior fraud/non‑disclosure.
- The jury awarded plaintiffs less than the case evaluation on some items but, after adding costs, interest, and attorney fees, the judgment totaled $299,282.70; the trial court also awarded MCR 2.403(O) case‑evaluation sanctions.
- Defendant appealed multiple rulings (jury instructions, exclusion of fraud questioning, denial of mistrial, witness‑recall, admission of 2019 bills, case‑evaluation sanctions, improper closing), and this Court affirmed.
Issues:
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Causation instruction — whether stating an accident may be “one of the causes” was insufficient without "incidental/fortuitous/'but for'" language | Instruction correctly states Michigan law for multi‑cause injuries: a motor‑vehicle accident that is one of the causes suffices. | Omitting "incidental/fortuitous/'but for'" lowered defendant's burden; instruction was incomplete. | Affirmed — instruction proper where accident clearly was a motor‑vehicle accident and multi‑cause instruction aligns with precedent. |
| Exclusion of questioning Jackson about prior fraud and undisclosed April 2017 accident | Exclusion proper; defendant didn’t plead fraud as an affirmative defense. | Prior fraud and failure to disclose are relevant to bias and credibility; defendant should be allowed to probe. | Trial court abused discretion by precluding such questioning, but error was harmless — no reversal. |
| Motion for mistrial after Jackson’s courtroom outburst | No mistrial warranted; outburst short and unlikely to prejudice. | Juror reaction and witness demeanor warranted mistrial. | Denial not an abuse of discretion; verdict not tainted. |
| Refusal to allow recall of claims adjuster McCowan | Plaintiffs: court acted within discretion. | Defendant: needed to rebut later testimony and explain billing review process. | Issue waived on appeal for insufficient argument; no relief. |
| Admission of March 2019 surgery bills disclosed one day before trial (30‑day statutory period) | Admissible; claim can be presented during trial and interest/overdue status addressed separately. | Unfair — insurer was denied the 30‑day grace period under MCL 500.3142. | Admission not an abuse of discretion; McMillan supports presenting claim during trial. |
| Case‑evaluation sanctions under MCR 2.403(O) | Plaintiffs entitled because adjusted verdict (with costs/interest) exceeded evaluation by >10%. | Verdict should be reduced to exclude post‑evaluation surgery claim not before panel, removing sanction entitlement. | Sanctions affirmed; adjustments and claim substitutions at trial meant the adjusted verdict still surpassed evaluations. |
| Improper closing argument (plaintiffs’ counsel said defendant tried to “stick” Jackson with bills) | Closing argument permissible commentary on evidence and theory. | Statement was unsupported, inflammatory, and required new trial. | Remark was improper but isolated and harmless; no new trial. |
| Motion for new trial or remittitur; denial without extended oral record | Plaintiffs: trial court gave concise reasons and did not abuse discretion. | Defendant: court abused discretion by not allowing oral argument and by denying remittitur on various claimed overcharges. | Denial not an abuse; remittitur claims inadequately supported or waived. |
Key Cases Cited
- Griffith v State Farm Mut. Auto. Ins. Co., 472 Mich 521 (Supreme Court) (explains two‑part causation test under MCL 500.3105(1)).
- Thornton v Allstate Ins. Co., 425 Mich 643 (Supreme Court) (no‑fault coverage requires causal connection more than incidental/fortuitous/'but for').
- Kemp v Farm Bureau Gen. Ins. Co. of Mich., 500 Mich 245 (Supreme Court) (causation analysis in no‑fault context).
- Buckeye Union Ins. Co. v Johnson, 108 Mich App 46 (Court of Appeals) (if maintenance/use is one cause, sufficient causal connection exists despite independent causes).
- Shinabarger v Citizens Mut. Ins. Co., 90 Mich App 307 (Court of Appeals) (same principle for multi‑cause injuries).
- McMillan v ACIA, 195 Mich App 463 (Court of Appeals) (a no‑fault claim may be presented during trial; interest may run from 30 days after insurer receives reasonable proof during trial).
- Veltman v Detroit Edison Co., 261 Mich App 685 (Court of Appeals) (standard for granting mistrial — abuse of discretion review).
- Willett v Ford Motor Co., 400 Mich 65 (Supreme Court) (curative instructions can obviate need for mistrial).