THE HEALING PLACE AT NORTH OAKLAND MEDICAL CENTER v ALLSTATE INSURANCE COMPANY
Docket No. 272960
Court of Appeals of Michigan
Submitted May 1, 2007, at Detroit. Decided October 23, 2007, at 9:00 a.m.
277 Mich App 51
The Court of Appeals held:
- The plaintiffs had the burden to prove that the services they rendered were compensable. Allstate supported its motion with sufficient evidence and the plaintiffs presented only a paucity of evidence to rebut Allstate‘s arguments.
- The services provided by the plaintiffs were not lawfully rendered under
MCL 500.3157 because the plaintiffs were not licensed to perform the services rendered. The focus of the statute is on natural persons or institutions. The language “lawfullyrendering treatment” does not permit an institution providing treatment to avoid licensure on the basis that a natural person providing the treatment at the institution is licensed. Similarly, the fact that an institution is licensed does not permit an unlicensed individual to provide treatment at the institution‘s facility. - The plain language of
MCL 500.3157 requires that before compensation for providing reasonable and necessary services can be obtained, the provider of treatment, whether a natural person or an institution, must be licensed in order to be “lawfully rendering treatment.” If both the individual and the institution were each required to be licensed and either was not, the lawfully rendered requirement would be unsatisfied. The court correctly granted summary disposition on the basis that the services in question were not lawfully rendered.
Affirmed.
SMOLENSKI, P.J., dissenting, stated that, in support of its motion for summary disposition, Allstate failed to meet its initial burden to produce evidence from which the trial court could determine that New Start and The Healing Place unlawfully provided services to Naylor. Because Allstate failed to meet its burden of production, the plaintiffs were not required to rebut the defendant‘s evidence, and Allstate was not entitled to summary disposition of the claims by those entities on that basis. The evidence was sufficient to support an inference that The Healing Place at North Oakland Medical Center operated as a psychiatric unit even though it only had a license to operate as a residential substance-abuse program. However, the lack of a license to operate as a psychiatric unit does not render unlawful the services it actually provides. The relevant inquiry in determining whether a particular service was lawfully rendered for purposes of
The section of the no-fault automobile insurance act providing that a physician, hospital, clinic, or other person or institution lawfully rendering treatment to an injured person may charge a reasonable amount does not permit an institution providing treatment to avoid licensure on the basis that a natural person providing the treatment at the institution is licensed; before compensation for providing reasonable and necessary services may be obtained, the provider of treatment, whether a natural person or an institution, must be licensed in order to be lawfully rendering treatment that requires licensure; if both the individual and the institution are required to be licensed and either was not, the lawfully rendered requirement would be unsatisfied (
Craig S. Romanzi & Associates, P.C. (by Craig S. Romanzi), for the plaintiffs.
Couzens, Lansky, Fealk, Ellis, Roeder & Lazar, P.C. (by Karen W. Magdich and Danielle M. Bozich), for the defendant.
Before: SMOLENSKI, P.J., and WILDER and ZAHRA, JJ.
WILDER, J. In this dispute concerning first-party, no-fault automobile personal protection insurance benefits, plaintiffs appeal as of right the trial court‘s grant of summary disposition to defendant Allstate Insurance Company. The key issue is whether the services at issue were “lawfully render[ed]” under
I
A
In 1995, plaintiff Edgar Naylor was struck by a car while he was riding a bicycle. At the time, Naylor had automobile insurance through Allstate. As a result of the accident, Naylor allegedly suffered a brain injury or
In 2004, after serving a prison sentence of several years, Naylor admitted himself to the program offered by New Start, The Healing Place, and The Healing Place at North Oakland Medical Center (THP at NOMC), wherein, in 2004 and 2005, he received various services as part of an integrated treatment for brain injury, psychiatric disorders, and substance abuse. Plaintiffs1 then submitted claims to Allstate for first-party, no-fault automobile personal protection insurance benefits for those services. Allstate denied the claims.
B
In October 2004, plaintiffs commenced this action for breach of contract and declaratory relief. In June 2006, Allstate moved for summary disposition under
In ruling on Allstate‘s motion, the trial court first noted that plaintiffs had the burden to prove that the services were reasonably necessary for Naylor‘s care and that they did not present any evidence of the nature
II
We review rulings on motions for summary dispositions de novo. Willett v Waterford Charter Twp, 271 Mich App 38, 45; 718 NW2d 386 (2006). To the extent that this dispute requires us to interpret the parties’ insurance contract, the proper interpretation of a contract is a question of law, Wilkie v Auto-Owners Ins Co, 469 Mich 41, 47; 664 NW2d 776 (2003); Randolph v Reisig, 272 Mich App 331, 333; 727 NW2d 388 (2006), that we review de novo, Rory v Continental Ins Co, 473 Mich 457, 464; 703 NW2d 23 (2005). To the extent that this dispute requires us to engage in statutory interpretation, the interpretation of a statute is also a question of law that we review de novo. Newton v Bank West, 262 Mich App 434, 437; 686 NW2d 491 (2004).
“Summary disposition under either
A motion made under
When deciding a motion for summary disposition under this rule, a court must consider the pleadings, affidavits, depositions, admissions, and other documentary evidence then filed in the action or submitted by the parties in the light most favorable to the nonmoving party.
III
A
Under
As established by Nasser v Auto Club Ins Ass‘n, 435 Mich 33, 49-50; 457 NW2d 637 (1990), it is plaintiffs’ burden to prove that the services provided by New Start, The Healing Place, and THP at NOMC were compensable. In its motion for summary disposition, Allstate argued that the services provided by plaintiffs were not “lawfully render[ed],”
In support of its motion, Allstate presented both documentary evidence and deposition testimony. Allstate‘s documentary evidence established that THP at NOMC held a license for residential substance abuse
B
We hold, on the existing record and as a matter of law, that the services provided by plaintiffs were not “lawfully render[ed],”
Another Michigan statute sheds light on the no-fault statute‘s “lawfully render[ed]” requirement.
In addition,
a health care facility; a person licensed, certified, or registered under parts 161 to 182 of Act No. 368 of the Public Acts of 1978, as amended, being sections
333.16101 to333.18237 of the Michigan Compiled Laws; any other person or facility, with the approval of the commissioner, who or which meets the standards set by the health care corporation for all contracting providers; and, for purposes of section 414a, any person or facility who or which provides intermediate or outpatient care for substance abuse, as defined in section 414a. [MCL 550.1105(4) (emphasis added).]
In so providing, § 1105(4) clearly provides that an unlicensed provider is not a health care provider. Reasoning by analogy, the no-fault act must be read to provide that if both the individual who provided services and the institution to which the individual be
C
The dissent relies on Miller v Allstate Ins Co (On Remand), 275 Mich App 649, 657-658; 739 NW2d 675 (2007). We find Miller distinguishable, because it considered only whether mere defects in corporate structure would render treatment provided by the incorrectly incorporated entity not “lawfully render[ed]” under
D
Because we find that the trial court correctly granted summary disposition on the basis that the services in question were not “lawfully render[ed],” plaintiffs’ remaining issues are moot. Ewing v Bolden, 194 Mich App 95, 104; 486 NW2d 96 (1992).
IV
For the foregoing reasons, we affirm the trial court‘s summary disposition in Allstate‘s favor.
ZAHRA, J., concurred.
SMOLENSKI, P.J. (dissenting). Because I conclude that the trial court erred when it granted summary disposition in favor of defendant, I respectfully dissent.
In the present case, plaintiffs alleged that they were entitled to compensation for services provided to defendant‘s insured. Under
[a] physician, hospital, clinic or other person or institution lawfully rendering treatment to an injured person for an accidental bodily injury covered by personal protection insurance ... may charge a reasonable amount for the products, services and accommodations rendered.
In Cherry v State Farm Mut Automobile Ins Co, 195 Mich App 316, 320; 489 NW2d 788 (1992), the Court read
In its motion for summary disposition, defendant argued that The Healing Place at North Oakland Medical Center (THP at NOMC) was required to be licensed as a psychiatric hospital unit, that The Healing Place, Ltd. (The Healing Place), had no license at all, and that New Start, Inc. (New Start), provided services that required a license to operate an adult foster-care facility. Defendant further argued that, because these entities did not have the requisite licenses, the services rendered by those entities were unlawful within the meaning of
Although plaintiffs bore the ultimate burden to prove that their charges were compensable under
In its motion for summary disposition, defendant alleged that New Start provided services to Naylor as an adult foster-care facility. Further, defendant alleged that New Start did not have a license to operate an adult foster-care facility. In order to constitute an “adult foster care facility,” New Start must provide foster care to adults who are aged, mentally ill, developmentally disabled, or physically disabled in such a way that they require ongoing supervision, but do not require continuous nursing care.
To support its claim that New Start unlawfully operated an adult foster-care facility, defendant attached a copy of a license for residential substance-abuse treatment issued to THP at NOMC. However, this license alone does not establish that New Start does not possess a license to operate an adult foster-care facility. Defendant also attached a letter from a staff member at New Start to Naylor‘s parole officer that states that Naylor had been admitted to the inpatient hospital-based program run by The Healing Place, but had since matriculated and was now participating in
In its reply to plaintiffs’ response, defendant also cited and attached the deposition testimony of Dr. Thomas Kane, who was a contract psychiatrist with New Start from 2003 to May 2004. Kane testified that, to his knowledge, New Start supervised the treatment of a person named Barbara Clark and also stated that he assumed that New Start provided hygiene, grooming, maintenance, and medication services to all its patients. Defendant did not explain how Barbara Clark‘s treatment was relevant to this case and failed to explain how Kane‘s assumptions about the services provided during the period of his contractual relationship with New Start established the nature of the services provided by New Start after Kane terminated his relationship with New Start. Finally, defendant cited the testimony of Roman Frankel, who apparently is an owner of at least one of the entities at issue.1 According to defendant, Frankel testified that New Start‘s staff was on call 24 hours a day. However, the attached pages of the deposition contain no such testimony.2
On the basis of the evidence presented by defendant in support of its motion for summary disposition, I conclude that defendant failed to meet its initial burden to produce evidence from which the trial court could determine that New Start and The Healing Place unlawfully provided services to Naylor. Quinto, supra at 362. Because defendant failed to meet its initial burden of production, plaintiffs were not required to rebut defendant‘s evidence and defendant was not entitled to summary disposition of the claims by those entities on that basis.
Defendant also claimed that THP at NOMC provided services to Naylor as a psychiatric unit without having
In Miller v Allstate Ins Co (On Remand), 275 Mich App 649; 739 NW2d 675 (2007), the Court examined whether a defect in the corporate form of an entity that provided services to an injured person insured by Allstate rendered the provision of services unlawful within the meaning of
While the language of
MCL 500.3157 speaks of a clinic or institution lawfully rendering treatment, treatment is invariably and necessarily performed or rendered by employees and personnel; the treatment itself has nothing to do with corporate formation issues. Moreover, the inclusion of “physician, hospital, clinic or other person or institution” in the statutory language is chiefly for purposes of identifying those entities and persons that “may charge a reasonable amount for the products, services and accommodations rendered.”MCL 500.3157 . While Allstate argues that the Legislature included entities (hospitals, clinics, and institutions) in the statute because the entities need to be lawfully rendering treatment independent from any consideration of whether individual employees or agents who actually treat patients are doing so, we read the inclusion of the entities in the statutory language as merely indicating that those entities can be paid by insurers for services provided at their institutions. Of course, each of these entities must be lawfully rendering treatment, but, again, the treatment is rendered through their personnel. Furthermore, the Legislature‘s focus on the lawfulness of rendering treatment as opposed to the lawfulness of an entity‘s corporate structure indicates the Legislature‘s desire not to burden individuals seeking medical treatment, ostensibly covered by insurance, from having to engage in an extensive and in-depth review and analysis regarding an entity‘s formation and related incorporation issues. The goal of the no-fault act was to provide accident victims with adequate, assured, and prompt reparation for their losses. Nelson v Transamerica Ins Services, 441 Mich 508, 514; 495 NW2d 370 (1992). This goal would be defeated by interpretingMCL 500.3157 as advocated by Allstate. [Miller, supra at 657-658 (emphasis in original).]
Although the holding in Miller applied to defects in corporate structure, I conclude that the reasoning applies equally to issues involving the licensing of entities.
The stated purpose behind establishing licensing requirement for psychiatric units is to ensure that the units “provide the facilities and the ancillary support-
I also disagree with defendant‘s argument that summary disposition was appropriate because plaintiffs failed to present evidence that the entities actually rendered compensable services. Defendant apparently conceded that each of the entities provided some services to Naylor. Indeed, defendant only argued that the services were (1) not related to the injuries caused by the accident, (2) not lawfully rendered, and (3) not reasonable. Because defendant did not challenge whether the services were actually provided to Naylor, plaintiffs cannot be faulted for failing to present evi-
Defendant also argued that summary disposition was appropriate because plaintiffs only treated Naylor for conditions that predated the injuries from the car accident. In support of this argument, defendant attached records that indicate that Naylor had suffered a closed head injury as a child and had a substance-abuse problem before the accident in question. However, the medical records also indicate that Naylor had decreased impulse control after the automobile accident that may have exacerbated his substance-abuse problem. In addition, the records indicate that the closed head injury he suffered in the accident may have increased his mental deficits. Hence, there is a question of fact regarding whether the services provided were reasonably necessary to treat Naylor for the injuries he suffered during the car accident as required by
Finally, defendant argued that plaintiffs’ fees were unreasonable. Although the trial court did not address this issue, on review de novo, I would conclude that this argument is unavailing. Defendant failed to present any evidence concerning the reasonableness of the fees plaintiffs charged for the services provided to Naylor. Instead, defendant merely argued that plaintiffs would have to prove that their fees were reasonable and noted that plaintiffs had not presented any evidence that the fees were reasonable. However, as noted above, defendant has the initial burden to provide evidence from which the trial court could conclude that the fees were unreasonable. See Quinto, supra at 362. Absent the
For these reasons, I conclude that the trial court erred when it determined that defendant was entitled to summary disposition in its favor. Therefore, I would reverse and remand this case for further proceedings.
