Adam Post and Courtney Fall secure dismissal of multiple Plaintiff provider claims based on underlying patient’s fraud.
Zausmer shareholder A. Adam Post, II and associate Courtney Fall recently achieved a significant victory for their client in a no-fault medical provider suit by obtaining summary disposition based on the fraudulent insurance acts of the underlying patient.
In the suit, four plaintiff medical providers claimed combined bills of over $295,000.00 for treatment allegedly related to injuries the underlying patient sustained in a motor vehicle accident. Through written discovery and depositions, Adam and Courtney focused on investigating the underlying patient’s pre-existing medical history, as well as his pre- and post-accident employment.
During the deposition of the underlying patient, the patient denied any pre-existing conditions and repeatedly claimed to have been employed at the time of the accident before being rendered unable to work due to his injuries. However, review of the medical records showed similar pre-existing medical conditions, while employment records showed that the patient had not been employed at the time of the accident as he claimed, but instead applied for the position and began working months after the accident occurred.
During oral argument, Courtney highlighted the fact that the requirements of proving a fraudulent insurance act under MCL 500.3173a(2) had all been met by the underlying patient’s conduct. He then argued that based on the statute, the patient’s claim as a whole, including the derivative claims of the plaintiff medical providers, were ineligible for benefits. Ultimately, the Court agreed and granted summary disposition, finding that there was no genuine issue of material fact that the underlying patient had committed fraudulent insurance acts, and as a result, the providers were ineligible for payment of benefits.
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