Court allows State Farm limited capacity to tax fees and costs after winning attendant care fight
This week three judges of the Court of Appeals returned a no fault PIP "attendant care" case to the Circuit Court to evaluate sanction claims made by State Farm. The case arises out of an effort by the Next Friend of John Raymond Gentris to secure payment of attendant care benefits for Gentris.
Gentris was struck by a car, while a pedestrian, and suffered horrible injuries. In addition to a severe traumatic brain injury, State Farm conceded that Gentris suffered from a continuing cognitive disorder, a seizure disorder, and left-sided hemiparesis with contracture of the left upper extremity, left foot drop, antalgic gait and associated depression.It was undisputed that John was rendered "nonfunctional...for all practical purposes." He used multiple splints and braces and his doctor confirmed that he required 24 hour supervision. State Farm paid his family $9.00 per hour, 24 hours a day, for four years, before completely stopping payment in 2008. At the time, State Farm accused the providers of "misrepresentations in paperwork submitted." The family sued and the Court reinstituted 16 hour per day benefits at the same rate for the interim. The disagreement boiled down to the family seeking payment for times when they were not physically with John.
At trial, State Farm documented several occasions when John was left unsupervised, allowed to walk to the corner grocery alone, or supervised by someone other than the family member who submitted an attendant care billing to State Farm. Apparently on the basis of this testimony, the jury concluded that the family was entitled to recover no attendant care benefits. State Farm then sought fees and costs in excess of $150,000.00 from the man's Conservator. (This award would allow State Farm to set off the Conservator's debt against any future benefits owed for John's care.)
The trial judge refused to award State Farm fees or costs, holding that there was no dispute that John was entitled to attendant care--only a disagreement about the proper rate and whether or not the identified family members actually provided the service billed. The Court of Appeals overturned this decision and sent the case back to the lower court for further analysis. It pointed out that the lower court judge had never made the ultimate analysis of whether the family's attendant care submissions were so excessive or fraudulent as to justify an award of fees.
Given that John's doctor had recommended that he have some "unsupervised" time, such as the trips to the grocery store which the family claimed to be monitoring, it was a matter of the trial court's reasonable discretion to decide whether State Farm should be allowed to recover costs and fees, regardless of the jury's holding. It is difficult to tell from the Court's opinion, however, it appears that the family's case may also have been tainted by an unreasonable over-reach in the market value it assigned to post-2008 attendant care services: the jury's decision may have reflected operation of the axiom that "pigs get fact but hogs get slaughtered."