Plaintiffs were catastrophically injured in automobile accidents. All sustained traumatic brain injuries in the accidents and are now mentally impaired to varying degrees. After their respective accidents, plaintiffs individually sued State Farm to recover the cost of attendant care services rendered at home. Each lawsuit, except the one involving plaintiff Jonathan Boyce, ended in settlements. State Farm agreed to pay each plaintiff at certain rates for a definite period of time to cover the estimated cost of attendant care services being provided at home by, or at the direction of, family members. In some cases, State Farm obviated the requirement for the insured to submit documentation regarding the details of the home care provided.
At varying times after State Farm’s obligations under the settlement agreements expired, State Farm began conducting market surveys to determine whether the rate it was continuing to pay for attendant care services was reasonable. Various third-party healthcare providers were asked how much they paid their home health aides – those who assist with an injured person’s basic physical and medical needs at home – and State Farm formulated a market rate based on this information. The rate was much less than State Farm had paid during the settlement periods. Based on these surveys, State Farm reduced the amount it was paying plaintiffs and stated that it would consider raising the hourly rate if it received documentation demonstrating that a higher rate was justified based on the nature and extent of the care provided. Despite repeated requests for documentation, plaintiffs, apparently at the urging of counsel, did not provide the requested information. State Farm later suspended benefits for attendant care services with respect to some of the plaintiffs after it was unable to verify whether any such services were being provided.
Judge(s): Richard Griifin
Jurisdiction: U.S. Court of Appeals, Sixth Circuit
Related Categories: Civil Procedure , Civil Remedies , Contracts , Health Care
|Circuit Court Judge(s)|
|Boyce Martin, Jr.|
|Trial Court Judge(s)|
|Appellant Lawyer(s)||Appellant Law Firm(s)|
|Appellee Lawyer(s)||Appellee Law Firm(s)|
|James Gross||Gross & Nemeth PLC|
|James Hewson||Hewson & Van Hellemont PC|