Case 4:21-cv-11309-SDD-DRG ECF No. 1, PageID.1 Filed 06/03/21 Page 1 of 7
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`UNITED STATES DISTRICT COURT
`EASTERN DISTRICT OF MICHIGAN
`SOUTHERN DIVISION
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`ALLSTATE FIRE AND CASUALTY INSURANCE COMPANY
`a foreign corporation,
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`Plaintiff,
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`v.
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`BLUE CROSS BLUE SHEILD OF ALABAMA,
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`Case No. 21-
`Judge
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`Defendant.
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`KENNETH P. WILLIAMS (P55790)
`Segal, McCambridge Singer & Mahoney
`Attorney for Plaintiff
`29100 Northwestern Hwy., Suite 240
`Southfield, MI 48034
`(248) 994-0060 / (248) 994-0061 (fax)
`kwilliams@smsm.com
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`COMPLAINT FOR DECLARATORY JUDGMENT
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`Plaintiff, ALLSTATE FIRE AND CASUALTY INSURANCE COMPANY
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`(“Allstate”), by and through its attorneys, SEGAL McCAMBRIDGE SINGER & MAHONEY,
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`LTD., and for its Complaint for Declaratory Judgment against the above-named Defendant, BLUE
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`CROSS BLUE SHEILD OF ALABAMA, states as follows for its Complaint for Declaratory
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`Judgment pursuant to MCR 2.605:
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`PARTIES, JURISDICTION & VENUE
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`1.
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`Plaintiff ALLSTATE FIRE AND CASUALTY INSURANCE COMPANY,
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`(“Plaintiff”) is a wholly owned subsidiary of Allstate Insurance Holdings, LLC, which is an Illinois
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`limited liability company. Allstate Insurance Holdings, LLC., is a subsidiary of The Allstate
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`Corporation, which is an Illinois corporation. The Plaintiff’s principal place of business is Illinois,
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`Case 4:21-cv-11309-SDD-DRG ECF No. 1, PageID.2 Filed 06/03/21 Page 2 of 7
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`where it maintains its headquarters, and it is licensed to conduct insurance business in the State of
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`Michigan.
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`2.
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`This case arises out of an automobile accident which occurred February 27, 2019
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`in Ann Arbor, in the County of Washtenaw County, State of Michigan, and the subsequent
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`treatment to follow. The injured party in said accident was Tamara Webster.
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`3.
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`That upon information and belief, Tamara Webster, at the time of said accident,
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`was domiciled in the State of Michigan with a permanent address of 20471 Elmwood Street Garden
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`City, Michigan 48135.
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`4.
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`The amount in controversy is $111,351.01 which exceeds Seventy-Five Thousand
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`Dollars ($75,000.00), exclusive of costs, interest and attorney fees, and is otherwise within the
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`jurisdiction of this Court for the reason that declaratory relief is sought.
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`5.
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`That this is a diversity case, as Defendant Blue Cross Blue Shield of Alabama is
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`headquartered in Alabama, and Plaintiff is an Illinois Corporation, and is licensed to conduct
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`business in the State of Michigan
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`5.
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`Upon information and belief, this Court is the proper venue for this action under 28
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`USC Sec. 1391 because a substantial part of the events giving rise to the claims at issue occurred in
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`this district.
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`6.
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`7.
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`8.
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`FACTS
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`Allstate restates the allegations pled in paragraphs 1–5 above as if set forth in full.
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`Allstate provided Ms. Webster with Michigan automobile insurance coverage.
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`On February 27, 2018, Webster was allegedly involved in a motor vehicle accident
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`while she was walking in a hospital parking structure. Webster was allegedly pulling a wagon when
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`the negligent driver hit the wagon which then hit the Plaintiff’s leg.
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`Case 4:21-cv-11309-SDD-DRG ECF No. 1, PageID.3 Filed 06/03/21 Page 3 of 7
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`9.
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`After the accident, Webster left the parking structure and returned to the hospital’s
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`emergency room to seek treatment. At the time, Webster only complained of injuries to her right leg.
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`Webster admitted that her right leg was also injured prior to the accident.
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`10.
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`On December 4, 2018, Tamara Webster filed litigation against Allstate (Wayne
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`County Circuit Court, Case No. 18-015368-NF). During that litigation, by court order, Allstate agreed
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`to indemnify and hold Webster harmless in the event that Defendant would file a lawsuit against her,
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`giving rise to this declaratory action.
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`11.
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`At the time of the accident Webster was had health insurance through her husband’s
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`employer with Blue Cross Blue Shield of Kentucky. This later changed to defendant Blue Cross
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`Blue Shield of Alabama. (Exhibit A- Proof of Coverage).
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`12. Approximately one year following the accident, from February 2019 to October
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`2019, Webster sought treatment for pre-existing injuries including an injury to her right leg prior
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`to the motor vehicle accident, a previous surgery on her right ankle, fibromyalgia, multiple
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`sclerosis, and a previous motor vehicle accident in 1984 which caused cervical and lower back
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`pain. These injuries and complaints pre-dated the subject motor vehicle accident and were
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`unrelated to the motor vehicle accident.
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`13.
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`Defendant Blue Cross Blue Shield of Alabama provided coverage to Webster and
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`paid $111,351.01 in benefits for treatment for the dates between February 2019-October 2019.
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`(Exhibit B- BCBS Lien)
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`14. Now, Defendant Blue Cross Blue Shield of Alabama seeks to enforce a subrogation
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`lien for the amount of $111,351.01 against Webster for the services provided to Webster from
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`February 2019-October 2019.
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`Case 4:21-cv-11309-SDD-DRG ECF No. 1, PageID.4 Filed 06/03/21 Page 4 of 7
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`15.
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`Pursuant to the Michigan No-Fault Act, Allstate is only liable for treatment casually
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`related to Webster’s injuries arising out of the accident. Any treatment rendered for injuries not
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`related to the motor vehicle, are to be covered by Webster’s health insurance carrier.
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`16. Blue Cross Blue Shield of Alabama listed the services in which they seek to recover
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`from Webster in their lien. These services provided to Webster include only treatment to injuries
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`Webster had prior to the motor vehicle accident.
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`17.
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`Among the treatments that Defendant included in the lien, Defendant included
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`physical therapy rendered to Webster from Dearborn Orthopedic Association. These sessions were
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`intended to rehabilitate Webster’s right leg. Webster testified that she injured her right leg prior to
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`the accident. Specifically, on October 17, 2017 Webster presented to the emergency room with
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`right leg pain after placing her daughter in bed, 9 days later Webster returned to the hospital after
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`hearing a pop in her right calf and started wearing a CAM boot. Webster’s calf injury and
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`subsequent treatment was unrelated to any injury sustained in the subject motor vehicle accident.
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`18.
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`In 1984, Webster was involved in a motor vehicle accident which caused cervical
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`and lower back pain. Webster also has a long history of multiple sclerosis and fibromyalgia. In
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`2000, Plaintiff was involved in another motor vehicle accident and her University of Michigan
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`medical records that year indicate that she had chronic lower back pain.
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`19.
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`Following the alleged accident, Webster suffered from a fall in Disney world in
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`September of 2019 and a slip and fall at Walgreens in November 2019. Among other services,
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`Defendant is also asking for reimbursement for a surgery performed at Ascension Providence
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`Hospital by Michigan Brain and Spine on October 24, 2019 which doctors directly related to
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`Webster’s fall at Disney World after the motor vehicle accident.
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`Case 4:21-cv-11309-SDD-DRG ECF No. 1, PageID.5 Filed 06/03/21 Page 5 of 7
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`20. Comparing the treatments included in Defendant’s lien, to Webster’s medical
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`records, it is clear that the treatment which Defendant is seeking reimbursement of is unrelated to
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`the injuries sustained in the motor vehicle accident.
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`21.
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`In addition, a full body scan of Webster eight months after the motor vehicle
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`accident demonstrated no fractures or acute abnormalities in her body.
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`22.
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`Here, Defendant seeks to recover for treatment over a year after the accident.
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`REQUEST FOR DECLARATORY RELIEF
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`23.
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`Allstate repeats the allegations pled in paragraphs 1-22 above as set forth in full.
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`24. Allstate provided Ms. Webster with Michigan Automobile insurance (Exhibit C-
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`Allstate Policy). Pursuant to Michigan No-Fault Acts, Allstate is only liable for medical treatment
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`that is reasonably necessary and causally related to the motor vehicle accident.
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`25. Here, Defendant, placed a lien on Plaintiff for non-payment of treatment that is
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`unrelated to the subject motor vehicle accident.
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`26. MCL 500.3105 (1) states that “an [automobile] insurer is liable to pay benefits for
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`accidental bodily injury arising out of the ownership, operation, maintenance or use of a motor
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`vehicle as a motor vehicle.
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`27. MCL 500.3105 (1) states that there must be a causal connection between the
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`injuries and the motor vehicle accident.
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`28. MCL 500.3107(1)(a) permits an injured person to recover PIP benefits from an
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`insurer for “[a]llowable expenses consisting of all reasonable charges incurred for reasonably
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`necessary products, services and accommodations for an injured person’s care, recovery, or
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`rehabilitation.” Under Griffith, this provision requires that “an ‘allowable expense’ must be ‘for’
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`one of the following: (1) an injured person’s care, (2) his recovery, or (3) his rehabilitation.”
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`Case 4:21-cv-11309-SDD-DRG ECF No. 1, PageID.6 Filed 06/03/21 Page 6 of 7
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`28. A mere change in the injured person’s post accident expenses is insufficient to satisfy
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`MCL 500.3107(1)(a); the new expense must be of a wholly different essential character than
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`expenses borne by the person before the accident to show that it is for the injured person’s care,
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`recovery, or rehabilitation.
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`29.
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`Complying with MCL 500.3107(1)(a) and determining what products, services, and
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`accommodations are actually for the injured person’s care, recovery, or rehabilitation requires a
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`careful examination of the injured person’s post accident expenses. A mere change in the injured
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`person’s post accident expenses is insufficient to satisfy MCL 500.3107(1)(a); the new expense
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`must be of a wholly different essential character than expenses borne by the person before the
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`accident to show that it is for the injured person’s care, recovery, or rehabilitation.
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`30.
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`The statute only entitles an injured party to reimbursement for products, services,
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`and accommodations that are actually for his care, recovery, or rehabilitation. (Admire v. Auto-
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`Owners Ins. Co., 494 Mich. 10 (2013) 831 N.W.2d 849).
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`29.
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`Here, the treatment that Defendant is seeking payment for, is unrelated to the
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`Webster’s injuries arising out of the February 2018 motor vehicle accident.
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`29.
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`Treatment unrelated to injuries arising out of the subject motor vehicle accident
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`does not fall under the category of personal protection insurance benefits.
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`30.
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`Pursuant to MCL 500.3105 the treatment in controversy does not fall under the
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`category of personal protection insurance benefits, therefore, Allstate is not liable for treatment
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`rendered to Webster for any injuries unrelated to the motor vehicle accident.
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`Case 4:21-cv-11309-SDD-DRG ECF No. 1, PageID.7 Filed 06/03/21 Page 7 of 7
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`RELIEF REQUESTED
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`For the reasons outlined above, Allstate requests the Court’s declaratory judgment that
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`Allstate has no duty to provide personal protection insurance benefits to Webster for treatment
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`unrelated to the subject motor vehicle accident pursuant to MCL 500.3105 (1) and MCL 500.3107
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`(1)(a).
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`WHEREFORE, Plaintiff ALLSTATE INSURANCE COMPANY, asks the Court to award
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`it any other equitable and declaratory relief in damages to which it is entitled in connection with the
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`prosecution of this declaratory judgment action.
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`Dated: May 11, 2021
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`SEGAL McCAMBRIDGE SINGER & MAHONEY, LTD.
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`/s/ Kenneth P. Williams ___________________________
`KENNETH P. WILLIAMS (P55790)
`Attorney for Plaintiff
`29100 Northwestern Hwy., Ste. 240
`Southfield, MI 48034
`(248) 994-0060
`kwilliams@smsm.com
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