FPCA Automobile Division: Allstate Sues Doctor, Clinics in Michigan

Allstate Insurance Company and Allstate Property and Casualty Insurance Company (“Allstate”) filed suit against a doctor and clinics in the Circuit Court of the County of Oakland, Michigan, on November 10, 2010.  A copy of the complaint is attached.

The complaint includes allegations of unjust enrichment, fraud, and misrepresentation.  Specifically, the complaint alleges the defendants performed unnecessary medical procedures and billed Allstate for procedures that were never rendered. 

Other allegations in the complaint include the following:

• Of the thirty Allstate insureds treated by defendants, every one of them had the same diagnosis of “radiculopathy,” and that it “is a statistical impossibility that every patient who happens to be insured with Allstate suffers from the same medical condition.”
• Defendants failed to perform a musculoskeletal exam to justify the diagnosis of radiculopathy, and that the diagnosis was utilized in an attempt to justify the unnecessary medical procedures that were billed to Allstate.
• There is no medical justification to perform procedures that burn and cut the nerves and to also perform a procedure that is purportedly to stimulate the same nerves that were burned and/or cut.
• Defendants claimed in progress notes to have injected 3-6 cc of cortisone into the epidural space, which “is a medical impossibility as the epidural space will not hold 3-6 cc of liquid.”

If you have any questions, please contact Megan Grant (mgrant@cftlaw.com).