No New Insurance Trial for Brain Injury Care

DETROIT (CN) - Car accident victims with traumatic brain injuries cannot get another trial to seek more money for in-home care from State Farm Auto Insurance, the 6th Circuit ruled.

Though State Farm had initially paid for home attendant care services at the rate requested by the patients, they later reduced those rates and refused to reinstate them for lack of documentation about the type and cost of care each patient received.

Six filed suit, but a jury sided with State Farm after a 20-day trial, finding that none of the plaintiffs had incurred "allowable expenses."

A three-judge appellate panel affirmed the lower court in nearly every respect last week.

Though family members are not required to provide documentation for home care services under Michigan law, "the burden rests with the insured to demonstrate by a preponderance of the evidence that each expense was actually incurred," Judge Griffin wrote for the court.

"And detailed documentation of the services rendered is certainly persuasive evidence on the matter," he added.

"State Farm persuaded the jury that detailed information regarding the times and specific types of care provided constituted the necessary proof of expenses incurred in this instance, given that care was being provided at home at the direction of family members instead of at a care facility where the type and extent of care would be documented in detail," the decision states. "It is certainly reasonable for a jury to conclude that an insured's failure to produce at trial detailed documentation of the care it claims was provided constitutes a failure to prove that expenses for the care were actually incurred."

The plaintiffs cited Buntea v. State Farm, a similar case from 2007 in which testimony from the woman who received home care was enough for a jury to determine expenses without documentation.

But the panel noted that "the District Court there simply held that the evidence in the record - testimony and doctors letters - was sufficient to permit a jury to find that the plaintiffs had incurred expenses for home care, not that a jury would act unreasonably if it found otherwise."

Citing a lack of jurisdiction, the judges refused to consider discovery sanctions that the trial court had imposed against State Farm.

Since the trial court has not yet determined or imposed the sanctions, a review of the decision would be premature, according to the appellate panel.

State Farm had tried to overturn the sanctions on appeal, while the plaintiffs argued that the court should have awarded them summary judgment instead.

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