6th Circuit Court Upholds Dismissal Of Injured Worker Suit For Attempting To Refuse Coverage

MERRITT, Circuit Judge. This is an appeal from the district court’s dismissal of Mark Marusza’s and Nancy Gucwa’s complaint, which alleged four causes of action. Marusza suffered a serious work-related accident in fall 2011. Marusza alleges that defendant Accident Fund Insurance Company neglected to pay their share of Marusza’s medical bills, which resulted in Medicare paying for a portion of his bills. Accident Fund likewise refused to pay Gucwa—Marusza’s long-term, live-in girlfriend—for the attendant care she provided Marusza. Accident Fund hired the four defendant physicians to examine Marusza’s condition.

Marusza and Gucwa allege that: (1) Accident Fund and the defendant physicians defrauded Marusza, Gucwa, and others of benefits, in violation of the Racketeer Influenced and Corrupt Organizations Act; (2) Marusza is entitled to double damages under the Medicare Secondary Payer Act; (3) the defendant doctors tortiously interfered with Marusza’s contractual relationship and/or business expectancy by inducing Accident Fund to deny his benefits; and (4) Accident Fund falsely imprisoned Marusza by requiring him to attend an examination with a neuropsychologist.

 

The district court dismissed each claim under Rule 12(b)(6) for failure to state a claim. Plaintiffs appeal and additionally argue that the district court abused its discretion by granting Plaintiffs’ request to exercise jurisdiction over the state law tort claims.

 

We affirm the district court.

 

Background:

 

A sport-utility vehicle struck a pedestrian, Mark Marusza, on October 18, 2011, while Marusza was on the job. Marusza sustained injuries to his brain, shoulders, cervical spine, and ribs. Following his release from the hospital, his live-in “significant other” of over twenty years, Nancy Gucwa, provided attendant care services for his brain and spinal injuries. According to Plaintiffs, Marusza expressly agreed to pay Gucwa for her care. Gucwa has no background as a professional healthcare provider.

 

Marusza’s workers’ compensation administrator—Accident Fund Insurance Company— initially paid Marusza’s claims for Gucwa’s care but terminated payment in July 2012. Accident Fund retained the four defendant physicians—Dr. Jeffrey Lawley, Dr. Harvey Ager, Dr. W. John Baker, and Dr. Barry Rubin—to examine Marusza’s disability. Following the doctors’ reports, Accident Fund refused to pay for certain treatments, including drugs to control injury-induced aggression, psychiatric hospitalization, pain medication, attendant care, physical therapy, doctors’ visits, nurse case management, and surgeries for his neck, back, and shoulders. Marusza alleges that Medicare paid $15,665.00 of Marusza’s treatment costs which Accident Fund had refused to cover.

 

On March 5, 2015, Plaintiffs filed a complaint in the U.S. District Court for the Eastern District of Michigan naming Accident Fund and the four doctors as defendants. Plaintiffs filed their First Amended Complaint the next day. Each defendant moved to dismiss for failure to state a claim upon which relief can be granted in spring 2015. See Fed. R. Civ. P. 12(b)(6).

 

Meanwhile, Marusza also sought help from the Michigan Workers’ Compensation Agency. In May 2016, Workers’ Compensation Board Magistrate Beatrice B. Logan issued her opinion that Marusza required treatment for a mild traumatic brain injury, vision problems, and injuries to his neck, shoulders, and lower back caused by the 2011 accident. Because Marusza lost all wage earning capacity in the accident, Magistrate Logan ordered Accident Fund to pay Marusza workers’ compensation benefits owed from October 19, 2011, onward at the rate of $592.88 per week and for reasonable and necessary medical treatment of Marusza’s employment-related conditions. On August 12, 2016, Accident Fund paid Marusza $74,382.00. According to Plaintiffs, Gucwa has not received compensation from Accident Fund or Marusza for the attendant care services she provided.

 

Following the Board’s decision, Plaintiffs filed a Second Amended Complaint. In January 2017, the district court granted the defendants’ motions to dismiss each claim, denied Dr. Rubin’s and Plaintiffs’ motions for sanctions against each other, and denied Plaintiffs’ motion for leave to amend their Second Amended Complaint. Gucwa v. Lawley, No. 15-10815, 2017 WL 282045, at *1 (E.D. Mich. Jan. 23, 2017), reconsideration denied, No. 15-10815, 2017 WL 2831691 (E.D. Mich. June 29, 2017).

 

Plaintiffs now appeal and argue that the district court abused its discretion in exercising jurisdiction over their state claims.

 

For more information, please see http://www.opn.ca6.uscourts.gov/opinions.pdf/18a0198n-06.pdf

 

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