1

UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF MICHIGAN

State Farm Mutual Automobile Insurance Company, )

)

Plaintiff, )

)

v. ) Case No. 15-cv-10993

)

Universal Rehab Services, Inc., ) Hon. Victoria A. Roberts

PhysioFlex, PLLC, )

Ahmad T. Abulabon, P.T., )

Summit Medical Group, PLLC, and, )

David Jankowski, D.O, )

)

Defendants, )

)

MILLER, CANFIELD, PADDOCK & STONE, 

P.L.C.

By: Thomas W. Cranmer (P25252) 

Attorneys for Plaintiff

840 W. Long Lake Road, Suite 200

Troy, MI 48098

(248) 267-3381 

cramer@millercanfield.com

allen@millercanfield.com

KATTEN MUCHIN ROSENMAN, LLP

By: Ross O. Silverman (IL 6226560)

Kathy P. Josephson

Attorneys for Plaintiffs

525 West Monroe Street

Chicago IL 60611-3693

(312)902-5200

Ross.silverman@kattenlaw.com

Kathy.josephson@kattenlaw.com

SEIKALY STEWART & BENNETT, PC.

By: Larry W. Bennett (P26294)

Attorneys for Universal Rehab Services,

Inc., Physioflex, Pllc, and Ahmad T.

Abulabon P.T.

30445 Northwestern Hwy., Suite 250

Farmington Hills, MI 48334

(248) 785-0102

lbennett@sslawpc.com

JOELSON ROSENBERG, PLC

By: David W. Warren (P32449)

Peter W. Joelson (P51468)

Co-Attorneys for Defendants Summit Medical 

Group PLLC and David Jankowski, D.O.

30665 Northwestern Highway, Ste. 200 

Farmington Hills, MI 48334 

(248) 626-9966 

dwwarren@joelsonrosenberg.com 

pjoelson@joelsonrosenberg.com

GARY R. BLUMBERG, PC

By: Gary R. Blumberg (P29820)

Co-Attorneys for Defendants Summit Medical 

Group PLLC and David Jankowski, D.O

15011 Michigan Ave.

Dearborn, MI 48126

(313) 230-1121

grblumberg@gmail.com

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DEFENDANT SUMMIT MEDICAL GROUP, PLLC’S 

COUNTERCLAIM AND JURY DEMAND

NOW COMES, Counter-Plaintiff, SUMMIT MEDICAL GROUP, PLLC, (hereinafter 

referred to as “Summit”), represented by the above counsel, and for its Counterclaim against 

Counter-Defendant, State Farm Mutual Automobile Insurance Company, (hereinafter “State 

Farm”) states as follows:

INTRODUCTORY STATEMENT

This Counterclaim is intended to expose State Farm’s illegal, fraudulent and unlawful 

claims handling processes spearheaded by Patricia Parr-Armelagos, State Farm’s Michigan task 

force commander, which are utilized, with specific intent and in conjunction with Court system, 

to subvert the Michigan No-Fault Act by extorting agreements preventing healthcare providers 

such as Summit Medical Group, PLLC, from submitting any claims to State Farm for treatment of 

State Farm insureds. 

NATURE OF THE ACTION

1. Counter-Plaintiff Summit brings this action seeking redress for the illegal acts of 

Counter-Defendant State Farm and its accomplices and co-conspirators, which have resulted in a 

loss of Summit’s property and a detriment to Summit ’s business, and for declaratory and 

injunctive relief to end those practices and prevent further losses.

2. This Counterclaim is based on the relationship State Farm has with healthcare 

providers, such as Summit, rather than on the relationship between State Farm and its insureds. 

3. However, Counter-Plaintiff Summit is also motivated by its belief that State Farm's 

scheme is harmful to the health of its patients and to the welfare of the people of the State of 

Michigan. By taking funds that have been rightfully earned by healthcare providers and diverting 

them to their own use, State Farm and its co-conspirators deprive healthcare providers of the 

adequate and timely payments they need to treat patients and maintain their practices.

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4. As further described below, the premise of the relationship between State Farm and 

the healthcare providers that treat its insureds is that the healthcare providers will be paid, in a 

timely manner and in accordance with the Michigan No-Fault Act, being MCL § 3101, et seq., for 

the medically necessary services they render.

5. State Farm, on its own and as part of a common scheme with its accomplices and 

co-conspirators, utilized an unlawful pattern of processing claims submitted by or through Summit

to systematically deny, delay, and diminish the payments due to healthcare providers in violation 

of the Michigan No Fault Act, being MCL § 3101, et seq..

6. State Farm accomplishes this by utilizing an unlawful pattern of processing claims 

and covertly denying payments to healthcare providers, including Summit, based on which 

healthcare provider or facility submitted the claim rather than on the reasonableness or necessity 

of the healthcare services provided to the insureds.

7. This is an action whereby Summit seeks judicial redress against State Farm and 

State Farm's co-conspirators and accomplices in the form of declaratory relief, injunctive relief, 

damages, costs and attorney fees, as a result of State Farm, often acting on behalf of the State of 

Michigan through the “assigned claims facility” under the Michigan No-Fault Act, being MCL § 

3101, et seq., and in cahoots with "'Independent' Medical Examination" doctors ("IME Doctors") 

denying certain insurance claims and refusing payments regarding the same for impermissible, 

illegal, and unconscionable reasons. These actions render State Farm, its IME doctors, and other 

co-conspirators liable for damages and other relief as set forth herein. 

8. The underlying factual basis for this Counterclaim results from the unsuccessful 

actions of State Farm, undertaken over a lengthy period of time, to legislatively, administratively, 

and judicially modify the existing coverage for “first party benefits” under the Michigan No-Fault 

Act, MCL § 500.3101 et seq. (sometimes, the “Act”), in order to reduce the medical payments that 

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they are required to make under the Act and to thereby maximize its profits. 

9. Notably, State Farm’s efforts to influence legislation to reduce or limit the payment 

by insurers of “first party benefits” under the Act did not succeed.

10. When such efforts failed, State Farm began utilized an unlawful pattern of 

processing claims submitted by or through Summit to systematically and fraudulently deny claims 

submitted by Summit under false pretexts as set forth below, forcing Summit and similarly situated 

health care providers to initiate litigation to collect the payment of “first party benefits,” which 

should have been promptly paid pursuant to the Act. As detailed below, the outcome of such 

actions shows that State Farm’s blanket denial of all claims or certain medical procedures was 

fraudulent and done for an improper purpose.

11. Summit further seeks both declaratory and injunctive relief against State Farm and 

its co-conspirators to have this Honorable Court enjoin the illegal and fraudulent claim handling 

procedures of State Farm and its co-conspirators, and to enjoin their engagement in the same. In 

this regard, the relief requested by Summit not only extends to itself, but to other similarly situated 

licensed healthcare professionals, to their patients, and to the people of the State of Michigan. 

Persons injured in automobile accidents in this State are entitled to know that they are permitted 

to select properly licensed healthcare professionals of their own choice, and that such selection 

will not in any way deprive them of any rights or benefits that they may have under the Act. 

12. State Farm has even gone as far in resolutions with various healthcare professionals 

as demanding agreements from such individuals that those properly licensed healthcare 

professionals can no longer submit ANY claims to State Farm, even though their patients require 

such medical care, and are therefore entitled to first-party medical payments under the Act.

13. State Farm illegal claim handling processes is utilized with specific intent to extort 

agreements which prevent healthcare providers such as Summit from submitting any claims to 

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State Farm for treatment of State Farm insureds. 

JURISDICTION AND VENUE

14. This Court has jurisdiction over the subject matter of this action pursuant to 28 

U.S.C. § 1332. 

15. Venue in this Court is appropriate pursuant to 28 U.S.C. § 1391(b) and (c), as the 

various acts complained of occurred and Summit operates within the Eastern District of Michigan. 

PARTIES

16. Counter-Plaintiff Summit Medical Group, PLLC, (“Summit”) is a Michigan 

professional limited liability company engaged in the business of providing medical, therapeutic, 

and rehabilitative services, and conducts business in Dearborn, Wayne County, Michigan. Dr. 

David Jankowski, D.O. is Summit’s sole shareholder. Dr. Jankowski is a board-certified osteopath 

and specializes in anesthesiology.

17. Counter-Defendant State Farm is incorporated under the laws of the State of 

Illinois, with its principal place of business in Bloomington, Illinois. It is licensed by the State of 

Michigan, and sells and provides within the State of Michigan, through its Michigan licensure and 

in particular within the Eastern District of Michigan, various insurance products, including 

automobile No-Fault insurance pursuant to the Act.

GENERAL ALLEGATIONS

18. Counter-Plaintiff Summit incorporates herein by reference each and every 

paragraph above as though fully set forth herein.

19. Summit provides healthcare services to State Farm's insureds upon the fundamental 

premise that, if the services are reasonable necessary pursuant to MCL § 500.3107, and the insured 

is covered by a State Farm insurance policy, Summit will be compensated in a timely manner for 

providing those services.

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20. State Farm represents to healthcare providers, such as Summit, that it will pay 

healthcare providers in a timely manner for rendering medically necessary services pursuant to the 

Act to its insureds. State Farm makes such representations in several ways, such as:

a. By providing to its insureds plans or policies stating that healthcare providers will 

be compensated for rendering covered, medically necessary services as defined in 

the Act.

b. By providing its insureds with insurance cards or other identification to show 

treating healthcare providers;

c. By confirming coverage for medically necessary services when contacted prior to 

treatment;

d. By providing billing information to healthcare providers;

e. By operating in Michigan, which requires timely payment pursuant to the Act.

The Michigan No-Fault Act

21. Pursuant to MCL § 500.3105(1) of the Act, under personal protection insurance 

(hereinafter “PIP”), an insurer is liable to pay benefits for accidental bodily injury arising out of 

the ownership, operation, maintenance or use of a motor vehicle as a motor vehicle, subject to the 

other provisions of the Act.

22. Pursuant to MCL § 500.3105(2) of the Act, PIP benefits are due under the Act 

without regard to fault.

23. Pursuant to MCL § 500.3105(3) of the Act, bodily injury is accidental as to a person 

claiming PIP benefits unless suffered intentionally by the injured person or caused intentionally 

by the claimant.

24. Pursuant to MCL § 500.3107(1)(a) of the Act, PIP benefits are payable for 

“[a]llowable expenses consisting of all reasonable charges incurred for reasonably necessary 

products, services and accommodations for an injured person’s care, recovery or rehabilitation.”

25. Under the Act, and in particular pursuant to MCL § 500.3171 et seq., the State of 

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Michigan has established an assigned claims facility for the purposes of assigning the 

administration and payment of PIP claims where: No PIP is applicable to the injury; no PIP 

applicable to the injury can be identified; the PIP applicable to the injury cannot be ascertained 

because of a dispute between two or more automobile insurers concerning their obligation to 

provide coverage or the equitable distribution of the loss; or where the only identifiable PIP 

applicable to the injury is, because of financial inability of one or more insurers to fulfill their 

obligations, inadequate to provide benefits up to the maximum prescribed.

26. Pursuant to MCL § 500.3171 et seq. and the regulations promulgated thereto found 

at R 11.101 to 11.116 of the Michigan Administrative Code (the “Regulations”), the Michigan 

Secretary of State is responsible for organizing and maintaining the Assigned Claims Facility and 

the assigned claims plan (the “Assigned Claims Plan”) to be adopted and implemented through the 

Regulations.

27. Pursuant to MCL § 500.3174, the Assigned Claims Facility shall, upon the filing 

of a claim to it, assign the claim to an insurer in accordance with the Assigned Claims Plan and 

notify the claimant of the identity and address of the insurer to which the claim is assigned or of 

the facility if the claim is assigned to it.

28. State Farm is an “Insurer” and a servicing insurer pursuant to the Assigned Claims 

Plan.

29. Upon information and belief, with regard to a number of the claims submitted by 

Summit to State Farm for payment under the Act, State Farm was the insurer for such claims 

pursuant to assignment by the Assigned Claims Facility. 

30. Pursuant to MCL § 500.3175(1), an insurer to whom claims have been assigned 

through the Assigned Claims Facility shall make prompt payment of loss in accordance with the 

Act, and is thereupon entitled to reimbursement by the Assigned Claims Facility for the payments 

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and the established loss adjustment cost, together with certain statutory interest.

31. Pursuant to R 11.103(1) of the Regulations, a servicing insurer to whom a claim 

has been assigned shall either deny the claim as being ineligible for benefits under the Assigned 

Claims Plan or make prompt payment of loss or other lawful disposition of the claim in accordance 

with the Act.

32. Pursuant to R 11.109(1) of the Regulations, upon assignment of a claim from the 

Assigned Claims Facility, the servicing insurer shall investigate the claim expeditiously and make 

prompt payment for loss within the time prescribed in the Act.

33. By failing to process, as required by the Act, “first party claims” received through 

the Assigned Claim Facility, State Farm, utilizing its fraudulent pre-planned claim processing 

protocol of blanket denials of claims and/or certain procedures, has artificially and wrongfully 

deprived Summit of reimbursement pursuant to the Act.

34. After failed attempts to reduce the payment of “first party benefits” owed pursuant 

to the Act, State Farm commenced its predetermined pattern of claim processing procedure to 

wrongfully deny certain procedures en masse and sometimes the entire claim submitted through 

Summit for reimbursement under the Act, using State Farm's co-conspirators and accomplices to 

assist in denying or justifying the denial of claims. 

35. Such denials were made based upon a pre-planned protocol of claims-processing 

utilized by State Farm, the purpose of which was to indiscriminately and wrongfully avoid the 

payment of benefits and other obligations under the Act, including the payment of all reasonable 

charges incurred for reasonably necessary products, services, and accommodations for an injured 

person’s care, recovery, or rehabilitation.

36. Such pre-planned protocol of claim and procedure denials utilized some of the 

below fraudulent claim handling procedures:

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a. “TIN Diversions”: the process by which a healthcare provider is targeted by State 

Farm and any and all claims submitted by or through such healthcare provider based 

on the tax payer identification number of such healthcare provider are diverted to 

special task forces called the Special Claims Investigation Unit (“SCIU”) or the 

Multiple Claim Investigation Unit (“MCIU”) which then employ special claims 

handling procedures not tailored to the individual merits of the subject claim, but 

tailored solely and specifically to justify a denial of such claim;

b. “TIN Stop”: the process, similar to a TIN Diversion, by which State Farm targets a 

healthcare provider and denies any and all claims submitted by or through such 

healthcare provider based on the tax payer identification number of such health care 

provider which submitted the claim and not based on the individual merits of the 

subject claim;

c. “Project”: the internal code-name referred to by State Farm adjusters after State 

Farm targets a healthcare provider for investigation to falsely justify the denial of 

all claims or certain procedures submitted by such health care provider.

d. “Cut-off Doctors”: the term commonly used by State Farm referring to the doctors 

employed by State Farm to conduct purported “independent” medical exams as a 

pre-text to support State Farm’s improper denial of a claim. Specifically, “Cut-off 

Doctors” are hand-selected doctors who provide predetermined and pre-planned 

reports, which are then falsely represented as “independent” to buttress State 

Farm’s wrongful denials of claims submitted by health care providers.

37. As a result of the wrongful, fraudulent, bad faith, and tortious behavior of State 

Farm and its co-conspirators and accomplices, including the “Cut-off Doctors”, Summit was 

forced to initiate litigation in order to obtain the payment of benefits that were otherwise legally 

payable under the Act. 

38. A representative of State Farm, Michael Flannery, admitted to utilizing these illegal 

claims handling procedures, specifically with respect to Summit and Dr. Jankowski.

39. In the excerpt of Mr. Flannery’s testimony below, Mr. Flannery is testifying 

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regarding four payments for treatment that he personally approved and determined to be reasonable 

and necessary and otherwise in compliance with the requirements for payment by State Farm, but 

that those payments were not issued because of a TIN stop:

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40. Another State Farm employee, Dawn Mills, admitted under oath that Summit was 

the subject of a TIN stop by the Special Investigations Unit (“SIU”):

41. For instance, a patient identified as “MF” sought treatment from Summit (and other 

healthcare providers) for injuries sustained in a motor vehicle accident—however, State Farm 

denied payment for all treatment provided to patient MF other than the EMS Bill.

42. This particular claim for patient “MF” was tried to a verdict in the Wayne County 

Circuit Court, Case No. 2012-016021-NF, in which the jury awarded payment to Summit for 

treatment provided to MF (Exhibit A, Jury Verdict Form in Case No. 2012-016021-NF) and the 

Court ordered that State Farm pay Summit’s attorneys fees pursuant to MCL § 500.3148(1). 

(Exhibit B, Order Regarding Motions in Case No. 2012-016021-NF).

43. The litigation for patient MF is emblematic of the manner in which State Farm uses 

an unlawful claims handling process to avoid payment of No-Fault benefits.

44. Amazingly, State Farm has refused to pay No-Fault benefits for patient MF even 

after the jury trial verdict (Exhibit C, Explanation of Review for unpaid bill for patient MF).

45. During such litigations, State Farm, also in violation of the Act, retained “Cut-off 

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Doctors” as purported “independent” medical doctors, such as Dr. Paul J. Drouillard, D.O., Dr. 

Stanley Lee, D.O., Dr. Steve N. Geiringer, M.D., Dr. Philip Mayer, M.D., Joseph P. Feminineo, 

M.D., Scott Monson, M.D., Dr. Alex Steinbock, D.O., Dr. Saul Foreman, M.D., and Dr. L. Patrick 

Stephens, M.D., and through certain IME companies, including Exam Works, Evaluations Plus, 

Medical Evaluation Services Solutions (“MES Solutions”), and Medicolegal Services, all of whom 

claimed to be “independent,” as accomplices to provide form/predetermined denials to further 

justify State Farm's wrongful claim processing procedures refusal to pay benefits lawfully owed 

under the Act. An individual with knowledge of State Farm’s fraudulent claims-handling 

procedures, including its relationship with “Cut Off Doctors” testified in a first-party no fault 

litigation about the existence and State Farm’s utilization of such “Cut Off Doctors”: 

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46. Rather than conducting accurate evaluations of each patient, State Farm’s IME 

accomplices routinely and systematically utilize a predetermined, unlawful protocol to “examine” 

the insured and generate a form report to improperly deny the payment of allowable expenses and 

reasonable charges incurred for reasonably necessary products, services, and accommodations for 

an injured person’s care, recovery, or rehabilitation.

47. State Farm also utilized certain parties currently unknown to Summit as 

accomplices to provide hypothetical “paid opinions” to justify the wrongful acts of State Farm and 

its co-conspirators and accomplices, and to avoid the payment of proper claims submitted under 

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the Act. 

48. Upon information and belief, the utilization of such paid accomplices, including 

IMEs, was wrongful and done for the sole purpose of avoiding the payment of benefits due and 

owing under the Act. 

49. Pursuant to State Farm’s predetermined unlawful claim-processing protocols and 

procedures used to reject certain claims submitted by Summit, State Farm routinely denies the 

entire claim simply because Summit Medical Group, PLLC, or Dr. Jankowski appear on the bill 

or list of care providers for a particular patient. State Farm then pays IME doctors and other 

accomplices to support the wrongful denials. 

50. State Farm has subverted the express provisions of the Act requiring State Farm 

and similarly situated insurers to pay “allowable expenses consisting of all reasonable charges 

incurred for reasonably necessary products, services and accommodations for an injured person’s 

care, recovery or rehabilitation,” when those expenses are causally connected to an “accidental 

bodily injury arising out of the ownership, operation, maintenance or use of a motor vehicle. MCL 

§§ 500.3105 and 3107(1)(a).

51. Despite the express provisions of MCL §§ 500.3107(1)(a) and 500.3142, State 

Farm intentionally failed to follow the claim processing protocol for reviewing and authorizing the 

payment of No-Fault PIP benefits and instead instituted fraudulent claim handling procedures as 

set forth above.

52. State Farm and its co-conspirators and accomplices knew or should have known 

that the wrongful denials of claims by use of the predetermined and unlawful claim processing 

protocol for claims submitted by Summit were made intentionally, tortiously, negligently, and/or 

recklessly with knowledge of their falsity in view of the actual state of affairs, and said promises 

and representations were made with the then present intention of not performing said promises and 

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representations.

53. As a direct and proximate result of the wrongful actions of State Farm and its coconspirators and accomplices as stated above, Summit has suffered and will continue to suffer 

damages and economic losses as more detailed below. 

State Farm's Unlawful and Fraudulent Scheme

54. Though it is paramount to the relationship between the healthcare provider and 

State Farm, and is necessary to prevent healthcare providers from being misled by State Farm's 

apparent actions and statements, State Farm concealed the fact that its predetermined protocol 

described herein will be used to delay, deny, and diminish payment for covered, reasonable and 

necessary services.

55. After providing healthcare services to a State Farm insured who was injured in an 

automobile accident, Summit is required to submit a standard coded claim form to State Farm.

56. Summit, and other healthcare providers, rely on State Farm's express and implied 

representations that it will review each claim pursuant to the Act and then pay Summit and other 

healthcare providers for rendering covered, medically necessary services by providing those 

services, and then requesting payment from State Farm in the manner required by State Farm, 

rather than billing the patients directly.

57. State Farm and its co-conspirators and accomplices engage in a common fraudulent 

scheme designed to automatically and systematically utilize its unlawful predetermined claim 

processing procedure to deny, delay, and diminish payments to Summit using the protocols and 

techniques described herein with the goal of pressuring health care providers to enter into 

agreements which prohibit the provider from every again submitting any claim for treating State 

Farm insureds under the Act. Summit and countless other healthcare providers have been 

victimized by this scheme.

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Improper Denial of Payment Requests

58. State Farm secretly does not use the standard described in MCL § 500.3107 as 

criteria for evaluating payment requests. Instead, State Farm employs its fraudulent claims 

handling protocols such as TIN Diversions, TIN Stops, Projects, and Cut-off Doctors and 

automatically denies certain claims submitted by Summit simply because the claims were 

submitted by Summit, and without any inquiry into the specific claim and, specifically, without 

any inquiry into the claims medical necessity or other standards prescribed by the Act.

Improperly Delaying Payment

59. State Farm not only systematically denies claims submitted by Summit, it also 

intentionally and improperly delays payments.

60. As part of its unlawful claim processing procedure, State Farm improperly delays 

payments by sending to Summit a letter in which State Farm notifies Summit that it "has not yet 

made a determination of its obligation to pay" and that the matter is "presently under investigation," 

assuring Summit that it will be notified "as soon as a determination has been made." (See Exhibit 

D, “Investigation Letters” for patient RD).

61. These form “investigation letters” are sent immediately after receiving a claim for 

payment of benefits from Summit, and at other various stages of the claim process, which letters 

contain false and misleading information and statements as to the propriety of the charges sought 

to be paid to Summit.

62. The purpose of the “investigation letters” is to delay or preclude the payment of 

benefits due and owing under the Act and to serve as a predicate for the later wrongful denial of 

the payment of benefits due and owing under the Act. 

63. Subsequent to the issuance of the purported “investigation letters,” State Farm 

again issues form, predetermined explanation of benefit (“EOB”) letters, which contain false and 

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misleading information and statements as to the propriety of the charges sought to be paid to 

Summit, to fraudulently deny the payment of benefits due and owing under the Act. (See Exhibit

E, “EOBs” for patient RD).

64. The wrongful denial of benefits through the pattern of wrongful, fraudulent, bad 

faith, grossly negligent, and malicious claim processing procedure of State Farm and its coconspirators, to facilitate the issuance of the above “investigation letters” and EOB letters, forced 

Summit to either seek judicial relief for the payment of benefits which would otherwise be 

conferred under the Act and Michigan law or lose the payment of such benefits by operation of 

law.

65. State Farm demanded that patient RD be examined by Dr. Steven Geiringer, who 

has conducted hundreds of examinations on behalf of State Farm. (Exhibit F, October 25, 2010 

Report from Dr. Geiringer for patient RD).

66. In his report of October 25, 2010, Dr. Geiringer acknowledged that a motor vehicle 

accident occurred.

67. In his report of October 25, 2010, Dr. Geiringer acknowledged that patient RD’s 

injuries could have been caused by the motor vehicle accident.

68. However, Dr. Geiringer concluded that the physical therapy treatment provided to 

RD “would not be warranted.” (Exhibit F)

69. Dr. Geiringer made this determination without reading the patient’s file. (Exhibit 

F).

70. Dr. Geiringer issued another report (Exhibit G, October 27, 2010 Report from Dr. 

Geiringer for patient RD), and came to the same conclusion that the treatment provided to RD was 

not appropriate.

71. State Farm used Dr. Geiringer’s reports to justify denying payment to Summit for 

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RD’s treatment.

72. In fact, State Farm did not pay any of the bills submitted by Summit for patient RD.

73. State Farm first notified Summit that it was refusing to pay on January 24, 2011, 

through form “Explanation of Benefits” letter. (Exhibit E, EOBs for patient RD).

74. State Farm based its decision to deny payment for any of the treatment provided to 

RD upon its own claim file and the report by Dr. Geiringer. (Exhibit H, Denial Letter for patient 

RD, January 21, 2011).

75. Specifically, State Farm based its decision to deny payment solely on Dr. 

Geiringer’s report of October 25, 2010, in which Dr. Geiringer didn’t review any of the patient’s 

records.

76. Dr. Geiringer requested additional records from State Farm (see Exhibit G), 

specifically MRI records for the patient RD.

77. There is no evidence that State Farm provided those records or that they were 

considered by Dr. Geiringer in his report or opinion.

78. State Farm was aware that its co-conspirator, Dr. Geiringer, was conducting the 

examination because State Farm wrote a request for the examination to Dr. Geiringer specifically. 

(Exhibit I, Letter to Evaluations Plus/Dr. Geiringer).

79. The above predetermined pattern of claim processing procedures including, without 

limitation, State Farm’s use of fraudulent claims handling protocols such as TIN Diversions, TIN 

Stops, Projects, and Cut-off Doctors, and then issuing various written correspondence such as 

Investigation letters and EOBs informing that the claims submitted through Summit were under 

“investigation” was a plan, policy, and pattern of activity by State Farm and its co-conspirators to 

attempt to intentionally circumvent the provisions of the Act with the goal of pressuring health 

care providers to enter into agreements which prohibit the provider from every again submitting 

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any claim for treating State Farm insureds.

80. State Farm routinely sends an investigation letter to Summit shortly after receiving 

a claim from Summit. For instance, in the case of patient RD, State Farm sent an "investigation 

letter" on November 5, 2010, after it received a claim from Summit for services provided on 

October 5, 2010. State Farm sent several other identical letters to Summit for this patient:

(See Exhibit D, “Investigation Letters” for patient RD).

81. In these letters, State Farm makes material, false representations to Summit:

a. That the matter “is presently under investigation,” when State Farm has no 

intention of doing anything to investigate the claim; and 

b. That State Farm will notify Summit “when a determination has been made,” 

when State Farm has already denied the claim but is delaying informing 

Summit.

82. In the case of a patient identified as RD, State Farm sent at least one “investigation 

letter” on January 19, 2011, (Exhibit D), more than one year after the motor vehicle accident 

occurred, that contained two material, false representations to Summit:

a. That the matter “is presently under investigation,” when State Farm has no 

intention of doing anything to investigate the claim; and 

b. That State Farm “has not yet made a determination of its obligation to pay,” 

when it has already decided to deny the claim.

83. The truth is that by the time State Farm has sent the letter, it has already "made a 

determination of its obligation to pay," and has decided to deny payment on or even before the 

date the investigation letter is mailed.

84. The truth is that the matter is not "presently under investigation" because State Farm 

does nothing even remotely appreciable to investigate the matter. 

85. The result is that payments are delayed well beyond the amount of time required by 

the Act, as well as the time set by industry practice. This allows State Farm a significant float and 

increased access to funds, which State Farm is using to persecute healthcare providers, for 

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example, by filing RICO claims against them with the ultimate goal of pressuring health care 

providers to enter into agreements which prohibit the provider from every again submitting any 

claim for treating State Farm insureds. This also wrongfully deprives Summit of the value of its 

money, as well as the practical ability to treat patients injured in automobile accidents.

Explanation of Benefits and Fraudulent Concealment

86. After Summit’s payment requests have been improperly denied and/or delayed, 

State Farm provides Summit with an explanation of benefits ("EOB").

87. Exhibit E, the EOBs for patient RD, show that State Farm denied all claims 

submitted by Summit for patient RD citing “SF450: The injury did not arise out of the ownership, 

operation, maintenance or use of a motor vehicle as a motor vehicle, subject to the requirements 

of MCL 3105.” (Exhibit E).

88. Explanation Code SF450 is cited for every treatment Summit rendered to patient 

RD.

89. State Farm’s c o-conspirator even acknowledged that RD’s injuries were sustained 

in the motor vehicle accident, but still concluded that the treatment provided to RD was “not 

warranted.”

90. State Farm also conceals the manner in which it actually processes requests for 

payment by refusing to disclose its procedures and by depriving Summit of information that might 

enable it to discover State Farm's processing techniques.

Coercive Use of Economic Power

91. In order to perpetrate its scheme and continue to collect No-Fault insurance 

premiums from unsuspecting insureds while working towards its end-goal of effectively 

eliminating insureds' ability to obtain healthcare services from any healthcare provider in 

Michigan, State Farm uses its overwhelming economic power to coerce Summit and other 

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healthcare providers, at the risk of being "black-listed" or slapped with a RICO lawsuit, into 

providing care under State Farm's policies and practices without receiving fair or timely payment.

92. State Farm uses its considerable economic means to hire its own healthcare 

professionals (referred to as “Cutoff Doctors”) to conduct "independent" evaluations of Summit’s 

payment requests. These "independent" medical evaluations ("IME") are part and parcel of State 

Farm's scheme to limit or eliminate No-Fault benefits in Michigan. (See ¶36).

93. State Farm's IME co-conspirators are as culpable as State Farm in the scheme to 

subvert the Michigan No-Fault Act because the IME co-conspirators purport to provide 

"independent" justification for State Farm's wrongful denial of claims without properly evaluating 

the claims based on MCL § 500.3107, and sometimes without ever even seeing the injured person.

94. State Farm's extortionate conduct is made more effective by, and enforced through, 

the conspiracy described herein, as well as the co-conspirators' efforts to aid and abet each other 

in wrongfully confiscating or withholding Summit’s property.

Conspiracy

95. State Farm has not undertaken these unlawful claim processing practices alone—it 

has done so as part of a common scheme and conspiracy, which includes State Farm, its IME 

doctors (“Cut-Off Doctors”), IME companies such as Exam Works, Evaluations Plus, MES 

Solutions, and Medicolegal Services, and their local subsidiaries and affiliates. 

96. State Farm and its co-conspirators, with knowledge and intent, agreed to the overall 

objective of the conspiracy, agreed to participate in the conspiracy, agreed to commit acts of fraud 

to deprive Summit of its rightful compensation, and actually committed such acts.

The Need for Declaratory and Injunctive Relief

97. State Farm's unlawful claims-processing scheme to deny, delay, and diminish 

payments to healthcare providers who treat its insureds is an ongoing problem that will continue 

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to cause Summit economic losses and threaten Summit’s ability to provide healthcare services to 

the public.

98. A money judgment in this case will only compensate Summit for past losses. It 

will not stop State Farm's unlawful interference in healthcare treatment decisions, and it will not 

stop State Farm from continuing to confiscate the money Summit earns, which is necessary for 

Summit to maintain its practice.

COUNT I –FRAUD/FRAUDULENT MISREPRESENTATION

99. Counter-Plaintiff Summit incorporates herein by reference each and every 

paragraph above as though fully set forth herein.

100. State Farm made material representations to Summit related to Summit’s claims 

submitted to State Farm.

101. State Farm represented to Summit that State Farm had not yet made a determination 

regarding its obligation to pay certain claims. (See Exhibit D).

102. State Farm represented to Summit that State Farm was conducting an investigation 

regarding certain claims. (Exhibits D).

103. State Farm made these representations repeatedly in the form of the letters 

described herein and attached hereto as Exhibit D.

104. State Farm represented to Summit that it was denying payment of claims submitted 

by Summit because “[t]he injury did not arise out of the ownership, operation, maintenance or use 

of a motor vehicle as a motor vehicle, subject to the requirements of MCL 3105.” (Exhibit E).

105. State Farm, in fact, denied payment because Summit and/or Dr. Jankowski were 

under investigation by State Farm, not because State Farm had actually examined the file and 

determined that the treatment provided by Summit was “not reasonable and necessary.”

106. State Farm refused payment based upon “SF450” even though their expert 

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acknowledged that patient RD’s injuries were the result of a motor vehicle accident.

107. State Farm’s representations were false when they were made.

108. On or before the date the Investigation Letters were mailed to Summit, State Farm 

had, in fact, “made a determination” regarding the claims submitted by Summit; in fact, State Farm

had decided to DENY said claims. State Farm’s representation that it had not yet “made a 

determination” regarding the claims was therefore false when made.

109. State Farm’s representation that certain claims were “under investigation” was also 

false when made, because State Farm did not conduct any investigation regarding the claim itself; 

at most, State Farm may have consulted with its attorneys relative to the development of a litigation 

defense of such claim rather than investigating the individual merits of such claim as required 

under the Act.

110. State Farm’s representation that certain claims were denied because the services 

provided were not reasonable necessary was false when made because State Farm actually denied 

payment because of a Project, TIN Diversion, or TIN Stop for Summit.

111. State Farm knew that its representations were false when they were made.

112. State Farm knew that it had “made a determination” regarding certain claims 

submitted by Summit, and that it had already decided to DENY those claims on or before the date 

State Farm sent the fraudulent letter to Summit.

113. On information and belief, one or more of the claims for which State Farm issued 

a letter had already been subject to a Project or TIN Stop or TIN Diversion, meaning that State 

Farm, using its own fraudulent protocol, had DENIED the claim before the letter was sent to 

Summit.

114. State Farm is certainly aware of its internal “investigation” procedures, or lack 

thereof, and was aware that it had not actually begun investigating the claims submitted by 

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Summit, had no intention of investigating the claims, and in fact did not investigate the claims.

115. State Farm made these fraudulent statements to Summit to induce Summit to forego 

or delay legal action against State Farm to collect payment.

116. State Farm made these fraudulent statements to Summit to induce Summit to 

continue to treat State Farm insureds, without intending to pay Summit for such treatment.

117. Summit relied on State Farm’s fraudulent statements by delaying or foregoing legal 

action against State Farm to collect payment.

118. Summit relied on State Farm’s fraudulent statements by continuing to provide 

treatment and services to State Farm insureds.

119. Summit relied on State Farm’s fraudulent statements by continuing to provide 

treatment and services to State Farm insureds and submitting claims for payment to State Farm, 

rather than to the patients directly.

120. Due to State Farm’s secretive internal procedures and refusal to disclose its claimshandling processes and practices, there was no reasonable way for Summit to discover that State 

Farm had made a determination regarding certain claims, although State Farm represented to 

Summit that it had not yet made a determination on its obligation to pay.

121. Due to State Farm’s secretive internal procedures and refusal to disclose its claimshandling processes and practices, there was no reasonable way for Summit to discover that State 

Farm was not investigating certain claims, although State Farm represented to Summit that it was 

investigating the claims.

122. Summit suffered monetary damages as a direct and proximate result of State Farm’s 

fraudulent representations and Summit’s reasonable reliance thereon.

COUNT II – CIVIL CONSPIRACY

123. Counter-Plaintiff Summit incorporates herein by reference each and every 

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paragraph above as though fully set forth herein.

124. State Farm and its accomplices and co-conspirators, some of which are known to 

Summit and some of which are unknown to Summit at this time, acted in concert to commit fraud 

on Summit and violate the Michigan No Fault Act.

125. State Farm routinely hires the same IME doctors, including Dr. Paul J. Drouillard, 

D.O., Dr. Stanley Lee, D.O., Dr. Steve N. Geiringer, M.D., Dr. Philip Mayer, M.D., Joseph P. 

Feminineo, M.D., Scott Monson, M.D., Dr. Alex Steinbock, D.O., Dr. Saul Foreman, M.D., and 

Dr. L. Patrick Stephens, M.D., and utilizes certain IME companies, including Exam Works, 

Evaluations Plus, MES Solutions, and Medicolegal Services, to conduct “independent” medical 

examinations to support State Farm’s predetermined decision to deny claims submitted by Summit.

126. On information and belief, these IME doctors are aware that they have been 

retained by State Farm to conduct a purported “independent” examination, and are aware that State 

Farm has already denied the claim or that State Farm intends to deny the claim.

127. State Farm needs the form reports and opinions signed by the IME doctors to justify 

denying claims.

128. State Farm routinely hires specific IME doctors (“Cut-off Doctors” see ¶36) with 

whom State Farm has an established relationship and who are willing to comply with State Farm’s 

predetermined protocol and sign form reports supporting State Farm’s decision to deny claims.

129. State Farm pays these IME doctors exorbitant amounts to incentivize them to 

knowingly participate in the scheme.

130. The Michigan No-Fault Act requires that insurers, including State Farm, timely pay 

all reasonable claims for reimbursement or payment for medically necessary treatments rendered 

to its insureds.

131. State Farm uses its IME co-conspirators to unlawfully deny or delay payment of 

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claims in violation of the Act.

132. State Farm uses the form reports and opinions signed by its IME co-conspirators

(Exhibits F and G) to justify its decision to deny certain claims submitted by Summit as described 

herein.

133. Summit has suffered and continues to suffer monetary damages as a direct and 

proximate result of State Farm’s scheme using its IME co-conspirators to wrongfully and 

unlawfully deny claims submitted by Summit.

COUNT III – DECLARATORY RELIEF

134. Counter-Plaintiff Summit incorporates herein by reference each and every 

paragraph above as though fully set forth herein.

135. Pursuant to MCL § 500.2006 of the Michigan Unfair Trade Practices Act, a person 

must pay on a timely basis to its insureds, to an individual or entity directly entitled to benefits 

under its insured’s contract of insurance, or to a third-party tort claimant, the benefits provided 

under the terms of its policy, or, in the alternative, the person must pay to its insured, an individual 

or entity directly entitled to benefits under its insured’s contract of insurance, or a third-party tort 

claimant 12% interest, as provided in MCL § 500.2006(4) on claims not paid on a timely basis. 

Failure to pay claims on a timely basis or to pay interest on claims as provided in MCL § 

500.2006(4) is an unfair trade practice unless the claim is reasonably in dispute. 

136. The requests for payment by Summit to State Farm are not reasonably in dispute. 

137. Pursuant to MCL § 500.2014(b), unfair methods of competition and unfair or 

deceptive acts or practices in the business of insurance include making a false entry of material 

fact in a book, report, or statement of a person engaged in the business of insurance or omitting to 

make a true entry of a material fact pertaining to the business of the person in a book, report, or 

statement of the person.

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138. Pursuant to MCL § 500.2020, it is an unfair method of competition and an unfair 

and deceptive act or practice in the business of insurance to make or permit any unfair 

discrimination between individuals of the same class and of essentially the same hazard in the 

amount of premium, membership or policy fees, or rates charged for any policy or contract of 

accident or health insurance applicable to individual or family expense coverage or in the benefits 

payable thereunder, or in any of the terms or conditions of such contract, or in any other manner 

whatever. 

139. Pursuant to MCL § 500.2026(1), unfair methods of competition and unfair or 

deceptive acts or practices in the business of insurance, other than isolated incidents, are a course 

of conduct indicating a persistent tendency to engage in that type of conduct, and include: 

a) Misrepresenting pertinent facts or insurance policy provisions relating to 

coverage at issue: 

b) Failing to acknowledge promptly or to act reasonably and promptly upon 

communications with respect to claims arising under insurance policies; 

c) Failing to adopt and implement reasonable standards for the prompt 

investigation of claims arising under insurance policies; 

d) Refusing to pay claims without conducting a reasonable investigation based 

upon available information; 

e) Failing to affirm or deny coverage of claims within a reasonable time after 

proof of loss statements have been completed; 

f) Failing to attempt in good faith to effectuate prompt, fair, and equitable 

settlements of claims in which liability has become reasonably clear; 

* * * 

l) Delaying the investigation or payment of claims by requiring an insured, 

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claimant, or the physician of either to submit a preliminary claim report and 

then requiring subsequent submission of formal proof of loss forms, seeking 

solely the duplication of a verification;

n) Failing to promptly provide a reasonable explanation of the basis in the 

insurance policy in relation to the facts or applicable law for denial of a 

claim or for the offer of a compromised settlement.

140. Pursuant to MCL § 500.2064(1), no insurer, or any officer, director, agent or 

solicitor thereof shall issue, circulate or use or cause or permit to be issued, circulated, or used, 

any written or oral statement or circular misrepresenting the terms of any policy issued or to be 

issued by such insurer, or misrepresenting the benefits or privileges promised under any such 

policy. 

141. State Farm violated the statutory provisions set forth above, and each and every one 

of them. 

142. Pursuant to MCL § 500.2118(1), as a condition of maintaining its certificate of 

authority, an insurer shall not refuse to insure, refuse to continue to insure, or limit coverage 

available to an eligible person for automobile insurance, except in accordance with underwriting 

rules established pursuant to that section and MCL §§ 500.2119 and 500.2120.

143. There is no basis under MCL §§ 500.2118, 500.2119 or 500.2120 for State Farm to 

limit the payment of medical expense PIP benefits in the fashion that it has with regard to Summit. 

144. State Farm’s illegal, wrongful, grossly negligent, bad faith and malicious in fact 

actions as described above demonstrate a complete disregard for its obligations as an insurer 

pursuant to statutory provisions set forth herein.

145. This Court should declare the actions of State Farm as referenced above, undertaken 

pursuant to authority under Ruth Johnson, Michigan Secretary of State, in regard to their actions 

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in furtherance of claims assigned through the Assigned Claims Facility, and undertaken pursuant 

to the authority authorized by Kevin Clinton, Michigan Commissioner of Insurance, to be illegal, 

unconstitutional, grossly negligent, in bad faith and malicious in fact, and further order either 

Kevin Clinton, Michigan Commissioner of Insurance, to suspend, revoke, or limit the authority of 

State Farm, or, in the alternative, order both Ruth Johnson, Michigan Secretary of State, and Kevin 

Clinton, Michigan Commissioner of Insurance, to order State Farm to cease and desist their illegal, 

unconstitutional, wrongful, grossly negligent, in bad faith and malicious in fact actions toward 

Summit.

JURY TRIAL DEMAND

Counter-Plaintiff Summit hereby demands a trial by jury.

PRAYER FOR RELIEF

WHEREFORE, Counter-Plaintiff Summit request relief as follows: 

A. Entry of an award of damages against State Farm and in favor of Counter-Plaintiff 

Summit in amounts to which Summit is found to be entitled;

B. Entry of an award of exemplary/punitive damages against State Farm and in favor of 

Summit in amounts to which they are found to be entitled; 

C. Entry of relief pursuant to MCL § 500.2006; and

D. Entry of an award of such other and further relief as the Court deems just and proper in 

the circumstances.

Respectfully submitted,

JOELSON ROSENBERG PLC

/s/ Peter W. Joelson

Peter W. Joelson (P51468)

pjoelson@joelsonrosenberg.com

David W. Warren (P32449)

dwwarren@joelsonrosenberg.com

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Emily Warren (P76675)

ewarren@jrlawplc.com

Co-Attorneys for Defendants/Counter-Plaintiff

Summit Medical Group PLLC and David 

Jankowski, D.O

30665 Northwestern Hwy., Ste 200

Farmington Hills, MI 48334

(248) 626-9966 fax: (248) 855-9496

LAW OFFICES OF GARY R. BLUMBERG PC

/s/ Gary R. Blumberg

Gary R. Blumberg (P29820)

grblumberg@gmail.com

Co-Attorneys for Defendants/Counter-Plaintiff

Summit Medical Group PLLC and David Jankowski, 

D.O

15011 Michigan Ave.

Dearborn, MI 48126

(313) 230-1121

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CERTIFICATE OF SERVICE

The undersigned certifies that the foregoing document along with a Certificate of Service 

was electronically filed on October 29, 2015, with the Court’s e-filing system, which will send 

notification of such filing to all attorneys of record.

/s/ Emily Warren

Emily Warren

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INDEX OF EXHIBITS

Exhibit A: Jury Verdict Form in Case No. 2012-016021-NF

Exhibit B: Order Regarding Motions in Case No. 2012-016021-NF

Exhibit C: Explanation of Review for unpaid bill for patient MF

Exhibit D: “Investigation Letters” for patient RD

Exhibit E: “EOBs” for patient RD

Exhibit F: October 25, 2010 Report from Dr. Geiringer for patient RD

Exhibit G: October 27, 2010 Report from Dr. Geiringer for patient RD

Exhibit H: Denial Letter for patient RD, January 21, 2011

Exhibit I: Letter to Evaluations Plus/Dr. Geiringer

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