UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF MICHIGAN 

NORTHERN DIVISION

LEE E. STEINMAN,

Plaintiff,

v.

ACE AMERICAN INSURANCE 

COMPANY,

Defendant.

Case No. 15-cv-11068

Hon. Thomas L. Ludington

Magistrate Judge Patricia T. Morris 

DEFENDANT’S ANSWER TO PLAINTIFF’S COMPLAINT

NOW COMES Defendant, ACE AMERICAN INSURANCE COMPANY, 

by and through its attorneys, Kevin J. Plagens and Kopka Pinkus Dolin, PLC and 

for their Answer to Plaintiff Complaint, hereby state as follows:

1. Answering Paragraph 1 of Plaintiff’s Complaint, Defendant neither 

admits nor denies the allegations contained therein for lack of sufficient 

information to form a belief and leaves Plaintiff to his strict proofs.

2. Answering Paragraph 2 of Plaintiff’s Complaint, Defendant admits 

the allegations contained therein. 

3. Answering Paragraph 3 of Plaintiff’s Complaint, Defendant neither 

admits nor denies the allegations contained therein for lack of sufficient 

information to form a belief and leaves Plaintiff to his strict proofs.

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4. Answering Paragraph 4 of Plaintiff’s Complaint, Defendant neither 

admits nor denies the allegations contained therein for lack of sufficient 

information to form a belief and leaves Plaintiff to his strict proofs. 

5. Answering Paragraph 5 of Plaintiff’s Complaint, Defendant neither 

admits nor denies the allegations contained therein for lack of sufficient 

information to form a belief and leaves Plaintiff to his strict proofs.

6. Answering Paragraph 6 of Plaintiff’s Complaint, Defendant neither 

admits nor denies the allegations contained therein for lack of sufficient 

information to form a belief and leaves Plaintiff to his strict proofs.

7. Answering Paragraph 7 of Plaintiff’s Complaint, Defendant admits 

the allegations contained therein. 

8. Answering Paragraph 8 of Plaintiff’s Complaint, Defendant denies the 

allegations contained therein for the reason that the same are untrue. 

9. Answering Paragraph 9 of Plaintiff’s Complaint, Defendant denies the 

allegations contained therein for the reason that the same are untrue. 

WHEREFORE, Defendant, ACE AMERICAN INSURANCE COMPANY, 

prays this Honorable Court dismiss this matter and award Defendant attorney fees, 

costs and such other relief as the Court deems just and equitable in the premises, 

all as provided by Michigan statute as will be shown by competent proof at trial. 

Case 1:15-cv-11068-TLL-PTM ECF No. 9, PageID.51 Filed 06/18/15 Page 2 of 15
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Respectfully submitted,

 By: /s/ Kevin J. Plagens 

Dated: June 18, 2015 KEVIN J. PLAGENS 

KOPKA PINKUS DOLIN, PLC 

Attorneys for Defendant

33533 W. Twelve Mile Road, Suite 350

Farmington Hills, MI 48331-5611

(248) 324-2620

KJPlagens@kopkalaw.com

P55992

Case 1:15-cv-11068-TLL-PTM ECF No. 9, PageID.52 Filed 06/18/15 Page 3 of 15
UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF MICHIGAN 

NORTHERN DIVISION

LEE E. STEINMAN,

Plaintiff,

v.

ACE AMERICAN INSURANCE 

COMPANY,

Defendant.

Case No. 15-cv-11068

Hon. Thomas L. Ludington

Magistrate Judge Patricia T. Morris 

DEFENDANT’S ORDINARY AND AFFIRMATIVE AND DEFENSES

NOW COMES Defendant, ACE AMERICAN INSURANCE COMPANY, 

(henceforth “ACE”) by and through its attorneys, Kevin J. Plagens and Kopka, 

Pinkus, Dolin, and for their Affirmative and Ordinary Defenses states as follows:

PRESENTMENT

1. The benefits that Plaintiff claims in this action are not past due 

pursuant to MCLA 500.3142(1), MSA 24.13142(1) because losses have not yet 

accrued.

2. The benefits that Plaintiff claims in this action are not past due 

because Plaintiff has not provided Defendant ACE with reasonable proof of the 

fact and the amount of loss sustained.

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3. Plaintiff’s claims are based on an assignment of a right to benefits 

payable in the future and are therefore invalid pursuant to MCLA 500.3143, MSA 

24.13143.

STATUTE OF LIMITATIONS/ONE-YEAR-BACK RULE

4. Plaintiff’s claims are barred by MCLA 500.3145(1), MSA 

24.13145[1]. DeVilleers v ACIA 473 Mich 562; 702 NW2d 539 (2005). 

ENTITLEMENT

5. Defendant ACE may not be the highest order of priority, pursuant to 

MCLA 500.3114, MSA 24.13114, for the payment of personal protection 

insurance benefits to Plaintiff

6. When the accident occurred, Plaintiff may have been occupying a 

vehicle operated in the business of transporting passengers and may not be entitled 

to benefits from Defendant. MCLA 500.3114(2), MSA 24.13114[2]. 

7. Plaintiff’s claims may be, in whole or in part, fraudulent or so 

excessive that they have no reasonable foundation which entitles Defendants to an 

award representing an attorney fee for the cost of defending this action pursuant to 

MCLA 500.3148(2), MSA 24.13148[2].

8. Plaintiff’s benefits are not past-due, nor did Defendant ACE 

unreasonably delay or refuse to pay benefits because a reasonable question of 

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entitlement and/or a reasonable question of law existed such that Plaintiff is not 

entitled to an attorney fee under MCLA 500.3148(1), MSA 24.13148[1].

COORDINATION

9. Plaintiff may have a coordinated policy of insurance and has failed to 

obtain primary coverage within the obligations of his primary health carrier to the 

detriment of Defendant pursuant to MCL 500.3109(a). Tousignant v Allstate 

Insurance Co., 444 Mich 301.

PROXIMATE CAUSE

10. Plaintiff’s claims for benefits are not causally related to any injuries 

allegedly sustained as a result of the accident.

11. Plaintiff’s alleged injuries did not arise out of the ownership, 

maintenance, or use of a motor vehicle on October 3, 2012.

REASONABLENESS AND NECESSITY

12. Plaintiff’s claims for benefits represents unreasonable, unnecessary, or 

excessive charges contrary to the Michigan No-Fault Insurance Act and the policy 

provisions. MCLA 500.3107(1)(a), .3157, MSA 24.13107[1][a], 13157.

13. Plaintiff’s entitlement to benefits under the alleged policy of insurance 

with Defendant ACE is in dispute, in whole or in part, on the basis that Plaintiff’s 

claims for allowable expenses and medical services is for unreasonable or 

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excessive charges or was incurred for products and services that were not 

reasonably necessary or otherwise not proximately related to injuries allegedly 

sustained as a result of the accident.

OTHER

14. Defendant ACE has complied with all the applicable statutes and 

insurance policy provisions in the handling and processing of Plaintiff’s claims.

15. Defendant ACE is entitled to any and all set-offs, deductions, and 

limitations applicable to the payment of personal protection insurance benefits 

provided for in the Michigan No-Fault Insurance Act. MCLA 500.3101 et seq., 

MSA 24.13101 et seq.

16. Plaintiff was represented by legal counsel at all times, complained of, 

must accept the actions and/or inactions of attorneys as being his own, e.g., White 

v Sadler, 350 Mich. 511; 87 N.W.2d 192 (1957).

17. Plaintiff has failed to state a cause of action upon which relief may be 

granted.

18. Plaintiff has failed to comply with the provisions of the insurance 

contract and/or Michigan No-Fault Act MCL 500.3101 et. seq. which require 

adequate documentation and substantiation of the fact and amount of the claimed 

benefits, along with reasonable proof that said expenses, lost wage claim, or 

service claim, respectively, are related to the accident in question.

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19. The contract of insurance applicable to this accident, may provide for 

coordinated benefits which renders any other health and accident coverage as the 

primary coverage for medical expenses, and/or wage loss indemnification. Thus, 

Defendant ACE can only be held responsible for excess medical expenses and/or 

wage loss, which is not otherwise paid or payable by said primary coverage.

20. The contract of insurance applicable to this claim permits a 

deductible, and that said deductible payment must be subtracted from any payment 

of benefits in this matter.

21. The Plaintiff’s hospitalizations and/or treatment were neither 

reasonable, nor necessary, and were excessive in length given the nature and 

circumstances surrounding the accident at issue.

22. The hospitalizations and expenses relating thereto were unreasonable, 

unnecessary, excessive in length, and were solely for purposes of creating a 

windfall to the Plaintiff premised on his election of non-coordinated benefits under 

Defendant ACE’s policy of insurance.

23. All benefits allegedly due and owing at the time of the filing of the 

Complaint have been paid, and therefore, Plaintiff’s Complaint is barred on the 

basis of release, set-off, payment, and/or statute of frauds.

24. The Plaintiff’s claims for payment of all medical bills allegedly 

arising out of the allegations set forth in Plaintiff’s Complaint are barred based 

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upon the Learned Profession Doctrine and the Corporate Practice of Medicine 

Doctrine, and therefore, Defendant ACE is entitled to a judgment as a matter of 

law.

25. To the extent that Plaintiff has accepted and negotiated checks from 

Defendant ACE in payment of any and all such benefits, same represents an accord 

and satisfaction precluding re-submission, renegotiation, or re-litigation of such 

items.

26. Defendant ACE denies any wrongful refusal of pay/No-Fault benefits 

and avers that the Plaintiff’s claims are unreasonable, and spurious, and that the 

Defendant is entitled to reimbursement for actual attorney fees and costs in 

defending this litigation, as set forth in MCLA 500.3148.

27. The Plaintiff has failed to comply in whole or in part with the 

Michigan No-Fault Act, as amended, as a precondition for the recovery of benefits, 

and has violated the terms, conditions and exclusions of the insurance policy.

28. Pursuant to MCL 600.6304, Defendant is entitled to have the trier of 

fact determine the percentage of total fault of all of the parties, if any, regarding 

each claim made by Plaintiff, and are further entitled to have the trier of fact 

consider both the nature of the conduct of each party found to be at fault, if any, 

and the extent of the causal relationship between the conduct and the damages 

claimed.

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29. Pursuant to the contract between the parties, Defendant ACE did not 

owe and/or breach any duties or contract as alleged.

30. Defendant ACE reserves its right to the full benefit and protection of 

any and all relevant portions of the Michigan Tort Reform Act, including but not 

limited to MCL 500.3101 et seq., MCL 600.1483 through MCL 600.6455, MCL 

500.3131 through MCL 500.3177, inclusive.

31. Plaintiff’s claims are barred due to his failure to fulfill the contractual 

requirements.

32. Plaintiff’s claims are barred under the doctrine of laches.

33. Plaintiff’s claims are barred due to a contractual clause and/or 

statutory provisions of Michigan’s No-fault Act MCL 500.3101 et seq, limiting the 

amount of Plaintiff’s benefits/damages.

34. Plaintiff’s Complaint may be barred because of prior judgment, 

bankruptcy, immunity granted by law, presumption of risk, an agreement to 

Arbitrate, an assignment, or other disposition of the claim before commencement 

of the action. 

35. Plaintiff’s injuries fail to meet the No-Fault threshold as set forth in

MCL 500.3135 and, therefore, all economic and non-economic benefits are barred.

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36. Plaintiff is barred from recovery of economic and/or non-economic 

damages per MCL 500.3101, et seq., and Defendants requests all applicable setoffs.

37. Plaintiff has failed to comply with the applicable statute of limitations 

pursuant to MCL 500.3101 et seq. 

38. Plaintiff has failed to join all claims and/or necessary parties.

39. Plaintiff’s claims are barred by release and/or accord and satisfaction.

40. ACE has not violated any provision of the Michigan No-fault Act as 

alleged. 

41. ACE has not made any false, deceptive, or misleading 

statements/representations to the Plaintiff regarding, payments of any alleged 

benefits due and owing, the terms or conditions of insurance policy, or no-fault 

benefits Plaintiff alleges he is entitled to.

42. ACE has not made any false, deceptive, or misleading 

statements/representations to the Plaintiff.

43. ACE has not misrepresented, made, advertised, published, circulated 

either directly or indirectly any false or misleading information regarding the 

coverage to the Plaintiff, and/or payments for benefits he alleges are due and 

owing.

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44. Plaintiff’s claims for no-fault benefits, for expenses, services, 

products, wage loss and replacement service benefits are time barred pursuant to 

MCL 500.3107, and/or MCL 500.3145. 

45. Defendant is not in the highest order of priority to provide the Plaintiff 

with no-fault benefits pursuant to MCL 500.3101 et seq. 

46. Defendant is entitled to set off all government benefits Plaintiff has 

received or may be entitled to receive.

47. There are intervening and superseding injuries that were not the 

proximate cause of this incident.

48. There are intervening and superseding injuries that were not 

proximately caused by the automobile accident on October 3, 2012.

49. No wage loss benefits are due and owning.

50. No attendant care benefits are due and owing.

51. No benefits for reasonable and/or related services are due and owing.

52. No replacement service benefits are due and owing. 

53. Plaintiff has failed to provide the Defendant with reasonable proof of 

the fact and amount of loss sustained as required pursuant to the Michigan NoFault Act 500.3101 et seq.

54. Any and all benefits Plaintiff alleges are due and owing more than one 

year prior to the filing of this complaint are barred pursuant to MCL 500.3145.

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55. Defendant hereby demands a reply to each and every affirmative 

defense as set forth herein.

Respectfully submitted,

 By: /s/ Kevin J. Plagens 

Dated: June 18, 2015 KEVIN J. PLAGENS 

KOPKA PINKUS DOLIN, PLC 

Attorneys for Defendant

33533 W. Twelve Mile Road, Suite 350

Farmington Hills, MI 48331-5611

(248) 324-2620

KJPlagens@kopkalaw.com

P55992

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UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF MICHIGAN 

NORTHERN DIVISION

LEE E. STEINMAN,

Plaintiff,

v.

ACE AMERICAN INSURANCE 

COMPANY,

Defendant.

Case No. 15-cv-11068

Hon. Thomas L. Ludington

Magistrate Judge Patricia T. Morris 

DEFENDANT’S DEMAND FOR TRIAL BY JURY

NOW COMES the Defendant, ACE AMERICAN INSURANCE COMPANY, by 

and through its attorneys, Kevin J. Plagens and KOPKA PINKUS DOLIN PLC, and 

hereby makes a demand for a trial by jury of each and every matter at issue in the above 

entitled cause pursuant to Fed. R. Civ. P. §38 and Fed. R. Civ. P. §5(d).

Respectfully submitted,

 By: /s/ Kevin J. Plagens 

Dated: June 18, 2015 KEVIN J. PLAGENS 

KOPKA PINKUS DOLIN, PLC 

Attorneys for Defendant

33533 W. Twelve Mile Road, Suite 350

Farmington Hills, MI 48331-5611

(248) 324-2620

KJPlagens@kopkalaw.com

P55992

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CERTIFICATE OF SERVICE

I hereby certify that on June 18, 2015, I electronically filed the foregoing 

paper with the Clerk of the Court using the ECF system which will send 

notification of such filing to the following: Kenneth L. Butters: 

Ken.butters@brickgentrylaw.com.

/s/ Ominique Rogers

OMINIQUE ROGERS

Legal Assistant 

KOPKA, PINKUS, DOLIN, PLC

ODRogers@Kopkalaw.com

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