A Detroit family is facing uncertainty over the continued home healthcare for a young child who sustained a traumatic brain injury in a car crash that occurred while he was still in his mother's womb in the spring of 2023. The family's attorneys contend that the insurance company, USAA, is not fully covering the necessary care for the mother and child, a claim USAA describes as a billing dispute with a service provider.
The incident unfolded in the spring of 2023 when the child's mother, Angelica, who was eight months pregnant, was involved in an accident near Inkster and Ford. Her vehicle was struck by a car reportedly fleeing Westland police. While Angelica survived the crash, her baby, Sire, had to be delivered by emergency C-section. Michael Winton, Angelica's father and Sire's grandfather, highlighted the unique nature of the injury, noting Sire "was still in my daughter’s womb when this accident happened." This led to what Winton described as "a double concern" for the family.
According to Lawrence Kajy, CEO of Kajy Law, Sire was born with a traumatic brain injury, which attorneys attribute to a reduction of oxygen and blood flow to the central nervous system following the crash. Now 3.5 years old, Sire is described as a "sweet, Lions-loving kid," but his attorneys report that doctors indicate he scores "as low as the second percentile" compared with other children his age, reflecting the profound impact of his birth injuries.
The crash also left Angelica with significant, life-changing effects. Her attorney says her brain function is now comparable to that of a 12-year-old. Her father, Michael Winton, noted that these effects make it difficult for her to care for Sire on her own, underscoring the family's reliance on external support.
Currently, Sire receives around-the-clock care from Diversified Home Health Care. Kajy stated that the company "is providing around the clock care for Sire," addressing his needs. However, attorneys for the family assert that USAA has not been paying Diversified Home Health Care for these services. USAA, on its part, has stated that it has paid over $7 million in policy benefits related to this case, characterizing the ongoing issue as solely "a billing dispute with one service provider."
Further complicating the situation, attorneys for the family revealed that USAA commissioned a doctor to evaluate Sire’s needs. Chris Mene, an attorney with Kajy Law, stated that this doctor, who works at Henry Ford, produced a report with seemingly contradictory findings. Mene explained that the report acknowledged Sire's severe developmental issues, including his placement "in the second percentile for his age group" and noted "potentially disability-causing issues he got at birth." Yet, Mene stated, the report then concluded that Sire "doesn't need any of these services" or benefits, suggesting he could be cared for by a parent or family member. This, according to Mene, would eliminate his access to the critical specialized care provided by the home healthcare company.
In contrast to the insurance company's commissioned report, Sire's own three treating doctors have strongly opposed this opinion, according to his legal team. Mene highlighted that despite the payment dispute, Diversified Home Health Care continues to provide care to Sire in good faith, emphasizing the critical nature of the services for the child's well-being.
When asked what he would convey to USAA directly, Michael Winton urged the company to "Stop playing" and fulfill its responsibilities, expressing a desire for his daughter, grandchildren, and extended family to "not go through this."
USAA issued a statement affirming its commitment to its members: "Serving military members and their families has been our mission for more than a century, and USAA takes member concerns seriously. USAA has paid over $7 million in policy benefits on behalf of the victims of this tragic accident. This case involves a billing dispute with one service provider, and we remain committed to addressing our members’ concerns and resolving these matters.” The outcome of this dispute could determine the future of critical care for young Sire and the continued support for his mother.
