Make no mistake about it: insurance companies are in business to make money, and they will often fight tooth and nail to avoid paying legitimate claims. In the case of Barron Chiropractic & Rehabilitation, P.C. vs. Norfolk & Dedham Group, a medical provider had to fight all the way to the state supreme judicial court to assert a claim for full payment after an insurance company refused to pay $1,544.05 of a $3,940.oo chiropractic bill.
In 2008, the defendant’s insured was injured in a car accident. The vehicle in which she was riding was insured by the defendant insurance company pursuant to Mass. Gen. Law. ch. 90, § 34A, which requires compulsory motor vehicle liability insurance, including personal injury protection (PIP) benefits. About two and a half months after the accident, the insured made an application for PIP benefits. The defendant requested that the insured submit to an independent medical examination (IME) with a chiropractor. She did so, and the chiropractor opined that she had reached maximum therapeutic benefit. Based upon the report, the defendant maintained that any treatment rendered to the insured after the IME was unnecessary and unreasonable.
Nine months later, the plaintiff chiropractic practice sent the defendant a report stating that the insured had needed an additional nine treatments following the IME from the first chiropractor. The defendant disputed the plaintiff’s bill, and, over a year after the insured submitted her application for PIP benefits, the plaintiff filed suit against the defendant, seeking payment for the disputed amount, attorney fees, costs, and interest. The plaintiff’s allegations included unfair or deceptive practices regarding an insurance claim, as well as unfair settlement practices.
Since the IME chiropractor’s court appearance fee was going to exceed the amount in controversy, the defendant sent the plaintiff a check for the disputed medical bill amount prior to trial. The check did not include payment for attorney fees, costs, or interest. The plaintiff returned the check. The defendant sought – and was granted – summary judgment. The intermediate appellate court affirmed.
The Question for the Court
According to the court, the primary issue was whether an unpaid party that has brought suit and thereafter refused the insurer’s tender of amounts due and payable, made prior to the entry of judgment, may proceed with the suit and, if successful, obtain a judgment for those amounts as well as its costs and attorney’s fees.
The Court’s Decision
The court concluded that a party in fact could proceed with the action under Mass. Gen. Laws ch. 90, § 34M. Since the plaintiff declined the defendant’s tender of payment, the plaintiff remained an “unpaid party” pursuant to the PIP provision, § 34M, and it was thus entitled to seek a judgment for benefits due and payable. The court affirmed summary judgment as to the remaining claims, noting that there were no genuine issues of material fact as to the propriety of the defendant’s dealings under G. L. c. 93A.
If You Need to Speak with an Attorney
The Law Offices of John C. Manoog, III, handles car accident and other injury cases, including those against insurance companies. Call us today at (888) 262-6664 for an appointment to discuss your case. You can also contact us online through this website. If you live in the Cape Cod area, including Plymouth and Hyannis, we are here to help.
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