Almy v. Commercial Union Insurance

6 Mass. L. Rptr. 420
CourtMassachusetts Superior Court
DecidedFebruary 13, 1997
DocketNo. 952174
StatusPublished

This text of 6 Mass. L. Rptr. 420 (Almy v. Commercial Union Insurance) is published on Counsel Stack Legal Research, covering Massachusetts Superior Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Almy v. Commercial Union Insurance, 6 Mass. L. Rptr. 420 (Mass. Ct. App. 1997).

Opinion

Fabricant, J.

INTRODUCTION

This action presents a dispute as to the defendant insurance company’s handling of the plaintiffs tort claim against its insured arising from a motor vehicle accident. The plaintiff contends that the insurer violated G.L.c. 176D, §3(9)(f) and G.L.c. 93Aby “failing to effectuate [a] prompt, fair and equitable settlement” of the tort claim. Based on the evidence presented at trial and arguments of counsel, the Court makes the following findings of fact, conclusions of law, and order for judgment.

I.Findings of Fact

1. On January 22, 1993, at approximately 1:00 a.m., the plaintiff Robert Almy was driving North on Route 1 in Peabody, when he was struck in the rear by Ronald LaPorte, who was driving a vehicle owned by John Sullivan, an insured of Commercial Union. LaPorte was intoxicated and was driving very fast. Almy’s car rolled over several times, but came to rest upright. Almy was restrained by his seat belt and shoulder harness, which spared him the devastating injuries that might otherwise have resulted. Almy suffered injuries to his shoulder and knee, requiring medical treatment and disabling him from work for a period of time, along with emotional injuries requiring psychiatric treatment and affecting his ability to drive at night for a period of time.

2. Commercial Union, according to its records, received notice of the incident on January 27, 1993. On that date, its adjuster, Stuart McKay, attempted unsuccessfully to contact Almy. McKay prepared an “Adjuster’s First Report" form, on which he noted his evaluation of liability as 100%.

3. McKay’s next written report, dated February 25, 1993, indicates that by that date McKay had had some communication with Attorney Michael Fuller on behalf of Almy. Attorney Fuller had informed McKay that Almy had fractured his right shoulder, that Fuller was not yet in a position to provide further information regarding the injuries, and that Almy would be unable to return to work until March 25, 1993.

4. Commercial Union’s company policy requires adjusters to make an evaluation of each claim within thirty days of the company’s receiving notice, from whatever information is available at that time, in order for the company to post a reserve for the claim. A reserve is an amount identified as the approximate settlement value of the claim, a percentage of which the company is required by state regulation to set aside in an escrow account pending resolution of the claim.

5. In accord with this requirement, McKay calculated a figure of $13,100 for Almy’s lost income, added to that a figure of $3,900 (the meaning of this figure was not established in testimony at trial), and arrived at a total of $17,000, which he indicated on his February 25, 1993 report as his recommended reserve. McKay also noted on the report his evaluation of liability as “100%.”

6. As of April 27, 1993, when McKay’s supervisor signed a “90 Day/6 Months Supervisory Review Form” on the case, the company had given the case a damage reserve of $17,000 and an expense reserve of $1,000. McKay’s supervisor noted on the form that no “support” had yet been received from Almy’s attorney, and that the adjuster would follow up.

7. On May 21, 1993, Commercial Union received a subrogation claim from Almy’s insurer for the amount it had paid Almy for the value of his car and for towing fees. Commercial Union paid that claim on May 26, 1993, with McKay noting to his file that “we have accepted 100% liability.”

8. On July 29, 1993, McKay received a package of documentation from Attorney Fuller, showing expenses incurred of $7,929.91 for medical treatment and $688.95 for rental fees. McKay noted to his file that he contacted Fuller, that the attorney “has not kept up with case,” and “was unsure what medical treatments his client has incurred,” and that the attorney “will review and get back to me." McKay also noted that the company paid Almy for the rental charges, and that the “reserve will be increased next month.”

9. On October 8, 1993, McKay received additional documentation, bringing the medical expenses up to a total of $8,898.91, and providing further details of the injuries and lost wages. McKay made calculations, shown in his file note, reaching a total of $36,600. He noted that he made an unsuccessful attempt to contact Almy’s attorney, and that “upon reviewing will increase reserve.”

10. On November 1, 1993, McKay received additional invoices for medical treatment of Almy, bringing the total medical expenses to $9,443.66. He spoke [421]*421with Attorney Fuller, and “was informed that claimant has stopped treating and a demand will be forthcoming once final reports are received.” McKay noted to his file that he had “reevaluated loss with supervisor," and made calculations totaling $25,500. He further noted “range 23,000 — 25,000,” and “FV 25,000.” “FV” stands for “full value,” a term used in the insurance industry to refer to the company’s estimate of the settlement value of the claim, after consideration of all available information.

11. On November 9, 1993, McKay’s supervisor prepared a “90 Day/6 Month Supervisory Review Form,” indicating that as of that date the company’s damage reserve for the case was $25,000, its expense reserve was $2,500, its Full Value figure was $30,000, its “exposure factor” was 100%, and its settlement strategy was “continue toward settlement.”

12. In further correspondence between November of 1993 and April of 1994, McKay requested and Fuller provided further documentation of Almy’s injuries and expenses.

13. By letter to McKay dated April 18, 1994, Attorney Fuller forwarded a final medical report, and made a demand on behalf of Almy of $150,000 “for full and final settlement." This was Almy’s first demand in a specific dollar amount. McKay responded with a letter dated April 27, 1994, acknowledging the demand and requesting further documentation of lost wages.

14. The next communication between the parties was a letter from Attorney Fuller to McKay, dated July 22, 1994, enclosing the requested documentation, along with photographs of the damage to Almy’s car, and setting forth arguments in support of the $150,000 demand. The factors asserted as supporting the reasonableness of the demand included “today’s climate against drunk drivers” and “your insured operator’s continued default on his criminal charges.”

15. On July 28, 1994, McKay noted to his file that he had “received demand package from attorney.” He made a series of calculations, reaching a total of $31,300. He noted “range 25,000 — 30,000,” and that he would review with his supervisor before making an offer.

16. On August 2, 1994, McKay’s supervisor prepared a “90 Day/6 Month Supervisory Review Form." The supervisor noted that the present damage reserve was $25,000, that the “new res.” would be $40,000, that the Full Value of the case was $40,000, and that the exposure factor was 100%. The supervisor also noted that Almy’s attorney “has now made a demand of $150,000,” that the company would “have adjuster extend an offer. If no significant movement from atly. Then will refer for ortho. Medical record review,” and that the company’s settlement strategy at that time was “case to try and settle but demand is excessive.” The supervisor attached a note to McKay, suggesting “an initial offer of $25,000,” with an orthopedic medical record review to be conducted “if atly is still up around $100,000.”

17.

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Related

Brandley v. United States Fidelity & Guaranty Co.
819 F. Supp. 101 (D. Massachusetts, 1993)
Bonofiglio v. Commercial Union Insurance
576 N.E.2d 680 (Massachusetts Supreme Judicial Court, 1991)

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Bluebook (online)
6 Mass. L. Rptr. 420, Counsel Stack Legal Research, https://law.counselstack.com/opinion/almy-v-commercial-union-insurance-masssuperct-1997.