Commerce Insurance Co. v. Flores

11 Mass. L. Rptr. 587
CourtMassachusetts Superior Court
DecidedMarch 30, 2000
DocketNo. 9800842
StatusPublished
Cited by2 cases

This text of 11 Mass. L. Rptr. 587 (Commerce Insurance Co. v. Flores) 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
Commerce Insurance Co. v. Flores, 11 Mass. L. Rptr. 587 (Mass. Ct. App. 2000).

Opinion

Fecteau, J.

The plaintiff, Commerce Insurance Company (“Commerce”), seeks a judgment that declares that the failure of the defendant Angelina Flores (“Flores”), to submit to an examination under oath to its completion is a breach of the policy conditions relevant to the insurance benefits claimed by her. The claim that underlies the case at bar arises out of an alleged accident causing personal injury to the defendant that occurred between the defendant while a pedestrian and a motor vehicle being owned and operated by an insured of the plaintiff. Flores made a claim for personal injury protection benefits under the policy of insurance that Commerce had written on behalf of its insured and the examination under oath was scheduled on account of that claim.

The matter came on for a trial on the merits on March 28, 2000, before me sitting without jury. The parties agreed to submit the merits of the case upon written exhibits only, and made arguments thereon. Upon consideration of the evidence in the case and the arguments of the parties, I make the following findings of fact and rulings of law.

FINDINGS OF FACT

1.On or about February 27, 1997, Flores was walking in the parking lot of a commercial location in the Webster Square area in Worcester. She alleges that a motor vehicle owned and operated by one Eugene Leclair struck her, causing injury. In addition, her daughter-in-law Nancy Matías claims to have been injured by Leclair’s motor vehicle. A police officer had been called to the scene and Flores was not noted to have been injured in the accident.

2. Leclair was insured under a policy of automobile insurance coverage with Commerce, under policy number HT6565. The policy was a Sixth Edition policy. The Massachusetts auto policy includes “personal injury protection” benefits for persons injured as pedestrians by an insured vehicle under Part II, no. 3. In addition, the policy includes the following: “we may also require you and any person seeking payment under any part of this policy to submit to an examination under oath at a place designated by us, within a reasonable time after we are notified of the claim.”

3. On or about March 13, 1997, a letter of representation was sent to Commerce by Flores’ attorney, and requested an application for personal injury protection benefits (“PIP”) under G.L.c. 90, sec. 34M. Upon receipt of this notice of claim, Commerce contacted its insured, Leclair, and obtained a statement in which he denied having made any contact with any pedestrians on the relevant date, time and place, although admitting he had been present and operating his motor vehicle.

4. On May 16, 1997, Commerce sent the PIP application to her attorney; it was completed and returned to Commerce on May 20, 1997. Commerce acknowledged receipt of the applications and informed Flores through her attorney that it would request medical documentation and wage loss verifications, as well as asking her attorney to forward medical bills to it.

5. Flores’s attorney sent a package of medical bills and reports to Commerce on June 30, 1997. On July 25, 1997, Commerce informed counsel that it was not paying one or more medical bills at that time as the claim was under investigation. This resulted in a demand letter drawn under the provisions of G.L.c. 93A, sec. 2, incorporating therein various sections of G.L.c. 176D, sec. 3, being sent on August 5, 1997. Commerce replied to this letter on August 26, 1997, in which it outlined the questions it had concerning its liability for payment of the benefits claimed. These questions primarily concerned the difference among the versions of the accidents it received and Flores’s involvement therein, with Commerce pointing to the versions as given by their insured and the information received from the police officer suggesting that there had been no contact between the vehicle and Flores.

6. The plaintiff scheduled an “examination under oath” for December 11, 1997, sending notice to both Flores and Mafias. It was reasonable for it to do so given the questions raised by Commerce on Flores’s connection with the happening of the accident and her contact with the vehicle. Both claimants went to the examination accompanied by an attorney from their counsel’s office. The examination of Mafias went first. During the early stages of the examination, Flores’ attorney stated on the record that he was not going to permit any questions concerning liability to be asked of his client and limited examination to injuries and lost wages; during the examination, he refused to [588]*588permit his client to answer several questions concerning the happening of the accident, stating typically that a particular question related to “third-party liability" and thus irrelevant to the PIP application. Following the examination of Matias, Flores’ examination began. Before Commerce’s attorney had even begun her examination, Flores’ attorney reiterated his statement made during Matias’ examination, seeking a commitment from Commerce that if they (Flores and her attorney) go through with the examination that it will “affirm coverage and pay the PIP." Upon learning from Commerce’s attorney that she would not be able to confirm coverage following the examination, Flores’ attorney terminated the examination. I infer that by Flores’ attorney demanding that Commerce confirm coverage, he meant for Commerce to accept liability for payment of benefits. I also infer that the statement of Commerce’s attorney that she would not be able to confirm coverage after the examination meant that the results of the examination might dictate a contrary finding, saying that “I don’t know what they’re going to do.” She also intimated that if Flores’ attorney persisted in his position regarding the limitation of the examination, that Commerce was likely to deny liability on policy grounds.

RULINGS OF LAW

The claimant seeks payment of personal injury protection benefits from Commerce Insurance Company alleged by her to be due on account of suffering injury while a pedestrian and caused by a Commerce insured. Such coverage exists under the Standard Massachusetts Automobile Insurance Policy, Sixth Edition, Part II, no. 3. In addition, the policy includes the following: “we may also require you and any person seeking payment under any part of this policy to submit to an examination under oath at a place designated by us, within a reasonable time after we are notified of the claim.”

The defendant contends that the policy requirement that any person who seeks benefits to submit to an examination under oath is not a condition precedent to recovery of those benefits, that a failure to attend or submit to such an examination does not amount to a per se violation of the policy but rather requires that an insurer prove actual prejudice as it must under the general policy requirement that a claimant in Flores’ position has a duty to cooperate, that a claimant in the position of Flores need not submit if such exercise would be needless and/or futile, given the insurer’s obvious intent to deny liability for payments which was clear even before the examination began and that the insurer had adequate information from all other sources to act without the need for an examination.

In Mello v. Hinaham Mutual Fire Insurance Company, 421 Mass.

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Cite This Page — Counsel Stack

Bluebook (online)
11 Mass. L. Rptr. 587, Counsel Stack Legal Research, https://law.counselstack.com/opinion/commerce-insurance-co-v-flores-masssuperct-2000.