Curtis v. Metropolitan Property & Casualty Insurance

8 Mass. L. Rptr. 142
CourtMassachusetts Superior Court
DecidedJanuary 5, 1998
DocketNo. 9301153
StatusPublished

This text of 8 Mass. L. Rptr. 142 (Curtis v. Metropolitan Property & Casualty 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
Curtis v. Metropolitan Property & Casualty Insurance, 8 Mass. L. Rptr. 142 (Mass. Ct. App. 1998).

Opinion

Hely, J.

I. INTRODUCTION

This case was tried before the court on October 27 and 28, 1997. The two claims pressed by the plaintiff at trial were: (1) Metropolitan breached contract and statutoiy obligations to pay $1808 in Personal Injury Protection (PIP) benefits to him under his automobile insurance policy; and (2) Metropolitan’s handling of the plaintiffs PIP and underinsured motorist claims [143]*143violated G.L.c. 93A and 176D. The parties agreed that the contract claim based on the underinsured motorist coverage has been resolved by an arbitration award which Metropolitan has paid.

Based on an assessment of the weight and credibility of the evidence, the court finds for Metropolitan on both issues. The medical expenses in the PIP claim have already been paid, and Metropolitan did not engage in any unfair or deceptive practice in handling the claims.

II. THE PIP CLAIM

On January 15, 1993, the plaintiff was injured in an automobile accident with a second vehicle driven by David Taardie. The plaintiffs vehicle was insured by Metropolitan. The plaintiff sued Tardie for negligence. With Metropolitan’s consent, the plaintiff settled his suit against Tardie for $25,000, the liability limit under Tardie’s policy. The Tardie settlement was reached on September 11, 1995.

The plaintiff contends that Metropolitan still owes him $1808 for medical bills that he submitted to Metropolitan under his PIP coverage. The plaintiff also made a demand to Metropolitan to pay him the policy limit of $75,000 under the underinsured motorist coverage. As noted earlier, the underinsured motorist claim has been resolved by arbitration. On the particular facts of this case, the arbitration award is also dispositive of the PIP claim because the arbitrators determined the plaintiffs total damages for injuries from the accident and these damages have been paid.

It is clear from the arbitration award that the arbitrators assessed the plaintiffs total damages “for injuries sustained by him in a motor vehicle collision on January 15, 1993.” Ex. 21 at 3. Based on the evidence submitted by the plaintiff, the arbitrators found that the plaintiff had incurred medical expenses of $5132. These medical expenses were found to be reasonable, and they were included in the arbitrators’ calculation of the total damages. The plaintiffs total damages as determined by the arbitrators were $50,132. The arbitrators’ fact determination on the total damages was an essential part of the decision. It is binding on the parties.

The arbitrators then determined the amount of the damages that had already been paid to the plaintiff: $25,000 paid by Tardie’s insurer (“the primary insurer”); and $2592.29 that had been previously paid by Metropolitan under the plaintiff s PIP coverage. By deducting the paid amounts, the arbitrators determined that the net amount due from Metropolitan was $22,539.71. The parties agree that Metropolitan paid this amount to the plaintiff following the award.

The plaintiff has therefore been paid in full for his total damages. The total damages as found by the arbitrators included all of the plaintiffs medical expenses. When the arbitrators went on to calculate the net award, they credited Metropolitan only for the payment from Tardie’s insurer and for the PIP payments that Metropolitan had already paid. The previously unresolved PIP claim for $1808 in medical expenses was thus included as part of the net award that the arbitrators found to be still due from Metropolitan. Metropolitan paid this award, and it is not required to pay the $1808 a second time as part of the plaintiffs present action under the PIP coverage.

The court recognizes that the Agreement to Submit to Arbitration (Ex. 23) excluded from the arbitration matter the plaintiffs claims in the present action, Bristol C96-00418. The arbitration award therefore did not purport to decide the PIP claim per se. Nevertheless, in the course of deciding the value of the uninsured motorist claim, the arbitrators’ decision did make a binding determination of the amount of the plaintiffs total damages, including all medical expenses. Because the plaintiff has received full payment of the arbitration award, including payment of all previously unpaid medical expenses, he is not entitled to be paid second time under the PIP coverage for the same medical expenses.

III. THE UNFAIR OR DECEPTIVE PRACTICES CLAIM

The claims under G.L.c. 93A and 176D depend on the settlement discussions between the plaintiffs attorney and various Metropolitan claims representatives. All the witnesses were honest and honorable, but they had different memories and interpretations of these discussions. The court’s findings are based on an assessment of the relative weight and reliability of the testimony and exhibits.

Following the accident the plaintiff submitted a variety of medical service bills to Metropolitan for payment under the PIP coverage. Some of the bills were promptly paid. For others, Metropolitan requested further documentation. For example, Metropolitan wanted “explanation of benefits” forms from the plaintiffs health maintenance organization on why certain expenses were not included within the HMO’s service or coverage. The HMO’s “explanations” were skimpy at best. The plaintiff in good faith obtained and submitted as much information as he could. Metropolitan in good faith and with reasonable diligence sought more information. The delays on these bill were caused by the HMO’s lack of explanations and the inherent complexity of the HMO and multi-party medical payment system.

Another friction point was a town ambulance service bill which Metropolitan had paid early on. The town kept billing the plaintiff for this service erroneously. The plaintiff naturally kept sending the bill on to Metropolitan. Metropolitan was not required to pay it twice.

[144]*144On October 13, 1995, plaintiffs counsel sent Metropolitan a demand package detailing the plaintiffs total damages. He demanded the $75,000 policy limit on the underinsured motorist coverage. Since the plaintiff had already been paid $25,000 by Tardie’s insurer, the plaintiff was claiming that his total damages were $100,000.

In the next several months, a series of of Metropolitan claims representatives and settlement team members spoke by telephone with plaintiffs counsel or his office staff regarding the claim. In early December, 1995, Metropolitan valued the total damages at $24,000 to $31,000. After crediting the $25,000 primary insurance payment, they offered plaintiffs counsel $5500. The parties’ opening positions — $75,000 and $5500 — were a long way apart. Metropolitan’s first offer was conservative, but it was not a bad faith or unreasonable opening considering the plaintiffs outer-edge first demand and the insurer’s legitimate concerns over the plaintiffs preexisting back condition.

In a telephone discussion on December 4, 1995, Metropolitan asked plaintiffs counsel for a more reasonable demand. He replied that he would not respond to their ridiculous offer and said he would be filing for arbitration. Their next discussion was on January 9, 1996. Plaintiffs counsel described some of the specifics of the plaintiffs impaired activity. The insurer offered $10,000. This was still not unreasonable considering the plaintiffs age (30) and his potential for physical recovery. Plaintiffs counsel indicated he would come down to $65,000 but would not settle for any less.

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Cite This Page — Counsel Stack

Bluebook (online)
8 Mass. L. Rptr. 142, Counsel Stack Legal Research, https://law.counselstack.com/opinion/curtis-v-metropolitan-property-casualty-insurance-masssuperct-1998.