Lorenzo-Martinez v. Safety Insurance

790 N.E.2d 692, 58 Mass. App. Ct. 359
CourtMassachusetts Appeals Court
DecidedJune 19, 2003
DocketNo. 01-P-1313
StatusPublished
Cited by34 cases

This text of 790 N.E.2d 692 (Lorenzo-Martinez v. Safety Insurance) is published on Counsel Stack Legal Research, covering Massachusetts Appeals Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Lorenzo-Martinez v. Safety Insurance, 790 N.E.2d 692, 58 Mass. App. Ct. 359 (Mass. Ct. App. 2003).

Opinion

Porada, J.

The principal issue presented by this case is whether an insurer may deny uninsured motorist coverage under the standard Massachusetts motor vehicle insurance policy to a claimant who refuses to comply with his or her obligation under the policy to “submit to an examination under oath . . . within a reasonable time after [the insurer is] notified of the claim,” without proof by the insurer of actual prejudice to its interests caused by the claimant’s refusal. In separate motions for summary judgment filed by the insurers, Trust Insurance Company (Trust) and Safety Insurance Company (Safety), two Superior Court judges ruled that the submission to an examination under oath by the respective claimants, Luis A. Lorenzo-Martinez and Sylvia I. Suarez, was a condition precedent for coverage under their policies and that, by refusing to submit to an examination under oath, Martinez and Suarez had forfeited their coverage under their policies. Judgments entered dismissing Martinez’s and Suarez’s complaint seeking to compel their respective insurers to proceed to arbitration of their claims for uninsured motorist benefits. For the reasons stated, we affirm the judgment, as modified herein, for Trust but vacate the judgment for Safety, and we remand the action to the Superior Court for further proceedings.

[361]*361We recite the pertinent undisputed facts and procedural background. On July 19, 1998, Suarez was the operator of, and Martinez was a passenger in, a vehicle owned by Martinez when it was struck on a public highway by an unidentified pick-up truck. The driver of the truck left the scene without making his or her identity known. Martinez was insured under a Massachusetts motor vehicle insurance policy issued by Trust. Suarez was insured under a Massachusetts motor vehicle insurance policy issued by Safety. The policies each contained the following pertinent clauses:

“We may . . . 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.
“After an accident or loss, you or anyone else covered under this policy must cooperate with us in the investigation, settlement and defense of any claim or lawsuit.”

Martinez filed a claim with Trust for uninsured motorist benefits on July 23, 1998. In response, Trust requested that Martinez provide it with a recorded statement. On May 14, 1999, after numerous requests for a recorded statement from Martinez, to which Martinez did not respond, Trust requested that Martinez submit to an examination under oath in order for it to complete its investigation of the accident. Martinez refused to submit to an examination under oath on the ground that the request was not made within a reasonable time after Trust’s receipt of notice of the claim as required under the policy. Based upon Martinez’s refusal, Trust denied Martinez’s claim.

Suarez submitted a notice of her claim to Safety for uninsured motorist benefits on August 19, 1998. There is nothing in the record to indicate that there was any further contact between Safety and Suarez until May 10, 1999, when Suarez’s attorney made a demand upon Safety in writing for settlement of her claim and asserted claims under G. L. c. 93A and G. L. c. 176D, § 3. On June 2, 1999, Safety made an offer of $3,000 to settle her claim. On August 6, 1999, Safety sent a letter to Suarez’s attorney requesting confirmation of the medical expenses paid by the personal injury protection carrier.

[362]*362On September 14, 1999, Martinez and Suarez filed a complaint in the Superior Court requesting appointment of an arbitrator to resolve their claims against Trust and Safety for uninsured motorist benefits under their respective motor vehicle insurance policies. On September 29, 1999, Safety made a demand upon Suarez for an examination under oath, which she refused. Both Trust and Safety filed answers in opposition to the appointment of an arbitrator and counterclaims seeking a declaration that Martinez and Suarez were not entitled to coverage under their policies because of their refusal to submit to examinations under oath. Arbitration was stayed pending resolution of the defendants’ counterclaims for declaratory relief. Both Trust and Safety moved separately and at different times for summary judgment. Upon allowance of both motions and separate judgments in favor of Trust and Safety, Martinez and Suarez filed this appeal.

On appeal, both Martinez and Suarez claim that the allowance of summary judgment was error because Trust and Safety failed to request an examination under oath within a reasonable time after receipt of notice of the claim, and coverage cannot be denied without the insurers’ demonstration that they suffered actual prejudice by the refusal.

In Ellis v. Safety Ins. Co., 41 Mass. App. Ct. 630, 638-639 (1996), we held that the submission to an examination under oath is a condition precedent to recovery under an automobile insurance policy and that the unexcused failure to submit to such examination constitutes a material breach of the contract. We based our holding on Mello v. Hingham Mut. Fire Ins. Co., 421 Mass. 333, 336-337 (1995), in which the Supreme Judicial Court ruled that submission to an examination under oath, if the request is reasonable, is strictly construed as a condition precedent to the insurer’s liability and that the insured’s refusal to comply with such reasonable request results in forfeiture of coverage without proof of prejudice to the insurer’s interest. The result reached in Mello was in stark contrast to prior rulings by the Supreme Judicial Court holding that an insured’s failure to discharge other responsibilities under his or her insurance policy would not constitute a breach of the insurance contract without both proof of breach and actual prejudice to [363]*363the insurer’s interests resulting from the breach. See Johnson Controls, Inc. v. Bowes, 381 Mass. 278, 280-282 (1980) (failure to give notice of claim within time period required by policy); MacInnis v. Aetna Life & Cas. Co., 403 Mass. 220, 223 (1988) (failure to obtain consent of insurer to insured’s settlement of her claim against tortfeasor); Darcy v. Hartford Ins. Co., 407 Mass. 481, 490-491 (1990) (failure to cooperate with insurer in defense of underlying claim). It is not clear from the Mello decision what distinguishes the insured’s obligation to submit to an examination under oath in an insurance contract from those other recited obligations which require both proof of breach and actual prejudice. The Supreme Judicial Court in Mello, 421 Mass. at 336-337, apparently relied upon the fact that G. L. c. 175, § 99, prescribed the form of the fire insurance policy in question, including the provision obligating an insured to submit to an examination under oath, and that the insured’s failure to submit to an examination under oath might significantly hamper the insurer’s ability to investigate the claim, particularly where the claim is suspect.3 Although in Ellis we applied the holding of the Mello decision to the automobile insurance policy in question, we noted that the insured’s claim preceded the decision of Darcy v. Hartford Ins. Co.,

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Cite This Page — Counsel Stack

Bluebook (online)
790 N.E.2d 692, 58 Mass. App. Ct. 359, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lorenzo-martinez-v-safety-insurance-massappct-2003.