Martinez-Rivera v. Commerce Insurance

28 Mass. L. Rptr. 474
CourtMassachusetts Superior Court
DecidedApril 11, 2011
DocketNo. HDCV200600749
StatusPublished

This text of 28 Mass. L. Rptr. 474 (Martinez-Rivera v. Commerce 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
Martinez-Rivera v. Commerce Insurance, 28 Mass. L. Rptr. 474 (Mass. Ct. App. 2011).

Opinion

Moriarty, Cornelius J., J.

INTRODUCTION

This matter came on for a jury-waived trial on claims of violations of G.L.c. 93A and G.L.c. 176D. The plaintiff claims that the defendant, Commerce Insurance Company (Commerce), failed to conduct a prompt and reasonable investigation of his claim and failed to make a fair and equitable offer of settlement once liability had become reasonably clear. Based on the credible evidence, the following facts are found.

BACKGROUND

This case stems from a motor vehicle accident which took place on August 13, 2003. The plaintiff Efrain Martinez Rivera (Rivera), then 34 years of age, [475]*475was the operator of an automobile which was struck by a dump truck operated by Edward Mutti (Mutti). Mutti had a policy of insurance with Commerce with policy limits of $1,000,000.00. The plaintiffs filed suit against Mutti in the Superior Court in August, alleging personal injuries and a loss of consortium. They later amended the suit to add the claims against Commerce for violations of G.L.c. 176D and M.L.c. 93A in 2007. Those claims were severed and stayed from the underlying suit. In May 2008, the tort claim against Mutti was settled for the policy limits.

FACTS

At the time of the accident Rivera was married and the father of three children. He was employed as a laborer at Old Colony Envelope where he earned $616.00 per week and from where he was returning at the time of the accident.

The collision was caused by Mutti’s dump truck crossing the center line of the roadway, traveling into Rivera’s lane of travel and striking Rivera’s automobile head on. Rivera was taken by ambulance to the Baystate Medical Center where he was treated and released.

In August 2003, Commerce received a letter of representation from Attorney Ryan Alekman (Alek-man) on behalf of Rivera. Commerce conducted an investigation into the cause of the accident and by August 22, 2003, determined that the accident was solely the fault of Mutti. Commerce was then aware that Rivera would likely pursue a claim for personal injuries.

Contact between Commerce and Alekman was initially sporadic. In January 2004, Alekman advised Commerce that Rivera was still treating for his injuries. In February 2004, after a failed course of physical therapy, he was referred to Dr. Richard Anderson, a neurosurgeon. A CT scan demonstrated a disc herniation at L 4-5. He then underwent a left L5-S1 decom-pressive hemilaminotomy, disc space exploration and lateral recess decompression on May 3, 2004. During the course of this procedure Dr Anderson noted a compressed conjoined nerve root.

The operation did not relieve Rivera’s pain. In January 2005, Alekman advised Commerce that Rivera was still out of work. Later, in May 2005, Alekman forwarded medical bills and records to Commerce referencing the prior surgery. Commerce increased its reserves to $200,000.00.

In July 2005, Alekman called Commerce and advised that Rivera remained out of work and, on some days, spent the entire day in bed. Commerce then decided to undertake surveillance. The surveillance reports indicated that Rivera was observed walking and driving without any difficulty.

During this period Rivera continued to treat with a host of different medical providers who provided different forms of treatment without success.

In the summer of 2005, Commerce Claims Examiner, Janice Jankowski (Jankowski) noted that Rivera was wearing a waist support at the time of the accident. She questioned whether this was due to work requirements or a pre-existing injury. Noting that the medical records indicated that Rivera had previously treated at Northgate Medical Center, she requested that the medical records be obtained from that facility.

In September 2005, Commerce adjuster Marc Rischetelli wrote to Alekman requesting additional medical information. Alekman responded that his client would be undergoing a second surgery in November 2005. Shortly thereafter Dr. Anderson performed a second procedure described as an anterior lumbar interbody fusion.

In March 2006, Commerce received a health care lien asserting a lien in excess of $44,000.00. Attached to the lien was a list of medical bills totaling over $154,000.00. As a result the reserves were increased to $500,000.00.

Rivera saw Dr. Anderson post-operatively who noted his complaints of persistent pain and left leg weakness. Dr. Anderson last treated Rivera in June 2006, at which time he recommended a referral to another physician for implantation of a dorsal column simulator in order to provide Rivera some relief.

In July 2006, Alekman spoke with an adjuster at Commerce and stated that he was preparing to file suit due to the statute of limitations. In August, Commerce learned that the complaint had been filed but not yet served. At the time Alekman stated that the demand would be for the policy limits of $1,000,000.00.

On August 21, 2006 Commerce assigned the file to adjuster Michael Hall (Hall). Hall handled the underlying case until it settled in 2008. When Hall took over the investigation, one of the first things he did was to review the liability investigation. He determined that Mutti’s liability was clear. As part of his initial review, he also reviewed surveillance tapes.

By October 2006, Commerce had referred the matter to Attorney Stephen Anderson for defense of the claim. Attorney Anderson authored a “Litigation Analysis Report” in which he noted that liability appeared to rest with the insured and that the discovery deadline was June 3, 2007.

In December 2006, Rivera underwent implantation of a spinal cord simulator at the Baystate Hospital Pain Clinic.

Early in December 2006, Hall received additional medical bills and records from Alekman. On December 19, 2006, after confirming that Mutti did not have an umbrella policy, Alekman told Hall that he would settle for the policy limits. Hall responded that he had just received a large packet of materials and that his valuation was not yet complete. Alekman informed Hall of the spinal cord stimulator procedure and that [476]*476Rivera’s medical bills now totaled in excess of $250,000.00.

Hall was aware at the time he took over the file that Rivera had claimed back and left leg injures and had undergone two surgeries. Hall also knew that Rivera was earning approximately $32,000.00 a year before the accident and had been out of work for well in excess of three years.

In January, Hall spoke to Alekman and told him he was declining to make an offer of settlement because he had concerns as to causation and intended to request an opinion from an expert. By that time Commerce had also decided to conduct additional surveillance of Rivera.

Limited surveillance in January 2007 revealed Rivera carrying two 2’ x 4’ pieces of lumber for a short period of time with no restrictions or visible disability. Based on this surveillance tape, Hall unilaterally decided that Rivera was capable of working. Hall is a high school graduate and is presently working towards his college degree. He also has experience as a claims adjuster. However, he has no demonstrable expertise in vocational assessment or training and accordingly his opinion founders.

Hall, like Jankowski, noted that Rivera arrived at the emergency room after the accident wearing a waist support.

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Bluebook (online)
28 Mass. L. Rptr. 474, Counsel Stack Legal Research, https://law.counselstack.com/opinion/martinez-rivera-v-commerce-insurance-masssuperct-2011.