Metro West Medical Associates, Inc. v. Amica Mutual Insurance

2010 Mass. App. Div. 136
Massachusetts District Court, Appellate Division·Decided June 29, 2010·No. App. Div. No. 10-ADMS-10009·Published·Cited by 10 cases

Opinion

Greco, P.J.

The plaintiff, Metro West Medical Associates, Inc. (“Metro West”), is appealing the award of summary judgment to Arnica Mutual Insurance Company (“Arnica”). In its complaint, filed in July of 2009, Metro West alleged that it provided medical services to Mártires Cuevos (“Cuevos”) arising out of a motor vehicle accident, that Cuevos’ automobile insurance was with Arnica, and that Arnica had failed to pay bills totaling $407.61 for services covered under the Personal Injury Protection (“PIP”) provisions in that policy. It was undisputed that Arnica submitted those bills for review to BME Gateway (“Gateway”), a company that provided medical evaluations and review of the medical services underlying submitted bills, and that as a result of that review, Arnica paid bills totaling $342.39, but determined that the remaining bills, i.e., $407.61, were not reasonable and the services not necessary. However, in September of 2009, Arnica sent a check for those remaining bills to Metro West’s attorney. A week later, the attorney returned the check and demanded payment for its costs and attorney’s fees pursuant to G.L.c. 90, §34M.

In its motion for summary judgment, Amica, citing Fascione v. CNA Ins., Cos., 435 Mass. 88 (2001), argued that its “payment in full of the outstanding medical bills satisfied!]” its obligation to pay Metro West under §34M, thereby entitling it to summary judgment. One of the affidavits submitted by Arnica in support of that motion essentially set out the chronology of Arnica’s payments and Metro West’s return of the check for the balance due. In its other supporting affidavit, a “Senior Claims Supervisor for PIP litigation” stated that the unpaid bills of $407.61 were not “reasonable and necessary,” and that payment of that amount was “made as a business decision.” A one-page attachment purporting to be a record from Gateway set out the bills submitted and the “Allowable Fees,” the difference between those amounts being $407.61. The document indicated that “[ajllowable fees are calculated according to geographical and economical zones.” In opposition to summary judgment, Metro West filed an affidavit by its attorney, which referred to attached exhibits set[137] ting out the events, one of which was a “G.L.c. 93A Demand Letter,” asserting that Arnica’s actions were “unfair, deceptive, and an act of bad faith.” That affidavit did not address whether the bills of $407.61 were reasonable and necessary.

On appeal, Metro West first argues that Arnica’s payment of the balance due did not extinguish its claim under §34M, and that it was entitled to interest and attorney’s fees on that claim. Metro West also argues that assuming it could not prevail on its claim under §34M, it was error to deny its motion to amend its complaint to add a claim under G.L.c. 93A, §11.

1. G.L.c 90, §34M claim. In arguing that its §34M claim was not extinguished by Arnica’s payment of the balance due, Metro West maintains that the Supreme Judicial Court’s holding in Fasdone was limited to situations where the insurance company inadvertently failed to make timely payment and tendered payment soon after learning of its mistake. To be sure, Fasdone factually involved an inadvertent failure to pay. However, there is absolutely no basis to conclude that the Courtis holding was premised on that fact. In its opinion, the Court posed the issue as “what, if anything, Fasdone is still entitled to recover under G.L.c. 90, §34M” in view of CNA’s payment of the balance due. Id at 91. In answering that question, the Court noted that she would be entitled to costs and attorney’s fees “only if she ‘recovers a judgment for any amount due and payable’” under §34M. Id The Court agreed with CNA that “any amount due and payable” referred “only to PIP benefits” due under the policy and disagreed with Fascione’s argument that it referred to interest on the benefits “for the length of time that payment of her benefits was overdue.” Id. That conclusion was repeated twice more in the opinion, see id at 92,93, before the Court stated that “[ajccordingly, because Fasdone did not recover a judgment for any amount due and payable (i.e., PIP benefits due and payable), she is not entitled to costs and attorney’s fees.” Id at 94. Thus, clearly the holding in the case was based on the nature of the judgment, and not on the reason why CNA failed to make a timely payment.

Metro West’s reliance on the subsequent discussion in the text of the opinion and, in particular, footnote 6 concerning the objectives of §34M is misplaced. The Supreme Judicial Court recognized that “[w]hile late payments [by PIP insurers] are not to be encouraged, it is more likely that the Legislature was concerned with insurers that dispute their obligation to pay PIP benefits and force claimants to litigate their case to judgment, rather than insurers that pay PIP benefits inadvertently after the thirty-day period.” Id. at 95. However, any notion that the Court was limiting its holding to certain types of cases was quickly dispelled in the very next paragraph where it stated that “it was unnecessary for the Legislature to provide the kind of remedies that Fascione seeks under §34M in order to punish insurers that fail to pay PIP benefits reasonably promptly in view of the availability of an action under G.L.c. 93A to recover multiple damages, costs, and attorney’s fees upon a showing of an unfair settlement practice by the insurer. Id. See G.L.c. 176D, §3(9). Metro West sought to add such a claim in its motion to amend (discussed below). Finally, Metro West’s interpretation of footnote 6 as a “strict limitation” on the holding in Fasdone is tortured at best. All the Court was saying is that a claimant is not forced to rush out and hire an attorney when prompt payment is not received. A simple telephone call may remedy the problem where the insurer has made an inadvertent mistake. “If, however, the insurer persists in its refusal to pay PIP benefits,” the insured can [138] then decide to hire counsel to bring a claim under §34M and under Chapter 93A. Id at 95 n.6. If he prevails under §34M, he recovers attorney’s fees and costs. On the other hand, if the injured party does not preval on his §34M claim, he can still proceed on his Chapter 93A claim, which, if successful, can result in multiple damages as well as attorney’s fees.

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Metro West Medical Associates, Inc. v. Amica Mutual Insurance, 2010 Mass. App. Div. 136 (Mass. Ct. App. 2010).

2010 Mass. App. Div. 136 (Metro West Medical Associates, Inc. v. Amica Mutual Insurance) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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