Northshore Chiropractic v. Commerce Insurance

2010 Mass. App. Div. 168, 2010 Mass. App. Div. LEXIS 49
Massachusetts District Court, Appellate Division·Decided August 17, 2010·Published·Cited by 4 cases

Opinion

Swan, J.

Commerce Insurance Company (“Commerce”) has appealed a judgment entered by the Lowell District Court awarding damages to Northshore Chiropractic1 ("Northshore”) for violations of G.L.c. 90, §34M and G.L.c. 93A, §11. ‘We draw our factual summary from the findings of the judge, sitting without a jury, and the uncontested facts of record, all of which are supported by the trial record.... We reserve some details for later discussion where pertinent to our analysis.” Millennium Equity Holdings, LLC v. Mahlowitz, 456 Mass. 627, 630 (2010).

After a jury-waived trial in this case, the trial court “adoptjed] as controlling the findings of fact requested by” Northshore. According to those findings, Minh Chhoeuth (“Chhoeuth”) was injured in a car accident on September 21, 2004, and was treated for those injuries by Northshore from September 22, 2004 to March 29, 2005. Chhoeuth was eligible to receive Personal Injury Protection (“PIP”) benefits under an insurance policy issued by Commerce. On March 28,2008, Northshore, by counsel, sent to Commerce Chhoeuth’s assignment of benefits to Northshore, together with a demand for payment of PIP benefits of $3,783.00 for chiropractic services rendered to Chhoeuth. On April 10, 2008, Commerce replied with a letter stating: “PIP claim denied — no benefits available.” On April 17,2008, Northshore’s counsel requested a specific reason for denial of the claim. On April 30, 2008, Commerce replied: “[Cjlaim was denied, due to privacy acts.” Not satisfied with this answer, counsel advised Commerce that denial “due to privacy acts is an insufficient explanation.” Commerce responded that “as we have advised previously, the claim has been denied in its entirety.” On these findings, the trial court concluded that the failure to make PIP payments “caused [Northshore] to incur a financial loss in the form of attorney’s fees and costs” and that Commerce’s actions were unfair, deliberate, and violative of G.L.c. 93A.

Commerce raised noncooperation as a defense and, relying on Boffoli v. Premier Ins. Co., 71 Mass. App. Ct. 212 (2008), argued that neither Chhoeuth, nor Northshore, filed a timely PIP claim under G.L.C. 90, § 34M. We agree.

[169] In its findings, the trial court also adopted all of both Northshore’s and Commerce’s requested rulings of law. We discuss three of them. The first ruling was that an ‘‘automobile insurer need not show prejudice from [the] late filing of [an] application for personal injury protection (PIP) benefits, if the application is received after two years from the date of the accident.” This is a correct statement of the law, as G.L.c. 90, §34M provides in part:

Claim for benefits due under the provisions of personal injury protection or from the insurer assigned shall be presented to the company providing such benefits as soon as practicable añer the accident occurs from which such claim arises, and in every case, within at least two years from the date of accident, and shall include a written description of the nature and extent of injuries sustained, treatment received and contemplated and such other information as may assist in determining the amount due and payable (emphasis added).

In Boffoli, the Appeals Court held that while the filing of an incomplete PIP application five months after the accident may not have been “as soon as practicable,” it did not amount to noncooperation because “an insurer must demonstrate prejudice when denying PIP benefits because of the late filing of the application for such benefits, provided that the application is fled within two years after the accident” (emphasis added). Id. at 216. Significantly, the Appeals Court added: “The insurer, however, need not show prejudice if the application is received after two years from the date of the accident.” Id.

The trial court also adopted Commerce’s requested ruling that “[failure of an alleged injured PIP claimant to cooperate with the insurer provides an insurer with an absolute defense to any litigation brought under G.L.c. 90, §34M.” This is an accurate statement of the statute, subject, of course, to the parameters stated in Boffoli of what constitutes noncooperation.2 The third ruling adopted by the trial court, also correct, was that a PIP plaintiff bears the burden of proving compliance with the conditions precedent to recovery. Royal-Globe Ins. Co. v. Craven, 411 Mass. 629, 634 (1992).

Applying these rulings of law to the facts of the case, it was the burden of Northshore, as assignee of Chhoeuth’s claim, to prove that Chhoeuth had filed a PIP claim as soon as practicable but, in any event, no later than two years after the accident. In adopting all the findings of fact requested by Northshore, the trial judge did not “consider any of the contentions” of Commerce. Atlas Mtge. Corp. v. Lahey, 2008 Mass. App. Div. 265, quoting Marr v. Back Bay Architectural Comm’n, 23 Mass. App. Ct. 679, 681 (1987). We turn then to the uncontradicted facts in the record but not set forth in the findings. Millennium Equity Holdings, LLC, supra. It is undisputed that not only did Chhoeuth fail to file a PIP claim within two years of the accident, but she failed to file any claim at all. As counsel for both parties stipulated, on [170] September 23, 2004, Commerce sent Chhoeuth a letter enclosing a PIP application to be completed and filed. A second letter was sent on October 20, 2004. After Commerce received a letter of representation from Chhoeuth’s lawyer, a letter was sent to that attorney on November 5, 2004, requesting a PIP application. On December 13,2004, a fourth request was sent, also to the attorney, this time reserving Commerce’s rights to assert noncooperation as a defense should it prove to have been prejudiced. No response was received. Accordingly, on January 24, 2005, Commerce notified Chhoeuth’s attorney that PIP benefits were being denied for noncooperation, noting that it was the responsibility of the injured party to provide to Commerce “all legal documents in connection with the accident” and “medical records and other records.” In February, 2006, Northshore, in its first communication of record to Commerce, sent copies of “bills and records.” Commerce responded by letter dated February 7,2006 that Chhoeuth’s PIP “[cjlaim has been denied in its entirety. Please bill patient.” The record is thereafter silent as to any communication between the parties until March 28, 2008. On that date, Northshore’s attorney sent Commerce a letter enclosing an “Assignment of Benefits for the release of any information”3 and making a demand for payment of $3,783.00.

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Northshore Chiropractic v. Commerce Insurance, 2010 Mass. App. Div. 168, 2010 Mass. App. Div. LEXIS 49 (Mass. Ct. App. 2010).

2010 Mass. App. Div. 168 (Northshore Chiropractic v. Commerce Insurance) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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