Ortiz v. Examworks, Inc.

31 Mass. L. Rptr. 332
CourtMassachusetts Superior Court
DecidedDecember 18, 2012
DocketNo. SUCV201203325BLS1
StatusPublished

This text of 31 Mass. L. Rptr. 332 (Ortiz v. Examworks, Inc.) 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
Ortiz v. Examworks, Inc., 31 Mass. L. Rptr. 332 (Mass. Ct. App. 2012).

Opinion

Billings, Thomas P., J.

For the reasons that follow, the defendant’s Motion to Dismiss, brought under Mass.RCiv.P. 12(b)(6), is ALLOWED.

FACTS

According to the Complaint, whose allegations are taken as true for present purposes, the plaintiff (“Ortiz”) was injured on June 9, 2011 in an automobile accident. The vehicle was insured by Progressive Insurance Company, to whom applied for personal injury protection (“PIP”) benefits. Progressive requested an independent medical examination (“IME”), to which Ortiz assented. The defendant (“BME”) sent a confirming letter which, in addition to the date, time and place of the IMB, included the following:

Examining Physician: Eugene R. Boeglin, Jr., DPT, OCS
Exam Type: Physical Therapy Medical Evaluation

The letter was copied to the law firm representing Ortiz in this case.

Ortiz missed the appointment, so BME sent a second letter with the same information, but a new date and time. Ortiz kept this appointment. Mr. Boeglin took a medical history, performed a physical examination, reviewed medical records, and gave an opinion as to Ortiz’s total and partial disability.

[333]*333Boeglin “was not, and is not, a licensed physician pursuant to M.G.L.c. 112, §2.” In calling him an “Examining Physician,” the Complaint asserts, “BME intentionally deceived Plaintiff into attending an IME conducted by someone who is not a licensed physician pursuant to M.G.L.c. 112, §2.” Its intentwas to deceive Ortiz and others similarly situated “into believing that the physical therapist examiners are in fact physicians.” Claims are asserted under G.L.c. 214, § IB, the Massachusetts Privacy Act, and under Chapter 93A.

DISCUSSION

A. What’s in a Name?

In part, this case depends on what the Legislature meant when, in G.L.c. 90, §34M (para, third), it required that an injured party seeking PIP benefits “submit to physical examinations by physicians selected by the insurer as often as may be reasonably required and shall do all things necessary to enable the insurer to obtain medical reports and other needed information to assist in determining the amounts due.” (Emphasis supplied.) The plaintiff asserts that the term means a medical doctor licensed under G.L.c. 112, §2. The defendant argues that it should be read to include allied health professionals, including physical therapists.

Nowhere in section 34M, or in Chapter 90 as a whole, is the term “physician” defined, and no decision from the SJC or the Appeals Court has addressed the issue before me. 1

Looking first to “ordinary and approved usage,” Chandler v. County Comm’rs of Nantucket County, 437 Mass. 430, 435 (2002) (citation omitted), however, it means “[a] person skilled in the art of healing; specif: a doctor of medicine,” WEBSTER’S NINTH NEW COLLEGIATE DICTIONARY (1991); “[a] person licensed to practice medicine; medical doctor.” THE AMERICAN HERITAGE DICTIONARY, SECOND COLLEGE ED. (1985).

There is little reason to believe that the Legislature, in enacting section 34M, intended “physician” to mean anything other than a licensed medical doctor, or that if it had intended this, it would have had difficuliy expressing itself. The very next paragraph of the same section, for example, refers to allied health professionals in the following terms:

no insurer shall refuse to pay a bill for medical services submitted by a practitioner registered or licensed under the provisions of chapter one hundred and twelve, if such refusal is based solely on a medical review of the bill or of the medical services underlying the bill, which review was requested or conducted by the insurer, unless the insurer has submitted, for medical review, such bill or claim to at least one practitioner registered or licensed under the same section of chapter one hundred and twelve as the practitioner who submitted the bill for medical services. (Emphasis supplied.)

In Boone v. Commerce Ins. Co., 451 Mass. 192 (2008), the SJC held that the “plain language” of the just-quoted provision required that a records-only review—but not a physical examination—be conducted by a person in the same profession “as the practitioner who submitted the bill for medical services.” It cautioned against “add[ing] to a statute a word that the Legislature had the option to, but chose not to, include.” Id. at 199, quoting Dartt v. Browning-Ferris Indus., Inc., 427 Mass. 1, 9 (1998). Put only slightly differently, “(w]here the Legislature employs terms in one part of a statute but excludes them elsewhere, [a Court] will not imply the existence of those terms where excluded.” Passatempo v. McM-enimen, 461 Mass. 279, 288 (2012).

In fact, the General Laws are replete with instances in which the Legislature, when it wished to expand the term “physician” to include other healthcare professionals, did so in plain English.2 There are also instances where “physicians” and other providers are included in a single list of healthcare professions, a clear indication that each term—"physician" included—is meant to have a meaning distinct from the others.3 See Boston Gas Co. v. Century Indem. Co., 454 Mass. 337, 355 (2009) (“Eveiy word . . . ‘must be presumed to have been employed with a purpose and must be given meaning and effect whenever practicable’ ”; citation omitted).

The most direct announcement of the statutory meaning of the word “physician” in its unmodified form, however, is within the licensure statute itself (Chapter 112), at section 8A. This provides:

No person may, directly or indirectly, use the title “physician” or display or use the term physician in any title, advertisement, listing of affiliations, communication with the public or in any other manner to indicate or imply in any way that such person offers to engage or engages in the practice of medicine or in the provision of health care services to patients within the commonwealth who is not registered by the board of registration in medicine as a physician under section 2. This section shall not apply to use of the term “chiropractic physician” by individuals licensed and practicing under sections 89 to 97, inclusive, or the use of the term “podiatric physician” by individuals licensed and practicing under sections 13 to 22, inclusive, or the use of the term “physician assistant” by individuals licensed and practicing under sections 9C to 9K, inclusive. A person who violates this section shall be punished by a fine of not less than $100 and not more than $1,000 or by imprisonment for not less than 30 days and not more than 1 year in the house of corrections, or by both such fine and imprisonment.

ExamWorks’ approach undoubtedly facilitates prompt scheduling of IMEs, and correspondingly prompt resolution of claims and payment of providers, [334]*334all at a reasonable transaction cost. These are all laudable goals in the high-volume, low-margin world of PIP claims administration. I have in mind also that a literal application of the term “physician” likely means that under section 24M, para, fourth, a certification of disability by a physical therapist, a chiropractor, or any professional other than a medical doctor does not trigger the patient’s right to PIP payments—a result likely not desired by Mr. Ortiz or the class he seeks to represent.

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Cite This Page — Counsel Stack

Bluebook (online)
31 Mass. L. Rptr. 332, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ortiz-v-examworks-inc-masssuperct-2012.