Wheatley v. Massachusetts Insurers Insolvency Fund

925 N.E.2d 9, 456 Mass. 594
CourtMassachusetts Supreme Judicial Court
DecidedApril 27, 2010
DocketSJC-10510
StatusPublished
Cited by54 cases

This text of 925 N.E.2d 9 (Wheatley v. Massachusetts Insurers Insolvency Fund) is published on Counsel Stack Legal Research, covering Massachusetts Supreme Judicial Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wheatley v. Massachusetts Insurers Insolvency Fund, 925 N.E.2d 9, 456 Mass. 594 (Mass. 2010).

Opinion

Marshall, C.J.

General Laws c. 176D defines and regulates “unfair methods of competition and unfair or deceptive acts or practices in the business of insurance.” 2 G. L. c. 176D, § 3. General Laws c. 93A, § 9 (1), in turn, provides, among other *595 things, that a consumer “whose rights are affected by another person violating the provisions of” G. L. c. 176D, § 3 (9), may bring an action in the Superior Court for damages and equitable relief. In 1996, the Legislature amended G. L. c. 176D, § 1 (a), adding the Massachusetts Insurers Insolvency Fund (insolvency fund), as well as joint underwriting associations, to the definition of “person” as that term is defined in G. L. c. 176D. St. 1996, c. 313 (1996 amendment). The 1996 amendment was adopted in the wake of Barrett v. Massachusetts Insurers Insolvency Fund, 412 Mass. 774, 777 (1992) (Barrett), and Poznik v. Massachusetts Med. Professional Ins. Ass’n, 417 Mass. 48, 53 (1994) (Poznik), in which this court held, respectively, that the insolvency fund (in Barrett) and the Massachusetts Medical Professional Insurance Association (medical insurance association), a joint underwriting association (in Poznik), were not subject to suit under G. L. c. 93A. In this consumer action against the insolvency fund, we are asked to determine whether the 1996 amendment caused the insolvency fund to be subject to G. L. c. 93A, among other things.

General Laws c. 176D, § 1 (a), provides, in pertinent part, that a “[pjerson” is “any individual, corporation, association, . . . any other legal entity or self insurer which is engaged in the business of insurance, including agents, brokers, and adjusters, the Massachusetts Insurers Insolvency Fund and any joint underwriting association established pursuant to law.” 3 The insolvency fund argues that its placement in that definitional *596 section after the words “in the business of insurance” and after the words “including agents, brokers, and adjusters,” supports a conclusion that it is a “person” for some purposes of G. L. c. 176D, but it is not a person “engaged in the business of insurance” for all purposes of that chapter. The insolvency fund, it argues, is subject to investigation and enforcement by the Commissioner of Insurance (commissioner) under G. L. c. 176D, but it is not subject to consumer actions under G. L. c. 93A. A judge in the Superior Court agreed and allowed the insolvency fund’s motion for judgment on the pleadings. See Mass. R. Civ. P. 12 (c), 365 Mass. 754 (1974). We granted the plaintiff’s application for direct appellate review. For the reasons stated below, we conclude that the 1996 amendment had the effect of subjecting the insolvency fund, among other things, to consumer actions brought pursuant to G. L. c. 93 A, § 9 (1). Accordingly, we reverse the judgment.

1. Facts. We briefly summarize the allegations of the complaint, which we take as true. Jarosz v. Palmer, 436 Mass. 526, 529-530 (2002) (“In deciding a rule 12 [c] motion, all facts pleaded by the nonmoving party must be accepted as true”).

In July, 2003, Legion Insurance Company (Legion), a Pennsylvania company that provided insurance for the town of Duxbury (town), was declared insolvent by a Pennsylvania court. Accordingly, pursuant to G. L. c. 175D, § 5 (1), the insolvency fund became obligated to pay certain claims arising under policies issued by Legion and to “adjust, compromise, settle and pay covered claims to the extent of the [insolvency fund’s] obligation,” G. L. c. 175D, § 5 (1) (d). 4 One of the claims *597 concerned a negligence action commenced against the town by a student injured in the following circumstances.

In 2001, the plaintiff, Kirsten M. Wheatley, at the time a seven year old special education student who required the use of a walker and adult supervision to walk, was a student at a Duxbury public elementary school. On October 26, 2001, while walking to the school lunch room, Wheatley’s walker collided with an obstacle on the floor of the hallway as she was leaving the special education center. Falling forward, she fractured a front tooth. She was then permitted by a school nurse to eat her lunch, during which she swallowed a different tooth knocked loose by the fall. In July, 2004, following unsuccessful negotiations with the town described below, Wheatley filed a negligence action against the town seeking to recover damages for these injuries. The case went to trial, and in April, 2008, a jury awarded Wheatley $20,786.31.

Wheatley first presented her claims to the town in August, 2003, see G. L. c. 258, § 4, approximately one month after Legion had been declared insolvent. Neither the town nor the insolvency fund responded to Wheatley’s presentment letter. 5 When Wheatley filed her negligence action against the town, the insolvency fund defended the town, denying liability and asserting various affirmative defenses. Wheatley alleges that, by November, 2004, some fourteen months after Wheatley had made demand on the town and three months after she had commenced her negligence action against it, the insolvency fund had made no offer to settle her claims. She thereupon sent to the insolvency fund a demand letter pursuant to G. L. c. 93A, § 9 (3), to which the insolvency fund did not respond within thirty days of receipt. 6 Wheatley alleges here that at “all times *598 relevant” the town’s liability was “reasonably clear,” because she was in the town’s “exclusive care, custody and control at the time of the accident” and was “unable to exercise any degree of care to protect herself from injury” because of her age and disabilities.

In August, 2006, some twenty-two months after sending her G. L. c. 93A demand letter to the insolvency fund, Wheatley commenced this action alleging that the insolvency fund had not “effectuated a prompt, fair and equitable settlement” of her claims, and that in the course of its defense of the town in the underlying negligence action, the insolvency fund had engaged in “multiple” unfair claims settlement practices in “willful” violation of G. L. c. 176D, § 3 (9), and G. L. c. 93A, § 2, including failure “to acknowledge and act reasonably promptly upon communications with respect to claims arising under insurance policies,” in violation of G. L. c. 176D, § 3 (9) (b); failure “to adopt and implement reasonable standards for the prompt investigation of claims arising under insurance policies,” in violation of G. L. c. 176D, § 3 (9) (c); refusal to pay her claim “without conducting a reasonable investigation based upon all available information,” in violation of G. L. c. 176D, § 3 (9) (d); and failure “to effectuate prompt, fair and equitable settlement!]” of a claim “in which liability ha[d] become reasonably clear,” in violation of G. L. c. 176D, § 3 (9) (f).

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Bluebook (online)
925 N.E.2d 9, 456 Mass. 594, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wheatley-v-massachusetts-insurers-insolvency-fund-mass-2010.