Massachusetts' Boston Municipal Court, Appellate Division, recently held that a Massachusetts insurance company cannot be held liable under Massachusetts General Law Chapter 93A when it refuses to pay a medical bill submitted under the PIP portion of an automobile insurance policy when the treatment associated with the bill is not "reasonably clear." The attorney's at the Boston Law office of Neil Burns can help if you are injured in a car accident. The details as described below show there are many details involved in filing a personal injury. The Boston lawyers at the Law Office of Neil Burns can help.
The case involved the defendant, Commerce Insurance Company, who the injured plaintiff charged with violating Massachusetts General Law Chapter 93A, when Commerce Insurance refused to pay the injured plaintiff's $250 medical bill. The Court affirmed the lower court's decision dismissing the case because it found that under the circumstances, the insurer acted reasonably.
The Court said that "In this case, [defendant] Commerce reasonably relied on the IME [insurance medical examination] of [plaintiff Patricia] Genest performed by Dr. [Charles G.] Brennan in declining to pay Dr. [Margaret A.] Robinson's $250.00 bill for treatment of Genest's lower back. Dr. Brennan specifically concluded that '[t]here is nothing in [Geneses] medical records ... that would indicate that her left lower back pain is directly related to the motor vehicle accident. ... It is my opinion that any injuries directly sustained in the minor motor vehicle accident ... have resolved.' Subsequently, Commerce made a business decision to pay Dr. Robinson's bill to avoid further litigation costs. Based on the evidence presented, there was no error in the trial judge's conclusion that Commerce's liability to Genest had not become reasonably clear."
Thus, the fact that Commerce Insurance later paid a bill it initially denied was not a violation of Chapter 93A. Because Commerce relied on the results of an insurance doctor's report to deny the bill, this reliance was reasonable whereas the PIP statute allows insurer's to rely on the results of medical examinations in determining if medical treatment is reasonably and causally related to the automobile accident in question.
