Byron v. Hartunian, M.D., P.C. v. Pilgrim Insurance Co.
20 N.E.3d 260
Mass. App. Ct.2014Background
- Hartunian claimed Pilgrim delayed PIP payments for orthopedic treatment after an April 4, 2007 accident; Pilgrim paid partial amounts ($515 then $495) and later withheld $990 disputed by Hartunian.
- Pilgrim’s delay occurred after receiving Hartunian’s bills and before sending a final payment, with no ten-day notice as required by G. L. c. 90, § 34M, fourth par.
- Independent medical review was conducted by a physical therapist, not a licensed orthopedist, and Pilgrim denied payment based on that review among other reasons.
- Pilgrim relied on a computer-based review of the bills, and the record did not establish the specific results of that review or its reliability.
- Hartunian sued on November 7, 2008 in the District Court, seeking unpaid PIP benefits, treble damages under G. L. c. 93A, and related fees; after trial, Pilgrim was found liable for 93A/176D violations and penalties were awarded.
- The Appellate Division affirmed, and the Supreme Judicial Court affirmed, holding Pilgrim’s payment delay and methods violated §34M and demonstrated bad faith.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Pilgrim’s delay and methods violated §34M and supported a 93A claim | Hartunian argues Pilgrim breached §34M and acted in bad faith | Pilgrim contends good-faith dispute and proper evaluation supported denial | Yes; Pilgrim violated §34M and acted in bad faith. |
| Whether a non-orthopedist IME can support bad faith under 93A/176D | Hartunian asserts IME by a PT was improper for an orthopedist’s bill | Pilgrim relies on IME to justify nonpayment | Depends on specialty relevance; reliance on different specialty raises factual questions; court found improper use here. |
| Whether use of a computer review supports bad faith finding | Hartunian claims computer-only review shows lack of good faith | Pilgrim used computer review as part of evaluation | Yes; computer review without substantive supporting detail supports bad faith finding. |
| Whether treble damages and fees were proper | Hartunian seeks statutory treble damages and fees | Pilgrim disputes extent of damages | affirmed; damages, including treble interest and fees, upheld. |
| Whether Appellate Division’s affirmance was proper | Hartunian supports appellate affirmance | Pilgrim argues error in trial findings | Affirmed. |
Key Cases Cited
- Boone v. Commerce Ins. Co., 451 Mass. 192 (Mass. 2008) (insurer may rely on an IME; not all practitioners can render all medical opinions under §34M)
- Barron Chiropractic & Rehabilitation, P.C. v. Norfolk & Dedham Group, 469 Mass. 800 (Mass. 2014) (appropriate IME by licensed chiropractor when chiropractic services are questioned)
- Fabre v. Walton, 441 Mass. 9 (Mass. 2004) (fee shifting under appellate standards for attorney’s fees)