Golchin v. Liberty Mutual Insurance
460 Mass. 222
Mass.2011Background
- Golchin, a claimant, sustained injuries in a car accident and incurred medical expenses over $100,000.
- Her vehicle was insured under a Massachusetts auto policy with MedPay and PIP and she also carried Blue Cross health insurance.
- Liberty Mutual paid $2,000 in PIP benefits; it refused MedPay arguing expenses were already paid by health insurance.
- Golchin filed suit alleging breach of contract, bad faith, and 93A violation; Liberty Mutual moved to dismiss.
- The motion court treated the motion as a 12(b)(6) dismissal but the court considered extrinsic documents attached by Liberty Mutual.
- The court held that the policy language generally requires PIP to be exhausted or unavailable before MedPay becomes payable, but concluded Golchin’s complaint plausibly alleged MedPay may be payable after PIP exhaustion under the presented record.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether MedPay is payable after PIP exhaustion and health insurance considerations. | Golchin seeks MedPay once PIP is exhausted and health insurance does not preclude it. | Liberty Mutual contends health coverage and PIP coordination preclude MedPay until all applicable coverage is exhausted. | Golchin may be entitled to MedPay after PIP exhaustion. |
| Whether the 2008 coordination of benefits bulletin binds the court to preclude double recovery. | Bulletin is persuasive but not binding law; cannot foreclose MedPay here. | Bulletin prohibits double recovery and governs insurer behavior in coordination of benefits. | Bulletin is persuasive but not binding regulatory authority; does not require dismissal. |
| Whether Massachusetts 211 CMR 38.00 coordination of benefits regulations compel dismissal on the record. | Regulations do not foreclose MedPay when health and PIP coordination is at issue. | Regulations require examining Blue Cross and coordination to avoid duplicative payments. | Regulations do not mandate dismissal; issues remain at claim stage. |
| Whether extrinsic documents attached to the motion should convert a 12(b)(6) dismissal into summary judgment. | Extrinsic documents were available and relied on; pleading standard should rely on them as appropriate. | Extrinsic materials should be treated as summary judgment if conversion is required. | Extrinsic materials may be considered without converting to summary judgment; standard of review applied. |
Key Cases Cited
- Mejia v. American Cas. Co., 55 Mass. App. Ct. 461 (Mass. App. Ct. 2002) (PIP precedes MedPay; health policy affects MedPay if health benefits are payable)
- Metropolitan Prop. & Cas. Ins. Co. v. Blue Cross & Blue Shield of Mass., Inc., 451 Mass. 389 (Mass. 2008) (No-fault PIP priority; health insurer coordination considerations; policy language controls)
- Given v. Commerce Ins. Co., 440 Mass. 207 (Mass. 2003) (Policy interpretation; commissioner guidance persuasive in coordination of benefits)
- Dominguez v. Liberty Mut. Ins. Co., 429 Mass. 112 (Mass. 1999) (PIP and MedPay interplay; exhaustion and availability governability)