Golchin v. Liberty Mutual Insurance
466 Mass. 156
| Mass. | 2013Background
- Golchin sustained severe injuries in a motor vehicle accident; auto policy MedPay ceiling was $25,000 and health insurance paid most medical expenses.
- Blue Cross paid $100,893 for Golchin’s medical bills and later asserted a lien of $32,033.03; Golchin paid the lien in full from tort recovery.
- Liberty Mutual paid $8,000 in PIP benefits; Golchin sought MedPay for excess medical expenses not covered by PIP or health insurance.
- In Golchin I, the court held Golchin’s complaint stated a valid right to MedPay even where health insurance paid the expenses; the dismissal was error.
- On remand, the motion judge dismissed on summary-judgment grounds, relying on 211 CMR 52.12(8) to bar MedPay where health insurance paid the expenses; Golchin appealed.
- Massachusetts standard auto policy MedPay provides coverage for incurred medical expenses regardless of who pays, absent a specific exclusion for health-insurance coordination.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| May MedPay be paid when health insurance has paid the expenses? | Golchin, Golchin | Liberty Mutual | MedPay is payable despite health insurance payment |
| Does 211 CMR 52.12(8) preclude MedPay when health insurance is involved? | Golchin | Liberty Mutual | regulation irrelevant to auto MedPay |
| Does the bulletin 2008-12 limit MedPay when health insurer already pays? | Golchin | Liberty Mutual | bulletin does not compel preclusion of MedPay |
Key Cases Cited
- Golchin v. Liberty Mut. Ins. Co., 460 Mass. 222 (Mass. 2011) ( Medi Pay availability when health insurer pays is viable)
- Allstate Ins. Co. v. Bearce, 412 Mass. 442 (Mass. 1992) (no nonduplication provision required to permit MedPay recovery)
- Metropolitan Prop. & Cas. Ins. Co. v. Blue Cross & Blue Shield of Mass., Inc., 451 Mass. 389 (Mass. 2008) (coordination of benefits; MedPay context)
- Creswell v. Medical W. Community Health Plan, Inc., 419 Mass. 327 (Mass. 1995) (MedPay/health coverage context and legislative history)
- Feit v. St. Paul Fire & Marine Ins. Co., 209 Cal. App. 2d Supp. 825 (Cal. App. 2d Supp. 1962) (foreign authority supporting broad MedPay coverage)