Maxwell v. AIG Domestic Claims, Inc.
460 Mass. 91
Mass.2011Background
- Maxwell sustained a work-related injury on October 8, 2000, reported it, and filed a workers' compensation claim which AIGDC denied for lack of medical documentation and causal connection.
- A DIA conference regarding Maxwell's claim was scheduled for April 30, 2001, and Maxwell sought benefits through administrative procedures after denial.
- A private investigator observed Maxwell performing janitorial work while allegedly employed by a program funded stipend, leading AIGDC to suspect fraud and refer the case to the IFB for investigation.
- The IFB referred the matter to the Suffolk County district attorney, who charged Maxwell in October 2001 with workers' compensation fraud and larceny; Maxwell later faced criminal proceedings while DIA proceedings continued.
- AIGDC sought penalties and reconsideration of benefits in DIA, which ultimately found Maxwell totally disabled and clarified that the stipend was not earnings; Maxwell subsequently faced criminal sentencing and restitution.
- In 2005 Maxwell sued AIGDC, alleging malicious prosecution, infliction of emotional distress, abuse of process, and violation of 93A and 176D; AIGDC moved for summary judgment, which was denied.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does statutory immunity defeat Maxwell's tort claims? | Maxwell | AIGDC | Immunity does not bar claims outside reporting; not all claims are shielded. |
| Does workers' compensation exclusivity deprive the court of jurisdiction? | Maxwell | AIGDC | Exclusivity does not destroy jurisdiction; claims not solely claims-handling fall outside exclusivity. |
| Are some claims barred because they rest on actions outside the reporting process? | Maxwell | AIGDC | Certain conduct outside reporting is not protected by immunity or exclusivity; summary judgment not warranted. |
Key Cases Cited
- Adams v. Liberty Mut. Ins. Co., 60 Mass. App. Ct. 55 (2003) (IFB role and immunity context for fraud reporting)
- Fleming v. National Union Fire Ins. Co., 445 Mass. 381 (2005) (exclusivity framework for workers' compensation insurers)
- Boduch v. Aetna Life & Cas. Co., 26 Mass. App. Ct. 462 (1988) (insurer stands in shoes of employer; exclusivity in 93A claim)
- Kelly v. Raytheon, Inc., 29 Mass. App. Ct. 1000 (1990) (exclusivity and penalties; remedies within 152 framework)
- Foley v. Polaroid Corp., 381 Mass. 545 (1980) (limits of exclusive remedies; defamation/malicious prosecution context)
- West's Case, 313 Mass. 146 (1943) (purpose of G. L. c. 152 § 23 release and insurer rights)