N.E. Physical Therapy Plus, Inc. v. Liberty Mutual Insurance
466 Mass. 358
| Mass. | 2013Background
- Passenger Gitane Dalencourt received medically necessary chiropractic treatment after a 2003 car accident; NEPT billed $4,465 and Liberty Mutual paid $3,730.68, leaving $734.32 unpaid.
- NEPT sued Liberty Mutual under G. L. c. 90, § 34M seeking the unpaid balance; the only disputed issue at trial was reasonableness of charges.
- Liberty Mutual sought to admit Ingenix statistical billing-data summaries under G. L. c. 233, § 79B to show NEPT’s charges exceeded typical local charges.
- NEPT opposed, relying on an Appellate Division decision (Davekos) that found Ingenix data unreliable and on evidence of prior investigations and settlements raising accuracy concerns.
- The District Court excluded the Ingenix evidence; Liberty Mutual presented no other evidence of unreasonableness and the judge entered judgment for NEPT. Liberty Mutual appealed to the Appeals Court and then to the SJC.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether a trial judge may consider reliability when ruling on admissibility under G. L. c. 233, § 79B | §79B requires only three preliminary findings (issued to public; published for occupation; commonly used) — if met, publication is admissible | Judge retains discretion under §79B and may consider reliability/trustworthiness of compilations | Judge has discretion under §79B and may consider reliability; upheld |
| Whether exclusion of Ingenix data was an abuse of discretion | Ingenix data is commonly used; admission would show NEPT’s charges exceed local norms | Ingenix data derived from voluntary, unverified submissions and proprietary methodology; prior ruling (Davekos) found it unreliable | Exclusion was not an abuse of discretion on this record; judgment affirmed |
Key Cases Cited
- Mazzaro v. Pauli, 372 Mass. 645 (1977) (lists §79B preliminary findings that proponent must establish)
- Cruz v. Commonwealth, 461 Mass. 664 (2012) (abuse of discretion standard for evidentiary rulings)
- Commonwealth v. Polk, 462 Mass. 23 (2012) (review standard for trial judge evidentiary decisions)
- Commonwealth v. Fitzpatrick, 463 Mass. 581 (2012) (trial judge gatekeeper role regarding admissibility)
- Commonwealth v. Jones, 417 Mass. 661 (1994) (courts must follow clear legislative intent)
- White Indus., Inc. v. Cessna Aircraft Co., 611 F. Supp. 1049 (W.D. Mo. 1985) (commercial-list exception contemplates straightforward objective facts)
- Shepherd v. American Broadcasting Cos., 862 F. Supp. 505 (D.D.C. 1994) (compilations may be inadmissible where not shown to reliably reflect actual billed rates)