BARRON CHIROPRACTIC & REHABILITATION, P.C. vs. NORFOLK & DEDHAM GROUP.
Supreme Judicial Court of Massachusetts
October 15, 2014
469 Mass. 800 (2014)
Norfolk. May 5, 2014. - October 15, 2014. Present: IRELAND, C.J., SPINA, CORDY, BOTSFORD, GANTS, DUFFLY, & LENK, JJ.1
This court concluded that under
In a civil action arising from a disputed payment amount of personal injury protection benefits owed by the defendant automobile insurer to the plaintiff (a provider of chiropractic services to the defendant‘s insured), the judge properly entered summary judgment in favor of the defendant on the plaintiff‘s
CIVIL ACTION commenced in the Dedham Division of the District Court Department on November 25, 2009.
The case was heard by James J. McGovern, J., on a motion for summary judgment.
The Supreme Judicial Court granted an application for direct appellate review.
Francis A. Gaimari (Robert N. Fireman & Stephen B. Byers with him) for the plaintiff.
Joseph R. Ciollo (Michael L. Snyder with him) for the defendant.
E. Michael Sloman, for Automobile Insurers Bureau, amicus curiae, submitted a brief.
Chief Justice Ireland participated in the deliberation on this case prior to his retirement.
Christopher M. Mountain, for American Insurance Association & others, amici curiae, submitted a brief.
LENK, J. The personal injury protection (PIP) provision of the automobile insurance statute permits an unpaid party to bring an action for breach of contract against an automobile insurer if the latter has not paid PIP benefits for more than thirty days after those benefits became due and payable.
1. Background. The plaintiff, Barron Chiropractic & Rehabilitation, P.C. (Barron), provided chiropractic services to Nicole Jean-Pierre following her automobile accident on August 20, 2008. Jean-Pierre was injured while driving a vehicle insured by the defendant Norfolk & Dedham Group (Norfolk) pursuant to
Norfolk received notice of the accident on August 22, 2008, and, on October 10, 2008, received Jean-Pierre‘s application for PIP benefits.3 Shortly thereafter, pursuant to its contractual right under the terms of Jean-Pierre‘s insurance policy, as well as language in the PIP provision, Norfolk requested that Jean-Pierre
Approximately nine months later, on July 27, 2009, Norfolk received a response to Morgan‘s IME report from Scott Hayden, a licensed chiropractor and a Barron employee. Hayden disagreed with Morgan‘s conclusion that Jean-Pierre had reached a medical end result at the time of the IME, stating instead that proper rehabilitation had required nine treatment visits after that date. On August 17, 2009, Morgan sent Norfolk an addendum to his initial IME report, indicating that Hayden‘s rebuttal had not altered his assessment of Jean-Pierre‘s care, and stating further that subsequent care offered by Barron, while “within acceptable care guidelines” and “reasonable and necessary,” appeared aimed largely at preexisting conditions.
As an additional component of its investigation of Jean-Pierre‘s claim, Norfolk sent Barron‘s billing statements to BME Gateway (BME), an independent third party, for financial analysis. BME uses a computer database to determine whether a medical provider has sought fees that are usual, customary, and reasonable within a particular geographic region.
Barron submitted a bill to Norfolk seeking $3,940 in payment for its treatment of Jean-Pierre. Upon review, Norfolk concluded that it was not liable for the entirety of this requested amount. Based on BME‘s assessment, Norfolk deducted $64.05 from Barron‘s bill, allowing only $3,875.95 on that ground. In reliance on Morgan‘s IME report, Norfolk also limited its payment to service provided prior to the date of the IME, declining to pay a further $1,480 in charges for treatment occurring after October 27, 2008. In total, Norfolk determined that it was liable for only $2,395.95 of Barron‘s submitted fees, resulting in a disputed amount of $1,544.05.
On November 25, 2009, more than one year after Jean-Pierre had submitted her application for PIP benefits, Barron filed a complaint in the District Court.5 Barron sought payment of $1,544.05, plus interest, attorney‘s fees, and costs pursuant to
At some point prior to trial, Norfolk learned that Morgan‘s fee to appear as an expert witness was $500 per hour, with a minimum of five hours to be billed.6 Although still maintaining that it did not owe Barron any additional payments, Norfolk determined that its anticipated litigation costs would exceed the amount of the disputed medical fees by a substantial sum. Accordingly, on September 28, 2010, six days prior to the second scheduled trial date,7 Norfolk sent Barron a check for $1,544.05 with an attached check stub that stated “full and final settlement for Nicole Jean Pierre.” Norfolk included a letter stating that its payment was made pursuant to Fascione v. CNA Ins. Cos., 435 Mass. 88 (2001) (Fascione); the letter requested that Barron sign an acknowledgment of the receipt of final payment and file a stipulation of dismissal in the District Court as to its claims under the PIP provision. On October 12, 2010, Barron‘s counsel returned the check to Norfolk‘s counsel with a letter stating, “Your client‘s offer of settlement is rejected.”
Norfolk then filed a motion for summary judgment as to both the
2. Discussion. Summary judgment is appropriate where there are no genuine issues of material fact in dispute and the moving party is entitled to judgment as a matter of law. Community Nat‘l Bank v. Dawes, 369 Mass. 550, 553 (1976). If the moving party, in its pleadings and supporting documentation pursuant to
Barron contends that summary judgment was inappropriate as to its claim under
Barron also contests the entry of summary judgment for Norfolk as to the
a. Claim under
To construe this provision, we “look first to the text of the statute.” Boehm, supra at 690.
“Had the Legislature intended to treat contract actions brought pursuant to
§ 34M , fourth par., differently from the ordinary contract action, it could have said so explicitly as it did in the very next paragraph, which directs insurers to resolve disagreements concerning subrogation through arbitration.”
Boehm, supra. “That
Principles of contract law are “dispositive” of the present case, just as they were of the question addressed in Boehm. At common law, tender of a sum owed under a contract is valid only when made prior to the parties’ agreed-upon date for payment, even if that tender is for the entire disputed sum.10 There can “be no ‘tender’ in the legal meaning of the word if the offer was made
A party who receives an invalid late tender is not obliged to accept it. See Levin, 290 Mass. at 427 (plaintiff permitted to reject tender made on first day of trial for breach of contract and pursue his claim to judgment); Davis v. Harrington, 160 Mass. 278, 280 (1894) (plaintiff who accepted complete tender after filing breach of contract suit “could have preserved his right to interest by way of damages, and also to costs, by declining to accept the payment“); Loitherstein v. International Business Machs. Corp., 11 Mass. App. Ct. 91, 92 (1980) (defendant‘s late tender, which plaintiff rejected, did not extinguish plaintiff‘s claim for damages due to breach). Where a defendant attempts to tender payment after it has already breached the contract, “the rights of the parties depend, not on a tender, but on the acceptance of a payment which discharged the cause of action.” Davis, 160 Mass. at 280. Even if a plaintiff receives a tender of payment in full for a disputed sum, as here, “an underlying debt may not be discharged unless payment is accepted.” First Nat‘l Bank v. Commonwealth, 391 Mass. 321, 326 (1984). Late tender alone therefore does not preclude a plaintiff from filing a claim for breach or pursuing a then-pending suit.11
Here, Norfolk‘s tender of $1,544.05 was made past the deadline set forth in the PIP provision.
Norfolk maintains nonetheless that, under our decision in Fascione, its tender of payment was sufficient to discharge all of its obligations to Barron, and that the allowance of its motion for summary judgment was proper.12 This argument misapprehends the relevance of Fascione to the circumstances here. In Fascione, supra at 89, an insurer inadvertently failed to pay the full amount of a PIP claimant‘s benefits, and tendered the remaining payment after the claimant had filed suit under
Fascione affords no basis upon which to conclude that a PIP claimant, having filed an action in contract against an insurer for its delayed payment of benefits, is obliged to accept late tender and thus relinquish its suit. We held in that case that
Moreover, to interpret Fascione as Norfolk suggests would contravene the fee-shifting provision of
But these incentives would diminish if an insurer could disregard the thirty-day deadline yet nevertheless evade liability for attorney‘s fees and costs by tendering benefits at will after a suit has commenced. Under Norfolk‘s approach, the timeframe for prompt payment established by the Legislature would have little effect, since an insurer‘s delay would engender no more serious consequence than the payment of the very benefits sought from it at the outset. See Insurance Rating Bd. v. Commissioner of Ins., 356 Mass. 184, 189 (1969) (“An intention to enact a barren and ineffective provision is not lightly to be imputed to the Legislature“).
The provision for payment of attorney‘s fees and costs would be similarly toothless. When an insurer‘s payment of PIP benefits, as here, is made on the eve of trial, a claimant may well have incurred substantial expenses. If, as Norfolk suggests, a claimant were required to accept such late tender, she would be bound to forgo the recovery of those expenses whenever an insurer offered belated reimbursement of a disputed sum. See Pine v. Rust, 404 Mass. 411, 416 (1989) (“If an offer of the statutory minimum amount of damages were all that could be expected by plaintiffs, there would be no need for provision in the law for the award of attorney‘s fees“). Moreover, a contract suit under
In sum, an insurer‘s late tender of PIP benefits, made after a claimant has filed suit and which the claimant declines to accept, does not entitle an insurer to summary judgment. To be sure, an insurer may opt to tender payment of outstanding PIP benefits after the filing of a suit, and if a claimant accepts that tender, the action under
b. Claims under
In the circumstances of this case, there was no error in allowing Norfolk‘s motion for summary judgment on the
In its opposition to Norfolk‘s motion for summary judgment, Barron did not allege that material facts were in dispute, stating only that “[n]othing in Norfolk‘s submission demonstrates that no genuine issue of fact remains on the
3. Conclusion. The order allowing judgment for Norfolk on count 1, the
So ordered.
Notes
“Personal injury protection benefits... shall be due and payable as loss accrues, upon receipt of reasonable proof of the fact and amount of expenses and loss incurred.... In any case where benefits due and payable remain unpaid for more than thirty days, any unpaid party shall be deemed a party to a contract with the insurer responsible for payment and shall therefore have a right to commence an action in contract for payment of amounts therein determined to be due in accordance with the provisions of this chapter.... If the unpaid party recovers a judgment for any amount due and payable by the insurer, the court shall assess against the insurer in addition thereto costs and reasonable attorney‘s fees.”
