After obtaining a judgment in the District Court for damages arising out of an automobile accident, Debra O’Leary-Alison brought suit in the Superior Court against Metropolitan Property & Casualty Insurance Company (Metropolitan) for its alleged failure to effectuate prompt, fair, and equitable settlement of her claim against Metropolitan’s insured driver.
On December 1, 1989, Debra O’Leary-Alison was stopped at a red light in her car when she was rear-ended by Metropolitan’s insured, who was traveling between ten and fifteen miles per hour. The rubber guard on the rear bumper of O’Leary-Alison’s vehicle sustained $150 in damage. Metropolitan ascertained almost immediately that its insured was wholly at fault. The insured was covered by a policy with a bodily injury coverage limit of $100,000.
O’Leary-Alison did not exhibit signs of injury at the scene. Approximately three hours later, however, while visiting an emergency room, she complained of back and neck pain. Thereafter, there was a marked discrepancy between O’Leary-Alison’s claim of a debilitating back injury (supported by her chiropractor’s diagnosis) and the opinions of several other physicians, including an independent medical examiner, that such a claim was not borne out by examination. A magnetic resonance image (MRI) taken on August 6, 1990, was interpreted as showing a “minimal” disc bulge. This interpretation, however, was refuted by a second physician. By August 15, 1990, O’Leary-Alison had stopped working in her secretarial job because of claimed back pain.
In June, 1991, O’Leary-Alison demanded $70,000 from Metropolitan in damages. Metropolitan offered $9,000. In November, 1991, O’Leary-Alison filed a tort action in District
In April, 1993, an attorney for Metropolitan recommended a settlement offer in the range of $20,000 to $25,000, noting the possibility of an award of damages in the range of $30,000 to $40,000, or even as high as $60,000, if the case went to trial. As of April 21, 1993, Metropolitan had established a reserve of $35,800 to cover the plaintiff’s claim. Thereafter, Metropolitan offered $20,000, which O’Leary-Alison refused.
On February 7, 1994, the District Court judge awarded O’Leary-Alison damages of $125,000 (reduced by personal injury protection [PIP] benefits of $8,000), plus interest and costs, which resulted in a total judgment of $151,028.55. Metropolitan appealed the decision to the Appellate Division of the District Court. On February 14, 1994, O’Leary-Alison sent Metropolitan a demand letter pursuant to G. L. c. 93A. Metropolitan responded by denying any unfair or deceptive acts or practices, but later attempted to settle the matter with an offer of $50,000.
Before the appellate division issued a decision, the parties settled the matter for the policy limit of $100,000 and O’Leary-Alison executed a release of the insured from further liability, although she did not relinquish her claim against Metropolitan for unfair settlement practices.
The Superior Court judge found that Metropolitan’s $20,000 offer and corresponding refusal to pay the $75,000 demand was reasonable since the claim was based on equivocal medical evidence. O’Leary-Alison had incurred only $13,146 in medical expenses and lost wages and had indicated less than $25,000 in damages when she filed her tort action against the insured. Furthermore, relying on Parker v. D’Avolio,
Discussion. Resolution of a G. L. c. 93A claim, including the issue of bad faith, depends on a factual determination of the defendant’s knowledge and intent. See Williams v. Gulf Ins. Co., 39 Mass. App. Ct. 432, 436 (1995); Bolden v. O’Connor Café of Worcester, Inc.,
An insurer’s duty to settle arises when “liability has become reasonably clear.” G. L. e. 176D, § 3(9)(f). Clegg v. Butler, supra at 421. Liability, as the word is used in this context, “encompasses both fault and damages.” Ibid. Conversely, insurers do not have an obligation to settle as to an insured whose liability is not reasonably clear. Van Dyke v. St. Paul Fire & Marine Ins. Co.,
To determine when an insured’s liability became “reasonably clear” an objective test is used. The fact finder determines “whether a reasonable person, with knowledge of the relevant facts and law, would probably have concluded, for good reason, that the insurefd] was liable to the plaintiff.”
Here, the judge found that Metropolitan had multiple reasons
Accordingly, the judge did not err in his ultimate finding that the liability of Metropolitan’s insured was not reasonably clear and that Metropolitan’s offers to the plaintiff were not made in bad faith. See Premier Ins. Co. of Mass. v. Furtado, supra; Parker v. D’Avolio,
An insurer’s good faith, but mistaken, valuation of damages does not constitute a violation of c. 176D. See Parker v. D’Avolio, supra at 395 (defendants’ offer of $25 to plaintiff who subsequently obtained $1,250,000 verdict did not violate c. 93A because there was no evidence that defendants deliberately attempted to derail settlement process or litigate a claim in which causation and damages were clear); Bolden v. O’Connor Café of Worcester, Inc.,
Considering all of the circumstances, including Metropolitan’s knowledge of the equivocal medical evidence supporting
Judgment affirmed.
Notes
General Laws c. 176D, § 2, prohibits “unfair or deceptive act[s] or practice[s] in the business of insurance” including as an “unfair claim settlement practice[], . . . failing to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear.” G. L. c. 176D, § 3(9)(/). Individuals claiming injury by an insurance practice that is
We decline to address O’Leary-Alison’s arguments that the judge erred by failing to find fault with Metropolitan’s internal claims manual and Metropolitan’s decision to appeal the District Court judgment because the arguments are cursory and the plaintiff does not support them with proper citation to authority. Such arguments do not rise to the level of acceptable appellate advocacy. Mass.R.A.P. 16(a)(4),
Relevant evidence may include insurance industry practices in similar circumstances, expert testimony that the insurer violated sound claims practices, the defendant’s own evaluation of the plaintiff’s claim, and advice given to the insurance company on the probability of success at trial. Bolden v. O’Connor Café of Worcester, Inc., supra at 67 n.16.
