Justia Insurance Law Opinion SummariesArticles Posted in Massachusetts Supreme Court
Rhodes & others vs. AIG Domestic Claims Inc., & others.
This appeal related to insurance claims settlement practices of a primary and an excess insurance carrier. The underlying lawsuit involved a tort action against, among others, the truck driver who rear ended plaintiff's car, causing her serious injuries. The court concluded that the damages plaintiff and her family (plaintiffs) were entitled to recover under G.L.c. 93A, section 9, on account of defendants' postjudgment violation of G.L.c. 93A, section 2 and G.L.c. 176D, section 3(9)(f), must be based on the underlying judgment in plaintiffs' tort action, and not the loss of use of the sum ultimately included in the excess insurer's late-tendered settlement offer months after the jury's verdicts. This conclusion made it unnecessary to determine whether the excess insurer's willful and knowing violation of the application statutes before the verdicts in the tort case caused injury to plaintiffs, because even if, as they argued, plaintiffs did establish the requisite causal link between the excess insurer's preverdict violations and injury and thereby were entitled to a multiple of the underlying tort judgment as damages, plaintiffs could not recover that amount twice. Accordingly, the court affirmed the judge's determination that the primary insurer did not violate G.L.c. 93A and G.L.c. 176D, and was not liable to plaintiffs.
Passatempo, trustee, & others v. McMenimen, & others.
Samuel Pietropaolo Sr. (Sam Sr.)directed a substantial portion of his retirement benefits to the upkeep of a life insurance policy that he purchased in 1998 through his nephew, an insurance agent. The nephew assured Sam Sr. and the other plaintiffs that the policy provided death benefits of $500,000 but, in fact, the policy provided only $200,000 in benefits. Although plaintiffs regularly received accurate policy statements from the insurer that issued the policy, they relied on the nephew's assurances as to the policy's value for almost six years, only bringing this action in July 2004. The court concluded that plaintiffs' claims were properly pleaded in tort under G.L.c. 93A. Their claims were therefore subject to the limitations periods in G.L.c. 260, section 2A, and 5A, respectively, which were susceptible to tolling. The court further concluded that the nephew's fraudulent concealment of these claims tolled the limitation period as to claims against the nephew himself, but did not toll the limitation period with regard to the remaining defendants. However, because the limitation period for claims brought under G.L.c. 93A was longer than the limitation period for tort claims, the nationwide defendants have not shown that plaintiffs' G.L.c. 93A claim against Nationwide was time barred. The court finally concluded that the trial judge did not err in deciding that the economic loss doctrine did not bar plaintiffs' common-law claims; determining that it was not unreasonable as a matter of law for plaintiffs to have relied on the nephew's misrepresentations; dismissing plaintiffs' G.L.c. 93A claim against Barry G. Armstrong; determining the amount of the damages on plaintiffs' G.L.c. 93A claim against the nephew; or calculating the award of attorney's fees against the nephew.
Finch & others v. Commonwealth Health Ins. Connector Auth. & others
This case involved Commonwealth Care, a state-initiated program that provided structured premium assistance for low-income Massachusetts residents. In 2009, the Legislature made certain changes to the eligibility requirements of Commonwealth Care, enacted in a two-part supplemental appropriation for fiscal year 2010. Section 31(a) of the appropriation excluded all aliens who were federally ineligible under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), 8 U.S.C. 1601-1646, from participation in Commonwealth Care. Plaintiffs were individuals who either have been terminated from Commonwealth Care or have been denied eligibility solely as a result of their alienage. The court held that section 31(a) could not pass strict scrutiny and that the discrimination against legal immigrants that its limiting language embodied violated their rights to equal protection under the Massachusetts Constitution.
Posted in: Civil Rights, Constitutional Law, Government & Administrative Law, Health Law, Insurance Law, Massachusetts Supreme Court, Public Benefits
Awuah & others v. Coverall North America, Inc.
A United States District Court judge for the District of Massachusetts ruled in this case that defendant misclassified as independent contractors those plaintiffs who were Massachusetts residents. The judge certified to this court questions related to calculation of damages for one such plaintiff. The certified questions related to whether, under Massachusetts law, an employer could use a system of customer accounts receivable financing to pay its employee at the time the customer paid the employer for the employee's work rather than when the work was performed; and whether, under the Massachusetts Wage Act, G.L.c. 149, section 148, 150, an employer and an employee could agree that the employee would pay the cost of workers' compensation and other work-related insurance coverage. The court held that the accounts receivable financing system at issue improperly deferred payment of the employee's earned wages, and that an employer could not deduct the insurance costs from an employee's earned wages. In response to the judge's invitation to provide additional guidance, the court also addressed the question whether defendant could deduct "franchise fees" from such wages, and concluded that the Wage Act forbade the deductions.
Metropolitan Property and Casualty Ins. Co. v. Morrison, Jr.
This case arose when Robert Morrison, Jr. pleaded guilty to, among other things, four counts of assault and battery on a public employee (the arresting police officer) and the officer consequently brought a civil suit against Morrison for his injuries. Morrison and Metropolitan Property and Casualty Insurance Company (Metropolitan) subsequently applied for direct appellate review on the issue of whether Metropolitan had a duty to defend and indemnify Morrisson in the civil suit. The court held that an exclusion in a liability policy for "intentional and criminal acts" applied where the insured intended to commit the conduct that caused injury and where the conduct was criminal. The court also held that a guilty plea did not negate an insurer's duty to defend, even where the duty to defend would be negated by a criminal conviction after trial, because a guilty plea was not given preclusive effect and was simply evidence that the insured's acts were intentional and criminal. The court further held that one of the consequences of such a breach of its duty to an insured by failing to provide a defense was that, in determining whether the insurer owed a duty to indemnify the insured for the default judgment, the insurer was bound by the factual allegations in the complaint as to liability. The court finally held that, because the judge based her conclusion that Metropolitan had no duty to indemnify in large part on Morrison's guilty pleas and because the judge determined that Metropolitan had no duty to indemnify without first determining whether it owed a duty to defend at the time of the default judgment, the court vacated the declaratory judgment and set aside the allowance of Metropolitan's motion for summary judgment as well as the denial of Morrison's motion for partial summary judgment. Accordingly, the court remanded for further proceedings.
Golchin v. Liberty Mutual Ins. Co.
Plaintiff filed suit against Liberty Mutual, both personally and on behalf of a putative class of similarly situated individuals, alleging that the company's failure to disburse "medical payments" coverage (MedPay) benefits to her constituted a breach of contract, a breach of implied covenant of good faith and fair dealing, and a violation of G.L.c. 93A, 2. At issue was whether a claimant could seek medical expense benefits under the MedPay of a standard Massachusetts automobile insurance policy where she had already recovered for those expenses under a separate policy of health insurance. The court held that plaintiff's complaint and the extrinsic materials submitted by Liberty Mutual contained alleged facts sufficient to "raise a right to relief above the speculative level." The court also held that Liberty Mutual had not demonstrated as a matter of law that plaintiff could not receive MedPay benefits when she already had received medical expense benefits under her policy of health insurance. Accordingly, the order allowing Liberty Mutual's motion to dismiss was reversed and the matter remanded.
Posted in: Class Action, Contracts, Health Law, Injury Law, Insurance Law, Massachusetts Supreme Court
Maxwell v. AIG Domestic Claims, Inc.
Plaintiff, a workers' compensation claimant, brought suit against defendant regarding the company's conduct in referring his claim to the insurance fraud bureau (IFB), communicating with fraud investigators and prosecutors regarding his activity and claim, and using criminal processes to gain leverage in dealings with him. At issue was whether summary judgment in favor of defendant was properly denied. The court held that defendant enjoyed qualified immunity regarding its reporting of potentially fraudulent activity but that summary judgment was inappropriate because all of plaintiff's claims rely, at least in part, on conduct falling outside the scope of the immunity. The court also held that portions of plaintiff's claims could be barred by workers' compensation exclusivity under G.L.c. 152, but that not one of plaintiff's counts was barred entirely such that the Superior Court would be without subject matter jurisdiction. Accordingly, the court affirmed the order of the Superior Court denying summary judgment and remanded the case for further proceedings.
Posted in: Criminal Law, Injury Law, Insurance Law, Labor & Employment Law, Massachusetts Supreme Court
Wentworth v. Henry C. Becker Custom Building LTD
Plaintiff sued defendant, a general contractor at a residential construction site, alleging claims of negligence, cross negligence and/or willful, wanton, or reckless conduct which resulted in the deaths of two employees hired by the subcontractor that was hired by defendant. At issue was whether, pursuant to G.L. c. 152, 23, a general contractor that paid workers' compensation benefits to an employee of an uninsured subcontractor, was immune from liability for common law claims the employee could have against that general contractor. The court held that the plain language of section 23 did not release a general contractor that paid workers' compensation benefits to its uninsured subcontractor's employee and that G.L. c. 152, 18 made clear that suits were not barred against general contractors that were obligated to pay workers' compensation benefits to the uninsured subcontractor's employees. Accordingly, the immunity provided under section 23 did not apply to defendant and therefore, the court vacated summary judgment in favor of defendant and remanded for further proceedings.