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Ortiz v. Examworks, Inc. (Lawyers Weekly No. 10-036-15)

NOTICE:  All slip opinions and orders are subject to formal revision and are superseded by the advance sheets and bound volumes of the Official Reports.  If you find a typographical error or other formal error, please notify the Reporter of Decisions, Supreme Judicial Court, John Adams Courthouse, 1 Pemberton Square, Suite 2500, Boston, MA, 02108-1750; (617) 557-1030; SJCReporter@sjc.state.ma.us   SJC-11584   FLOR ORTIZ[1]  vs.  EXAMWORKS, INC.[2] Suffolk.     November 3, 2014. – March 3, 2015.   Present:  Gants, C.J., Spina, Cordy, Botsford, Duffly, Lenk, & Hines, JJ.     Insurance, Motor vehicle personal injury protection benefits. Motor Vehicle, Insurance. Doctor, License to practice medicine. Statute, Construction. Privacy. Consumer Protection Act, Unfair or deceptive act. Practice, Civil, Complaint, Motion to dismiss. Words, “Physician.”       Civil action commenced in the Superior Court Department on September 7, 2012.   A motion to dismiss was heard by Thomas P. Billings, J.   The Supreme Judicial Court on its own initiative transferred the case from the Appeals Court.   Matthew T. LaMothe (Robert E. Mazow with him) for the plaintiff. Mark J. Ventola for the defendant. Matthew Iverson & Justin A. Brown, for Premier Insurance Company of Massachusetts, amicus curiae, submitted a brief. David O. Brink, Douglas R. Tillberg, & Melissa C. Buynell, for Government Employees Insurance Company, amicus curiae, submitted a brief.     BOTSFORD, J.  The third paragraph of G. L. c. 90, § 34M (§ 34M), the “personal injury protection” (PIP) statute, provides in part that an injured person claiming PIP benefits “shall submit to physical examinations by physicians selected by the insurer as often as may be reasonably required” in order “to assist in determining the amounts due” (emphasis added).  The threshold question in this case is the meaning of the word “physicians” in this provision.  More particularly, the question is whether the word “physicians” refers solely to medical doctors licensed under G. L. c. 112, § 2, or whether the term also includes additional types of licensed health care practitioners.  We interpret the statute to intend the broader definition of the word because it is the one most consonant with the statutory purpose.  Adopting this interpretation, we affirm the order of a Superior Court judge dismissing the plaintiff’s complaint pursuant to Mass. R. Civ. P. 12 (b) (6), 365 Mass. 754 (1974), but for somewhat different reasons from those that the judge provided. Facts.[3]  In June of 2011, the plaintiff, Flor Ortiz, was injured in an automobile accident in Massachusetts while riding in a car that Progressive Insurance Company (Progressive) insured.  Following the accident, Ortiz notified Progressive that he sought PIP benefits available under the insurance policy to pay for medical expenses that resulted from the accident.[4]  Progressive then engaged the defendant, […]

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Posted by Massachusetts Legal Resources - March 3, 2015 at 10:04 pm

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