Byron V. Hartunian, M.D., P.C. v. Pilgrim Insurance Company (Lawyers Weekly No. 11-152-14)
NOTICE: All slip opinions and orders are subject to formal revision and are superseded by the advance sheets and bound volumes of the Official Reports.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 14-P-8 Appeals Court BYRON V. HARTUNIAN, M.D., P.C. vs. PILGRIM INSURANCE COMPANY. No. 14-P-8. Middlesex. September 9, 2014. – November 24, 2014. Present: Kantrowitz, Grainger, & Hanlon, JJ. Insurance, Motor vehicle personal injury protection benefits, Settlement of claim, Unfair act or practice. Consumer Protection Act, Insurance, Unfair or deceptive act. Motor Vehicle, Insurance. Civil action commenced in the Cambridge Division of the District Court Department on November 7, 2008. The case was heard by Severlin B. Singleton, III, J. Joseph R. Ciollo for the defendant. Francis A. Gaimari for the plaintiff. GRAINGER J. A $ 990 dispute, reduced shortly before a bench trial in the District Court to a claim for $ 188.10, has resulted in an award totaling $ 25,343.53 against Pilgrim Insurance Company (Pilgrim).[1] Pilgrim now appeals from the decision and order of the Appellate Division of the District Court affirming the District Court judgment in favor of Byron Hartunian, M.D., P.C. (Hartunian), on his claim that Pilgrim unfairly delayed payment for orthopedic treatment rendered by Hartunian to the claimant under Pilgrim’s policy. We affirm. This case arises out of an April 4, 2007, automobile accident in which a passenger was injured, resulting in her need for medical treatment. The automobile in which she was a passenger was covered by a standard Massachusetts automobile insurance policy (auto policy) issued by Pilgrim. A personal injury protection (PIP) benefits application was received by Pilgrim approximately ninety days after the accident. Some ninety additional days thereafter Pilgrim received treatment records and bills from Hartunian for five different dates of treatment.[2] Pilgrim initially paid $ 515 to Hartunian, constituting payment for the first two treatment dates of May 15 and June 20, 2007. Thereafter, Pilgrim paid Hartunian an additional $ 495 for the remaining three treatment dates of July 19, August 14, and October 2, 2007. Although these two payments were intentionally $ 990 less than the total of Hartunian’s billings, Pilgrim did not notify Hartunian or his patient of its intention not to pay the $ 990 within ten days of the submission of the bills. Pilgrim based its nonpayment on its determination that the charges exceeded an amount that was reasonable in comparison to other medical providers in the same geographic area. After approximately twelvemonths of demanding payment to […]
First Specialty Insurance Corporation v. Pilgrim Insurance Company (Lawyers Weekly No. 11-082-13)
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 12‑P‑1281 Appeals Court FIRST SPECIALTY INSURANCE CORPORATION vs. PILGRIM INSURANCE COMPANY. No. 12‑P‑1281. Suffolk. April 4, 2013. ‑ June 26, 2013. Present: Kantrowitz, Brown, & Kafker, JJ. Insurance, General liability insurance, Motor vehicle exclusion, Motor vehicle insurance, Insurer’s obligation to defend. Indemnity. Motor Vehicle, Insurance. Civil action commenced in the Superior Court Department on March 12, 2010. The case was heard by Geraldine S. Hines, J., on motions for summary judgment. David A. White for the defendant. Barbara O’Donnell for the plaintiff. KAFKER, J. The instant case involves a dispute between a general liability insurer, First Speciality Insurance Corporation (FSIC), and an automobile insurer, Pilgrim Insurance Company (Pilgrim), regarding the scope of an automobile exclusion in a commercial general liability insurance policy (CGL policy). By its express terms, this “exclusion applies even if the claims against any insured allege negligence . . . in the supervision[] [or] hiring[] . . . of others by that insured, if the ‘occurrence’ which caused the ‘bodily injury’. . . involved the . . . use . . . of any . . . ‘auto’ . . . owned or operated by . . . any insured.” The question presented is whether FSIC had a duty to defend and indemnify its insureds for negligent supervision claims relating to an automobile accident involving an intoxicated employee of the insureds. Pilgrim, which settled the underlying claims in their entirety, argues that the principles of Worcester Mut. Ins. Co. v. Marnell, 398 Mass. 240 (1986) (Marnell), and its progeny mandate coverage for all of FSIC’s insureds except the intoxicated driver, as they were not the owners or operators of the automobile, and therefore FSIC should reimburse Pilgrim for a portion of the costs incurred in litigating and settling the underlying action. We conclude, however, that because FSIC’s policy contains the express terms referenced above that were not present in Marnell, a different result is warranted. See Massachusetts Property Ins. Underwriting Assn. v. Berry, 80 Mass. App. Ct. 598, 602 (2011); Rhoades vs. Massachusetts Property Ins. Underwriting Assn., U.S. Dist. Ct., No. 09-11302-DPW (D. Mass. July 13, 2010). We therefore affirm the summary judgment in favor of FSIC. 1. Background. a. Underlying facts. The facts of the underlying litigation are undisputed in this action. In 2007, Dennis Pinto had […]