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NOTICE: All slip opinions and orders are subject to formal revision and are superseded by the advance sheets and bound volumes of the Official Reports.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 […]