Monday, May 24, 2010

Massachusetts Appellate Division holds that insurer did not violate 93A when it relied on IME opinion to deny PIP benefits

I reported here on the Salem District Court case of Genest v. Commerce Ins. Co., 2010 WL 1740605 (Mass. App. Div.), in which an insurer was held not to have violated Mass. Gen. Laws ch. 93A when it failed to pay PIP benefits.

The Massachusetts Appellate Division has affirmed that ruling. 2010 WL 1740605 (Mass. App. Div.).

Genest, the insured, was injured in an automobile accident. She sought PIP benefits from Commerce. Commerce paid medical expenses but cut off additional payments on the advice of an independent medical examiner, who opined that injuries caused by the accident had resolved.

The Appellate Division held that Commerce's reliance on the IME was reasonable, and that its subsequent decision to pay the medical bills was merely a business decision. Because Commerce's liability to pay the medical expenses was not reasonably clear, it was not liable for breach of 93A.