Source: http://masscases.com/cases/distapp/2012/2012massappdiv202.html
Timestamp: 2019-04-20 15:11:54+00:00

Document:
COVEN, J. Chiropractic Care Centers, Inc. ("Chiropractic Care") has appealed the allowance of summary judgment in favor of Arbella Mutual Insurance Company ("Arbella") based on its defense that Chiropractic Care's client failed to cooperate in its investigation into the client's claim for personal injury protection ("PIP") benefits by failing, wilfully and without excuse, to attend two scheduled independent medical examinations ("IME"). We are presented with the following question: Is wilfulness in failing to attend the IMEs established where (1) there is no dispute that the insured twice caused letters to be sent via U.S. mail, postage prepaid, and properly addressed to Chiropractic Care's client, in which it notified the client, in each letter, of the scheduled exam, and the client failed to attend (or contact Arbella), and (2) the client's counsel twice sent letters to the client to confirm the client's appearance for the medical examinations and the client did not respond to the letters. We conclude that a wilful failure to attend was established in the circumstances of this case and that summary judgment was properly granted.
Rule 56(b) of the Mass. R. Civ. P. provides that "[a] party against whom a claim ... is asserted ... may, at any time, move with or without supporting affidavits for a summary judgment in his favor as to all or any part thereof." Summary judgment shall be granted where there are no genuine issues as to any material fact and where the moving party is entitled to judgment as a matter of law. Cassesso v. Commissioner of Correction, 390 Mass. 419 , 422 (1983). The moving party has the burden of affirmatively demonstrating the absence of a triable issue. Pederson v. Time, Inc., 404 Mass. 14 , 16-17 (1989).
of medical bills was $1,775.00 and that there would not be additional medical expenses. The application was dated March 12, 2010.
Through one of its service providers, Arbella requested that an IME be scheduled for Chiropractic Care's client. Arbella gave the service provider the address of Chiropractic Care's client as listed in the accident report. On April 20, 2010, the service provider sent, by U.S. mail, postage prepaid, notice to Chiropractic Care's client of an examination scheduled for April 29, 2010. When the client failed to appear, another notice, on May 3, 2010, was sent by U.S. mail, postage prepaid, to Chiropractic Care's client informing the client of a scheduled exam for May 21, 2010. A copy of each letter was sent to counsel for Chiropractic Care's client. On receipt, counsel mailed letters to the client "to confirm her appearance for the medical examinations." Those "letters ... sent were not returned to [counsel's] office by the post office." Counsel also attempted to call the client, but was unable to contact the client because the client's telephone number had been disconnected.
Included in the record and referenced by counsel for Chiropractic Care's client was a July 20, 2010 letter sent by that counsel to Arbella in which he informed Arbella that counsel and the client had not been in contact "for several months." Counsel also requested that Arbella make payment to Chiropractic Care and stated that, following the payment, counsel would "have no other alternative but to close out [the] file." Counsel added that "[i]f for some reason [counsel] should hear from [the] client, [counsel] w[ould] let [Arbella] know."
an IME because that party has not yet formally filed a PIP application. Hodnett v. Arbella Mut. Ins. Co., 1996 Mass. App. Div. 131 , 132.
Under Massachusetts law, the mailing of a properly addressed letter constitutes prima facie evidence of the intended recipient's receipt of the mailing. See Anderson v. Town of Billerica, 309 Mass. 516 , 518 (1941) ("The mailing, postage prepaid of a properly addressed letter is prima facie evidence of its receipt by the addressee ... " [citation omitted].); Eveland v. Lawson, 240 Mass. 99 , 103 (1921) ("The depositing of a letter in the post office, postage prepaid, properly addressed to a person at his place of business or residence, is prima facie evidence that it was received in the ordinary course of mails."); Mutual Bank for Sav. v. Silverman, 13 Mass. App. Ct. 1059 , 1060-1061 (1982) ("Evidence of the mailing will ordinarily warrant a finding that the notice was received by the intended recipient. ... "). In this case, not only was there proper mailing by Arbella's service provider to the address provided for Chiropractic Care's client in the accident report, but there were also confirmation letters sent by the client's counsel to the client.
to its client. Chapter 90, §34M provides, in relevant part: "In any case where [PIP] benefits due and payable remain unpaid for more than thirty days, any unpaid party shall be deemed a party to a contract with the insurer responsible for payment of amounts therein determined to be due in accordance with the provisions of this chapter."
Care's client was a passenger. The driver was not identified as the owner of the vehicle.
"After an accident or loss, you or anyone else covered under this policy must cooperate with us in the investigation, settlement and defense of any claim or lawsuit. We must be sent copies of all legal documents in connection with the accident or loss.
"We may also require you and any person seeking payment under any part of this policy to submit to an examination under oath at a place designated by us, within a reasonable time after we are notified of the claim.
"If anyone makes a claim or seeks payment under Personal Injury Protection [coverage] ... , we have a right to require that person to be examined by doctors selected by us.
"[a]lthough prejudice to the insurer need not be shown to deny coverage, the plaintiff's admitted noncooperation prevented the defendant from verifying the plaintiff's physical condition as well as the reasonableness or necessity of his claimed medical treatment. The plaintiff's refusal to attend an IME put the defendant in the untenable position of paying the claim without question and without any means by which to measure the validity or necessity of the treatment, or being sued for violating the law. The existence of the prejudice is self-evident." Id. at 261. This observation is also relevant in this case. Although the first examination was to have occurred more than one month after Chiropractic Care terminated its services, the delay, in these circumstances, is not material. Chiropractic Care has not argued otherwise.

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