Source: http://masscases.com/cases/distapp/2010/2010massappdiv171.html
Timestamp: 2019-04-20 14:42:49+00:00

Document:
Present: Greco, P.J., Curtin & Brant, JJ.
Kevin J. McCullough for the plaintiff.
insurer, and the named defendant, ELCO Administrative Services (ELCO), administers claims on behalf of Enterprise arising out of accidents involving its vehicles. Following the accident, Ramaswamy was treated by Olympic Physical Therapy (Olympic) from September 24, 2007 to November 29, 2007. Olympic submitted bills to ELCO in the amount of $5,625.00 for those services. As part of its investigation of those bills, ELCO, pursuant to § 34M, requested that Ramaswamy submit to an independent medical examination (IME) by Michel Velsmid (Velsmid), a physical therapist. That examination took place on November 30, 2007. Two months later, Velsmid also conducted a review of the bills submitted by Olympic. After ELCO denied payment on the basis of Velsmids reports, Olympic filed this action.
There is cause to suspect that Mrs. Ramaswamy received physical therapy services in an unlicensed physical therapy facility by a practitioner representing himself as a physical therapist, when, in fact, he was not . . . . Based on the information provided by the claimant, the physical therapy treatment she received was not appropriate. Her treatment did not meet the standards for operating a licensed Physical Therapy Facility and providing physical therapy services under 259 CMR 5.00-6.00. These standards have been created to prevent insurance fraud and protect the health, safety, and welfare of the public.
genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law. If such a showing is made, an adverse party may not rest upon the mere allegations or denials of his pleading, but his response, by affidavits or as otherwise provided in [Rule 56], must set forth specific facts showing that there is a genuine issue for trial. If he does not so respond, summary judgment, if appropriate, shall be entered against him. Rule 56(e).
With respect to any reliance by the trial judge on Fascione in allowing ELCOs motion, this Division has recently taken the position that [n]othing in Fascione dictates that a tender of the balance due under [a] § 34M claim must necessarily stop that part of the litigation in its tracks . . . . Metro West Med. Assocs., Inc. v. Amica Mut. Ins. Co., 2010 Mass. App. Div. 137 , 139. We stated further that [i]t would not be inconsistent with the holding in Fascione to require that the insurer on the § 34M claim show more on summary judgment than simply that the bills have all been paid. It should also have to show that there is no genuine issue of fact concerning whether it had a valid reason not to pay, and that it paid an invalid claim for reasons unrelated to its merits. Id. [Note 1] Accordingly, consistent with our ruling in Metro West Med. Assocs., Inc., which was decided after the trial courts ruling in this case, summary judgment cannot be sustained on the ground that payment of the bills submitted was eventually made. However, on this review, we can consider any ground supporting the trial judges ruling. Foster v. Group Health Inc., 444 Mass. 668 , 672 (2005).
complaint itself was not verified and was not, therefore, the functional equivalent of an affidavit. Santana v. Brigham & Womens Hosp., 2003 Mass. App. Div. 79 , 81. See also Godbout v. Cousens, 396 Mass. 254 , 262-263 (1985). Thus, Olympic did not satisfy its burden to set forth facts showing that there would be a genuine issue at trial concerning the necessity of the services and the reasonableness of the bills. Accordingly, summary judgment was properly awarded on the § 34M claim. As to its count under G.L. c. 93A, Olympic simply incorporated the allegations made in its § 34M count, adding only the allegation that it sent ELCO a demand for settlement in the amount of $7400, and that ELCO had committed willful, knowing and bad faith violations of the consumer protection statute. However, Olympic has suggested nothing factually from which it could even be inferred that there was such a violation. Since its G.L. c. 93A claim so intricately relies on the same factual allegations as its § 34M claim, and absent a proper response to ELCOs motion, summary judgment was properly awarded to ELCO on the G.L. c. 93A count as well.

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