Source: http://masscases.com/cases/distapp/2017/2017massappdiv9.html
Timestamp: 2019-04-24 21:53:00+00:00

Document:
MERRIMACK VALLEY PHYSICAL THERAPY, LLC v. ENTERPRISE RENT-A-CAR COMPANY OF BOSTON, INC.
Present: Coven, PJ., Singh & Nestor, JJ.
Elizabeth H. Maims and Francis A. Gaimari for the plaintiff.
the IME be canceled because treatment had concluded. Caraballo failed to appear, and ERAC denied Merrimack's claim for PIP benefits on the basis of Caraballo's noncooperation.
"Summary judgment is appropriate where there are no genuine issues of material fact and the moving party is entitled to judgment as a matter of law." Boazova v. Safety Ins. Co., 462 Mass. 346 , 350 (2012). The PIP statute specifically provides that the injured person making the claim "shall submit to physical examinations by physicians selected by the insurer ... and ... [n]oncooperation of an injured party shall be a defense to the insurer in any suit for benefits authorized by this section." G.L.c. 90, §34M.
The Appeals Court has twice stated that where there is a "wilful and unexcused refusal" by an insured to undertake an examination under oath, there is an exception to the general rule that the insurer must show prejudice from the insured's failure to fulfill an obligation to the insurance company before it may decline to provide coverage under an automobile insurance policy. See Lorenzo-Martinez v. Safety Ins. Co., 58 Mass. App. Ct. 359 , 363 (2003) (uninsured motorist coverage); Boffoli v. Premier Ins. Co., 71 Mass. App. Ct. 212 , 216 (2008) (PIP coverage). The Court has not yet ruled on the application in the context of an IME. See Barron Chiropractic & Rehabilitation, P.C. v. Enterprise Rent-A-Car Co. of Boston, Inc., 2015 Mass. App. Div. 111 , 113 (motorist's failure to submit to request for IME amounted to noncooperation that was complete defense for rental car company).
In any event, even if the wilful and unexcused exception is inapplicable (present in this case), we disagree with Merrimack's argument that it was unreasonable (or at least a jury question) to request an IME because of the termination of treatment. The argument is premised upon the assertion that, as in this case, "an IME ... can yield, at best, the conclusion that the treating practitioner himself had reached - that the patient was 'pain free with all mobility' and needed no further treatment" As acknowledged at oral argument, whether an injury at all occurred or the severity of the injury itself may be revealed through a timely requested IME. It is in the denial of this opportunity that prejudice manifests itself.
Summary judgment for ERAC is affirmed.
[Note 1] "Section 34M is a 'critical part' of the Commonwealth's no-fault automobile insurance law, enacted to 'reduce the amount of motor vehicle tort litigation, control the costs of automobile insurance, and ensure prompt payment of claimants' medical and out-of-pocket expenses." Ortiz v. Examworks, Inc., 470 Mass. 784 , 787 (2015), quoting Fascione v. CNA Ins. Cos., 435 Mass. 88 , 94 (2001).
[Note 2] The term PIP or "personal injury protection" is defined as "provisions of a motor vehicle liability ... bond which provide for payment to the named insured," or to any passenger of the insured's car, "of all reasonable expenses incurred within two years from the date of accident for necessary medical, surgical, x-ray, and dental services ... as a result of bodily injury" caused by the accident, limited to $8,000 "on account of injury to ... any one person." G.L.c. 90, §34A.

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