Summary
In Kirby, the plaintiff sustained injuries in an automobile accident and incurred $13,387.56 in medical expenses. 89 Mass.App.Ct. 1136, 55 N.E.3d 434, Id. at *1.
Summary of this case from DeOliveira v. Liberty Mutual Insurance Co.Opinion
No. 14–P–1864.
08-05-2016
Jennifer KIRBY v. LIBERTY MUTUAL INSURANCE COMPANY.
MEMORANDUM AND ORDER PURSUANT TO RULE 1:28
The defendant, Liberty Mutual Insurance Company (Liberty Mutual), appeals from a decision of the Western Division of the Appellate Division of the District Court affirming an order of summary judgment that entered in favor of the plaintiff, Jennifer Kirby, on her claim for breach of contract. On appeal, Liberty Mutual contends that it properly denied Kirby's request for reimbursement of medical expenses because, Kirby is not entitled to medical payments (MedPay) benefits, as a matter of law, where (1) she has not exhausted all $8,000 of her personal injury protection (PIP) benefits, and (2) her health insurer has already paid her medical bills. We affirm.
Background. The summary judgment record reflects the following undisputed facts. Kirby, a driver of a car involved in automobile accident, sustained injuries that resulted in approximately $13,387.56 in medical expenses. At the time of the accident, Kirby was insured under a health insurance policy issued by Unicare State Indemnity Plan (Unicare). Liberty Mutual had issued Kirby a standard Massachusetts automobile policy that, among other things, provided $8,000 in PIP benefits and $5,000 in MedPay coverage.
Following the accident, Liberty Mutual paid a total of $3,283.92 in PIP benefits for medical expenses incurred by Kirby—an initial $2,000 in PIP benefits for Kirby's medical bills, and an additional $1,283.92 in PIP benefits to cover copayments and other medical expenses denied by Unicare. See G.L. c. 90, § 34A, as amended through St.1988, c. 273, § 16. When Kirby had exhausted the $2,000 in PIP coverage, Liberty Mutual notified Kirby in writing. In that letter, Liberty Mutual also advised Kirby to submit all outstanding medical bills to Unicare, which Kirby did. As a result, Unicare, paid out $4,956.67 in medical expenses. Unicare then executed a lien for that amount in the civil action Kirby had filed against the alleged third-party tortfeasor. To satisfy and release the lean, Kirby then paid Unicare the $4,956.67. Thereafter, Kirby submitted a claim to Liberty Mutual under the MedPay portion of her policy for reimbursement of the $4,956.67 she paid to Unicare. See G.L. c. 175, § 113C. Liberty Mutual declined Kirby's claim under the assumption that: “Med Pay benefits are not subject to the statutory lien available to health insurers pursuant to [G.L. c. 111, § 70A,] because such benefits do not constitute ‘damages' as set forth under the statute.” Following Liberty Mutual's refusal to pay her claim for reimbursement of the $4,956.67, Kirby commenced an action against Liberty Mutual in the District Court. In that action both Kirby and Liberty Mutual filed cross motions for summary judgment. After hearing, a judge of the District Court granted summary judgment in favor of Kirby, and Liberty Mutual appealed to the Appellate Division of the District Court. The Appellate Division affirmed the summary judgment in favor of Kirby. Liberty Mutual's appeal from that judgment is now before us.
Discussion. We review de novo the grant of summary judgment, District Attorney for the N. Dist. v. School Comm. of Wayland, 455 Mass. 561, 566 (2009), and determine whether, “viewing the evidence in the light most favorable to the nonmoving party, all material facts have been established and the moving party is entitled to a judgment as a matter of law.” Augat, Inc. v. Liberty Mut. Ins. Co., 410 Mass. 117, 120 (1991).
This case is governed in all material respects by Golchin v. Liberty Mut. Ins. Co., 460 Mass. 222 (2011) (Golchin I ), and Golchin v. Liberty Mut. Ins. Co., 466 Mass. 156 (2013) (Golchin II ). “Under the terms of the standard policy, if PIP benefits are available under any Massachusetts auto policy they are always paid first. So long as PIP coverage is available and has not been exhausted, MedPay benefits are not payable.” Golchin I, supra at 226 (citation omitted).
“Following an accident, therefore, the first $2,000 in benefits are paid by PIP with benefits above that threshold being payable by health insurance. After the $2,000 threshold has been reached, the standard policy provides that any medical expenses ‘which will not be paid by a health plan’ are payable by PIP and will erode its $8,000 limit of liability. Only after PIP benefits have been exhausted or where they are unavailable does the standard policy provide that MedPay benefits are due. See Mejia [v. American Cas. Co., 55 Mass.App.Ct. 461, 465–466 (2002) ]. The standard Massachusetts auto policy therefore contains language expressly precluding the simultaneous payment of health insurance and MedPay benefits at least until the $8,000 limit of PIP benefits has been reached.”
Id. at 227.
We reject Liberty Mutual's contention that MedPay is unavailable because Kirby did not exhaust all $8,000 of PIP. Kirby had private health insurance coverage, which rendered her PIP benefits unavailable once Liberty Mutual paid the first $2,000 of medical expenses. See ibid. Once notified that the $2,000 in PIP benefits had been exhausted, Kirby complied with the coordination of benefits required by statute by submitting her additional medical bills to Unicare. Contrast Mejia, supra at 463 (plaintiffs failed to submit accident-related medical bills to private health insurers prior to submitting them to auto insurer). Kirby also properly allowed the PIP coverage to pay out on “any medical expenses ‘which [were not] paid by [her] health plan,’ “ as evidenced by Liberty Mutual's payment of an additional $1,283 .92 in PIP benefits. Golchin I, 460 Mass. at 227.
Kirby injuries from the accident resulted in $13,387.56 in medical expenses, of which Unicare paid $4,956.67. These expenses were clearly “incurred” within the plain language of the policy—first, by Unicare, and later by Kirby when she satisfied the lien Unicare placed on her civil action against the third party tortfeasor. See G.L. c. 111, § 70A. See Golchin II, 466 Mass. at 163. Significantly, PIP was not available to Kirby when she incurred the $4,956.67 in medical expenses because at that time she was required to submit her bills to her health insurer, Unicare. See Golchin I, 460 Mass. at 229 (“[A]fter $2,000 in PIP benefits, PIP is secondary to health insurance”). Kirby's only recourse, therefore, was to seek reimbursement from Liberty Mutual for the amount she was required to pay Unicare. Accordingly, we conclude Kirby is entitled to MedPay benefits notwithstanding the fact that the medical expenses at issue were covered and paid under a separate health insurance policy. See Golchin II, 466 Mass. at 156–157, 165.
Liberty Mutual's concern that Kirby would receive a “windfall” from duplicative payments of MedPay and health insurance benefits before $8,000 in PIP benefits are exhausted is unwarranted. There is no danger of double recovery here because Kirby's claim is based upon her out-of-pocket payment of $4,956.67 to Unicare in satisfaction of their tort recovery lien and, therefore, Kirby has not been indemnified for the medical expenses that she actually incurred. See Kingsley v. Spofford, 298 Mass. 469, 474–475 (1937). For these reasons, and substantially those set forth in the decision of the Appellate Division, we conclude that summary judgment was properly entered in favor of Kirby.
Decision and order of the Appellate Division affirmed.