Insurance – PIP – Threshold

Where a defendant auto insurer denied a plaintiff chiropractor’s request for PIP benefits, the insurer was within its statutory rights to refuse any additional payments to the plaintiff beyond the $2,000 PIP threshold, so a grant of summary judgment in the insurer’s favor should be upheld.

“This appeal involves a dispute over the payment of medical bills pursuant to G.L.c. 90, §34M, the no-fault motor vehicle law, colloquially referred to as the ‘PIP’ statute. The medical provider, a chiropractor, appeals the entry of summary judgment in favor of the automobile insurer, which denied PIP benefits. For the reasons set forth below, we affirm. …

“Turning to the crux of the appeal — whether Amica was within its statutory rights to refuse any additional payments to Langlitz beyond the $2,000 PIP threshold — we conclude that the holding in Dominguez v. Liberty Mutual Ins. Co., 429 Mass. 112 (1999) is dispositive. There, the Supreme Judicial Court held that, under G.L.c. 90, §34A, the automobile insurer is not obligated to pay PIP benefits in excess of $2,000 if the claimant’s health insurer would have covered the medical expenses had the claimant received the treatment in accordance with his or her plan. …

“Langlitz aptly points out that the Dominguez decision issued twenty-five years ago and that much has changed with regard to the no-fault landscape, most notably, the promulgation of regulations establishing coordination of benefits as between PIP, MedPay, and health insurance coverages. See 211 Code Mass. Regs. §38.00. Toward that end, Langlitz asks us to rule that the ‘coordination of benefits’ formula expressed in §38:00 negates the holding in Dominguez and compels us to find that Amica wrongfully denied payment of the unpaid bills. We decline to do so. …

“We need not parse the distinction between the parties’ respective interpretations of 211 Code Mass. Regs. §38:00. Instead, like the motion judge, our analysis of the regulatory scheme for coordinating benefits as between PIP coverage and health insurance is informed by the aforementioned bulletin issued in 2017 by the then-Commissioner of Insurance. …

“We hold that it was appropriate for the motion judge to rely on Bulletin 2017-06 in deciding the cross motions for summary judgment for two compelling reasons. First, no appellate court to our knowledge has addressed the Supreme Judicial Court’s holding in Dominguez since the promulgation of 211 Code Mass. Regs. §38:00. Second, interpretation of the regulations at issue here, especially the ‘coordination of benefits’ formula, turns on obscure insurance lexicon that is not necessarily familiar to consumers or even lawyers and judges. Absent a judicial decree, who better to explain the regulations and their intent than individuals statutorily charged with overseeing and regulating the Commonwealth’s insurance laws.

“Finally, we acknowledge that the Dominguez decision was not unanimous and that the two dissenting jurists lamented the wisdom of the majority view for some of the same reasons cited by Langlitz in its brief. In the end, while we find that the result might be unfair to medical providers like Langlitz who render medical treatment to patients injured in car accidents with the expectation of payment through the coordination of the patient’s benefits (i.e., health insurance, PIP coverage, and Medical Payments coverage), we are not cloaked with discretion to disregard precedent set by the Commonwealth’s highest court.”

Langlitz Chiropractic & Massage v. Amica Mutual Insurance Company (Lawyers Weekly No. 13-041-24) (7 pages) (Peterson, J.) (Western District) Appealed from a decision by Maltby, J., in Springfield District Court. Laura Mangini, of Alekman DiTusa, LLC, for the plaintiff; Michael L. Snyder, of Snyder Law P.C., for the defendant (App. Div. No. 23-ADCV-121WE) (Sept. 6, 2024).

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