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Another Appellate Victory for Auto Accident Clients

Auto accident attorney Kevin McCullough recently secured yet another appellate victory for medical providers who offer medical services to those injured in motor vehicle accidents.

This victory providers further support that an insurance company who refuses to pay for reasonable medical bills to a provider will have to pay for the provider’s attorney’s fees if the provider successfully sues. Auto insurance companies can no longer simply refuse to pay for bills and then decide later, after suit, that they will pay without also suffering the consequences of paying for the medical provider’s attorney’s fees.

Patient with Auto Accident Injuries

Howard Physical Therapy provided medical services to a patient for injuries he suffered in an auto accident. Howard submitted medical bills to the patient’s insurer, Premier, and requested reimbursement. Premier paid some of the bills and refused to pay the remainder, asserting that the balance was unreasonable “upon review by an outside company.”

Does Auto Accident Insurance Cover Attorney Fees?

Two weeks after Howard filed suit, Premier offered to pay the balance plus costs incurred by Howard in filing and serving the complaint. The offer was rejected because it did not include payment of attorney’s fees. Premier then sent Howard a check for only the unpaid bill amounts, and moved for summary judgment. The District Court allowed the motion for summary judgment.

Kevin McCullough’s Argument

In Howard Physical Therapy, Inc. v. Premier Ins. Co., 2010 WL 3855302 (Mass. App. Div.), argued by Attorney McCullough on behalf of Howard, the Appellate Division reversed the summary judgment decision. It cited Metro West (another case appealed by Attorney McCullough) for the proposition that “the mere payment of the balance, in and of itself, would not justify summary judgment for Premier.” Rather, the insurer must show that it had “a valid reason not to pay, and that it paid an invalid claim for reasons unrelated to its merits.”

The court noted that although Premier had based its original decision, not to pay the full bill, on a review of the bill by “an outside company,” there was no indication that the bill was reviewed by a registered or licensed practitioner in the same field as the practitioner submitting the bills, as required by statute. For that reason the Appellate Division reversed the District Court’s summary judgment decision.

This is yet another victory for medical providers who dare to fight Massachusetts insurance companies to have their reasonable balances paid in full.

Contact a Massachusetts Auto Accident Lawyer

If you feel you have an auto accident case that relates to this decision, contact a Massachusetts auto accident lawyer at Mazow|McCullough, PC. Our team of experienced personal injury attorneys can help you decide whether your auto accident insurance company is behaving fairly.

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