This past October, the Supreme Judicial Court, the highest appellate court in Massachusetts, rendered a decision in Barron Chiropractic & Rehabilitation, P.C. v. Norfolk & Dedham Group. Mazow & McCullough, PC was not involved in the litigation but does handle numerous similar kinds of cases in its PIP Collection department.
The Barron case clarified a prior decision from the SJC in the case of Fascione v. CNA Insurance Cos. In both Fascione and Barron, chiropractors sought payment from automobile insurance companies for treatment rendered to patients injured in car accidents. The insurers denied payment of the chiropractors’ bills and the chiropractors filed lawsuits under the Massachusetts Personal Injury Protection (“PIP”) statute. The PIP statute allows a medical provider to sue an insurance company for outstanding bills related to treatment for car accidents. The statute also allows an insurer to deny payment to providers if medical treatment is not considered “reasonable, necessary, or related to the accident.” If the medical provider wins the lawsuit, the insurer must pay the bills as well as the attorneys’ fees. The PIP statute also states that if an insurer tenders the balance to the medical provider prior to judgment, and the balance is accepted, the insurer is not responsible for the attorneys’ fees.
In Fascione, the SJC held that because the medical provider accepted the full balance owed it prior to any judgment, the insurer was not also responsible for payment of attorneys’ fees.
Following the Fascione decision, insurers who denied payments to medical providers would wait to be sued and then at any time prior to judgment, tender the balance to the medical provider without also paying attorneys’ fees. This strategy obviously put the medical provider in an untenable situation where it would either have to write off a balance owed or risk having to pay its own attorneys fees if the insurer waited to pay it until just before judgment.
In Barron, a chiropractor challenged this strategy, which Norfolk and Dedham Group had followed. Briefly, the chiropractor sued Norfolk and Dedham Group for its unpaid balance. Norfolk and Dedham waited until just prior to trial to pay the balance owed and refused to pay attorneys’ fees pursuant to the Fascione decision. The court dismissed the chiropractor’s lawsuit and the Appellate Division of the Southern District Court affirmed the dismissal. Upon further appeal, the Supreme Judicial Court took the matter up.
In a 22-page decision, the SJC reversed the lower court’s ruling in Barron and also clarified the Fascione decision.
Attorney Robert Mazow of Mazow & McCullough was contacted by Massachusetts Lawyers Weekly to provide insight into the opinion. Mazow said the decision clarifies inconsistent and conflicting rulings out of the District courts. “For years, insurers, and many courts, have been interpreting [Fascione] to essentially gut the fee-shifting provision of the PIP statute,” Mazow said. “Based on an overly broad and essentially incorrect interpretation of Fascione, insurers would reduce or deny bills to medical providers, wait to see if suit was filed, and then, often times, tender just the disputed balance at any time prior to the entry of a judgment in order to avoid paying attorneys’ fees.” Barron, however, sends a clear message that those tactics will no longer stand, Mazow said, adding that in ruling as it did, the court reasoned that the insurer’s interpretation of the statute “would essentially vitiate the fee-shifting provision.”
This decision makes it safe once again for medical providers who believe their bills have been wrongfully denied to file a lawsuit and not be stuck with attorneys’ fees if they are successful.