2017 Mass.App.Div. 195, Patriot All Pro Physical Therapy Centers, Inc. v. Vermont Mutual Insurance Group

Citation:2017 Mass.App.Div. 195
Opinion Judge:FINIGAN, J.
Party Name:PATRIOT ALL PRO PHYSICAL THERAPY CENTERS, INC. v. VERMONT MUTUAL INSURANCE GROUP
Attorney:Brian P. McNiff for the plaintiff. Jason J. Mellon for the defendant.
Judge Panel:Present: Hand, P.J., Kirkman & Finigan, JJ.
Case Date:December 18, 2017
Court:Massachusetts Appellate Division
 
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2017 Mass.App.Div. 195

PATRIOT ALL PRO PHYSICAL THERAPY CENTERS, INC.

v.

VERMONT MUTUAL INSURANCE GROUP

Massachusetts Appellate Division, District Court Department, Southern District

December 18, 2017

February 3, 2017

Brian P. McNiff for the plaintiff.

Jason J. Mellon for the defendant.

Present: Hand, P.J., Kirkman & Finigan, JJ.

FINIGAN, J.

The defendant, Vermont Mutual Insurance Group ("Vermont Mutual"), appeals from the decision of the trial judge to exclude at trial any evidence regarding "usual and customary" charges for medical services based upon data collected by a third party while allowing testimony by the plaintiff, Patriot All Pro Physical Therapy Centers, Inc. ("Patriot"), regarding how Patriot determines the reasonableness of such charges in this action for personal injury protection ("PIP") benefits. The appeal comes before us on the record of the proceedings pursuant to Dist./Mun. Cts. R. A. D. A. 8C. For the reasons set forth below, we affirm the decision of the trial judge.

The action arose from an automobile crash that occurred on October 11, 2011, resulting in injuries to Brittany Waugh ("Waugh"). At the time of the collision, Waugh was covered by an insurance policy issued by Vermont Mutual that contained PIP benefits. Waugh sought and received physical therapy from Patriot stemming from injuries caused by the accident. After treating Waugh for a period of two months, Patriot submitted a bill to Vermont Mutual in the amount of $2,845.00. Vermont Mutual conducted a review of the bill and after determining $2,099.11 to be a "fair and reasonable" amount for the services provided, paid this amount to Patriot. 1 Patriot then filed an action to collect the balance of $745.89, together with costs and attorney's fees.

After a series of court dates to address discovery and other matters not relevant to this appeal, the parties prepared for trial. Anticipating that Vermont Mutual would seek to introduce evidence at trial regarding "usual and customary charges" for the services provided to Waugh by offering data provided by a third-party vendor, Patriot filed a motion in limine to exclude such testimony...

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