Morrison v. Toys "R" Us, Inc., 01-P-778.

• Decision Date: 16 October 2003
• Docket Number: No. 01-P-778.,01-P-778.
• Citation: 59 Mass. App. Ct. 613
• Court: Appeals Court of Massachusetts
• Parties: Susan MORRISON v. TOYS "R" US, INC., Massachusetts.

Page 1

Susan MORRISON

v. TOYS "R" US, INC., Massachusetts.

No. 01-P-778.

Court of Appeals of Massachusetts.

March 7, 2003.

October 16, 2003.

Consumer Protection Act, Availability of remedy, Insurance, Offer of settlement, Unfair act or practice, Trade or commerce. Statute, Construction.

Civil action commenced in the Superior Court Department on November 7, 2000.

The case was heard by Charles J. Hely, J., on a motion for summary judgment.

Steven T. Alpert for the plaintiff.

John R. Bologna for the defendant.

Present: Laurence, Rapoza, & Berry, JJ.

BERRY, J.

This is an appeal from the entry of summary judgment dismissing a G.L. c. 93A complaint alleging unfair and deceptive claim settlement practices by the claims facilitation department of a self-insuring company. Applying the principles set forth in Miller v. Risk Mgmt. Foundation of the Harvard Med. Insts., Inc., 36 Mass.App.Ct. 411 (1994), we determine that the summary judgment dismissal of the complaint was error of law. As Miller established, there is an independent right of action under G.L. c. 93A, § 9, for unfair settlement practices by (1) a self-insuring corporate entity engaged in trade and business, (2) which has established a risk management processing entity to facilitate claims settlement—both of which elements apply to Toys "R" Us in this case. Ibid.

1. Procedural and factual background. While shopping in a Toys "R" Us store in Kingston, the plaintiff, Susan Morrison, was struck on the head and face by a falling sign. She suffered significant injuries.¹ She brought suit against Toys "R" Us, Inc., Massachusetts, a wholly owned subsidiary of the holding company, Toys "R" Us, Inc. (hereinafter both entities will be collectively referred to as Toys "R" Us). A risk management and claims facilitation department ("the risk management claims department") in the parent holding company conducted the settlement negotiations with Morrison. By an initial letter, the risk management claims department offered $15,000 to settle the claim. Morrison, whose demand was for $250,000, rebuffed the offer. In light of what appeared to be a case of largely indisputable liability, serious injury, and substantial medicals bills (see notes 1 and 2 accompanying text), Morrison forwarded to Toys "R" Us a written notice, pursuant to G.L. cc. 93A and 176D, alleging bad faith settlement practices. At this point, the Toys "R" Us risk management claims department counteroffered at $30,000. Morrison stood firm on her demand for $250,000. It was not until the morning of trial that another settlement offer in the amount of $45,000 was advanced. This, too, was rejected by Morrison.

The record reflects that early in the claims review process the underlying liability of Toys "R" Us was clearly presented to the risk management claims department. Tellingly, following an independent medical examination, the expert retained by Toys "R" Us opined both that Morrison's injuries were serious, and were caused by the Toys "R" Us falling sign, stating that "[t]he etiology is the trauma experienced on May 30, 1996."² Against the backdrop of strong evidence concerning liability developed in the pretrial claims review process, at trial commencement Toys "R" Us essentially admitted liability in its opening statement. The central contested issue concerned damages, for which the jury awarded $1.2 million. Ultimately, the trial judge allowed Toys "R" Us's motion for remittitur and the judgment was reduced to $250,000 plus interest. Morrison thereafter commenced the present action alleging unfair claim settlement practices in violation of G.L. c. 93A, and G.L. c. 176D.

Toys "R" Us moved to dismiss the complaint. The judge treated the motion as one for summary judgment and analyzed the issues presented as follows. First, the judge noted that there was no independent right of action under G.L. c. 176D. Next, the judge determined that because the toy company was not engaged in the business of insurance, Toys "R" Us was not subject to the unfair insurance claim settlement prohibitions in c. 176D, § 3(9),³ accordingly, the aforesaid unfair practices were not relevant to Morrison's complaint. Finally, the judge dismissed the G.L. c. 93A claim, based on a determination that the right to litigate for unfair claims settlement practices set forth in c. 93A, § 9(1), was inextricably intertwined with, and limited to, claims asserted against insuring entities, the activities of which fell within the general insurance regulatory provisions of G.L. c. 176D, and the specific prohibitions against unfair insurance practices set forth in c. 176D, § 3(9). Because Toys "R" Us was not so engaged in the business of insurance and subject to c. 176D, the judge concluded, Morrison had no separate and independent right of action under c. 93A, § 9, generally.⁴

We are in accord with the points of law that Toys "R" Us is not an insuring entity within the meaning of c. 176D,⁵,⁶ and that the unfair practices defined in c. 176D, § 3(9), do not, by their own force and effect, give rise to a private right of action.⁷ However, there was error of law in that part of the summary judgment analysis which concluded that only entities engaged in the business of insurance and subject to the provisions of c. 176D may confront liability for unfair claim settlement practices in a private right of action under c. 93A, § 9. There was also error in that part of the summary judgment analysis which, in effect, denied relevance to the unfair insurance settlement practices defined in G.L. c. 176, § 3(9), in reviewing whether a G.L. c. 93A, § 9, violation may be provable. We turn to each of these issues.

2. The independent c. 93A, § 9, right of action for allegedly unfair claims settlement practices. The summary judgment determination that this business entity is not engaged in the business of insurance within the meaning of c. 176D, § 3(9), does not end the inquiry as matter of law and, contrary to the motion judge's ruling, does not automatically render a complaint, pleaded under G.L. c. 93A alleging unfair claims settlement practices, subject to dismissal. Rather, there is an independent sustaining cause of action in c. 93A, § 9, for unfair claims settlement practices (apart from the incorporation of unfair insurance-based claims settlement practices predicated exclusively on c. 176D). A complaint under c. 93A, § 9, which seeks damages for unfair claims settlement activities conducted by a risk management processing entity established to facilitate claims settlement by a self-insuring corporate entity engaged in trade or commerce is not subject to dismissal, simply because no insurance company regulated under c. 176D is a named defendant. Put another way, given the aforesaid requisite elements, this c. 93A right of action for unfair claims settlement practices is not limited to entities engaged in the business of insurance and subject to the entire insurance-based regulatory scheme of G.L. c. 176D.

These legal principles are controlled by Miller v. Risk Mgmt. Foundation of the Harvard Med Insts., Inc., 36 Mass.App.Ct. 411 (1994). As Justice Kaplan wrote for the court in Miller:

"Risk Management [here, the risk management claims department of Toys 'R' Us] is prompted to argue that if, because it is a noninsurer, no direct action can be brought against it under the special provision of c. 93A, § 9, which authorizes an action against an insurance company that violates c. 176D, § 3(9), there must be some mistake in using against it, in this ordinary c. 93A, § 9, action, standards drawn from c. 176D, § 3(9).

"The argument is perverse. Risk Management, [here, the risk management claims department of Toys 'R' Us] as claims negotiator and potential settler, has been interposed between the [self] insurer CRICO [here, Toys 'R' Us] and the claimant, and nothing seems more appropriate than to apply to it the standards of fair dealing expressed in c. 176D, § 3(9). This reference, moreover, is consistent with the broad policy of the courts, in defining what is or is not unfair or deceptive for purposes of c. 93A, to go for fruitful analogy to standards established by cognate statutes, common law rules, or other sources."

Id. at 417-418 (footnote omitted).

As in Miller, so too in this case, the risk management claims facilitation department as the sole agent of the self-insuring corporate entity, Toys "R" Us, conducted negotiations which involved assessing the merits of Morrison's claim, determining potential litigation exposure on the claim, engaging in claims facilitation and advancing settlement offers to Morrison. Accordingly, such claims settlement practices fall within the domain of the general consumer protections of c. 93A, and, if conducted in an unfair and deceptive manner may give rise to potential liability and sound in a sustainable complaint under that statute irrespective of the applicability of the c. 176D insurance regulatory scheme of oversight.⁸ This independent c. 93A right of action for alleged unfair claims settlement practices is consistent with "the commonplace ethical view that a claims facilitator ought not wear out the claimant by unduly delaying settlement when liability is clear." Miller, 36 Mass.App.Ct. at 418.

We note that the legislative history and principles of statutory construction support this independent right of action under c. 93A. First, as noted in Miller, the application of c. 93A rights and remedies to such unfair settlement practices (as distinct from cases exclusively involving insurance companies subject to c. 176D) is supported by the case law preexisting the 1979 amendments, which created the c. 93A, § 9(1), private right of action for c. 176D, § 3(9), violations. Miller, 36 Mass.App.Ct. at 418 n. 12. That is to say, even before this statutory amendment, it was the state of the law that "c. 93A, § 2(a ), cover[ed] insurance practices in its prohibition of unfair or deceptive acts or practices...