Golchin v. Liberty Mut. Ins. Co.

• Decision Date: 08 August 2013
• Docket Number: SJC–11305.
• Parties: Diane GOLCHIN v. LIBERTY MUTUAL INSURANCE COMPANY.
• Court: United States State Supreme Judicial Court of Massachusetts Supreme Court

466 Mass. 156

993 N.E.2d 684

Diane GOLCHIN

v.LIBERTY MUTUAL INSURANCE COMPANY.

SJC–11305.

Supreme Judicial Court of Massachusetts, Worcester.

Argued April 2, 2013.

Decided Aug. 8, 2013.

Kenneth D. Quat, Cambridge (Elliot Beresen, Framingham, with him) for the plaintiff.

Myles W. McDonough (Christopher M. Reilly with him), Boston, for the defendant.

E. Michael Sloman, for Automobile Insurers Bureau, amicus curiae, submitted a brief.

Timothy C. Kelleher, Boston, Michael C. Najjar, Lowell, & J. Michael Conley, Braintree, for Massachusetts Academy of Trial Attorneys, amicus curiae, submitted a brief.

Present: IRELAND, C.J., SPINA, CORDY, BOTSFORD, GANTS, DUFFLY, & LENK, JJ.

BOTSFORD, J.

This is the second time this court has considered the present case. Again, the issue presented is whether a claimant may seek medical expense benefits under the “medical payments” coverage (MedPay) offered in a standard Massachusetts automobile insurance policy (auto policy) where those expenses were covered and paid under the claimant's separate policy of health insurance. In Golchin v. Liberty Mut. Ins. Co., 460 Mass. 222, 236–237, 950 N.E.2d 853 (2011)( Golchin I ), we reversed the order dismissing the complaint filed in the Superior Court by the claimant, Diane Golchin, against Liberty Mutual Insurance Company (Liberty Mutual), concluding that Golchin had alleged facts sufficient to raise an actionable right to relief. Today, we conclude that Golchin is entitled to the MedPay benefits provided by her auto policy, notwithstanding that the medical expenses at issue were covered by and paid under a separate policy of health insurance. We therefore reverse the judgment of the Superior Court allowing Liberty Mutual's motion for judgment on the pleadings.¹

1. Background. We briefly summarize the facts that are pertinent to this appeal, as alleged in the complaint and contained in extrinsic documents introduced by the parties before the motion judge.²

Golchin sustained significant personal injuries, resulting in medical expenses in excess of $100,000, when she was involved in a motor vehicle accident as an occupant of her husband's car. The car was insured under an auto policy issued by Liberty Mutual that included optional MedPay benefits of up to $25,000. At the time of the accident, Golchin also was insured under a health insurance policy issued by Blue Cross Blue Shield of Massachusetts (Blue Cross).

As a result of the accident, Liberty Mutual paid $8,000 in personal injury protection (PIP) benefits to Golchin. Blue Cross paid Golchin's additional medical expenses, the charges for which came to $100,893, and later asserted a lien in the civil action filed by Golchin against the alleged tortfeasor. The lien was in the amount of $32,033.03—the sum Blue Cross actually paid to Golchin's medical providers to cover Golchin's medical expenses. Golchin submitted to Liberty Mutual documentation of the medical expenses that exceeded PIP benefits, seeking coverage under the MedPay provisions of the auto policy. Liberty Mutual, however, declined to pay Golchin any MedPay benefits because Blue Cross already had paid the submitted expenses. Thereafter, Golchin paid Blue Cross $32,033.03 out of her tort action recovery in full satisfaction of its lien.

On September 30, 2008, Golchin commenced the present action against Liberty Mutual on behalf of herself and a putative class of similarly situated individuals, alleging that the company's failure to disburseMedPay benefits to her constituted a breach of contract, a breach of the implied covenant of good faith and fair dealing, and a violation of G.L. c. 93A, § 2. In Golchin I, 460 Mass. at 236–237, 950 N.E.2d 853, on further appellate review, we concluded that Golchin's complaint was sufficient to raise a right to relief, that Liberty Mutual had not demonstrated as a matter of law that Golchin may not receive MedPay benefits when she already had received medical expense benefits under her health insurance policy, and that it was error for a Superior Court judge to have allowed Liberty Mutual's motion to dismiss Golchin's complaint. On remand, Liberty Mutual filed its answer and a motion for judgment on the pleadings. A different Superior Court judge (motion judge) allowed the defendant's motion, agreeing with Liberty Mutual that as a matter of law, Golchin never “incurred” any expenses for medical services within the meaning of the auto policy's MedPay provisions because 211 Code Mass. Regs. § 52.12(8) (2008) prohibits medical services providers from billing patients for the charges of services covered by insurance, except for deductibles, copayments, or coinsurance.³ Golchin again filed an appeal in the Appeals Court, and we granted the plaintiff's application for direct appellate review.

2. Review of Liberty Mutual's motion. The motion at issue before us was filed as a motion for judgment on the pleadings pursuant to Mass. R. Civ. P. 12(c), 365 Mass. 754 (1974), and the motion judge only considered it as such. However, it appears that in substance the motion was one for summary judgment under Mass. R. Civ. P. 56, as amended, 436 Mass. 1404 (2002). In the motion and opposition, the parties both made reference to facts and documents not contained in the pleadings and both attached multiple documents extrinsic to the pleadings. The motion judge's memorandum of decision also refers to facts outside of the pleadings, although the judge did not rule explicitly whether the parties were entitled to submit and rely on extrinsic materials. See Mass. R. Civ. P. 12(c) (“If, on a motion for judgment on the pleadings, matters outside the pleadings are presented to and not excluded by the court, the motion shall be treated as one for summary judgment and disposed of as provided in Rule 56, and all parties shall be given reasonable opportunity to present all material made pertinent to such a motion by Rule 56”).

In the circumstances, where the parties and the motion judge have relied on these extrinsic materials, where neither party appears to claim any factual disagreement with them or prejudice from their being considered, and where it also appears that there are no material facts in dispute in any event, we review the motion as one for summary judgment. See Mass. R. Civ. P. 56(c). Cf. Cousineau v. Laramee, 388 Mass. 859, 860 n. 2, 448 N.E.2d 756 (1983), and cases cited (where plaintiffs have not challenged trial judge's implicit conversion of motion filed pursuant to Mass. R. Civ. P. 12[b][6], 365 Mass. 754 [1974], to motion for summary judgment and where no prejudice to plaintiffs' rights to present extraneous matters, court “review[s] the judge's dismissal of this action as though he had granted a motion for summary judgment” and “[s]uch motion is properly granted when ‘there are no genuine issues as to any material fact and ... the [moving party] is entitled to judgment as a matter of law’ ”).

3. Discussion. Interpretation of an insurance policy is a question of law to be determined by the court. Massachusetts Bay Transp. Auth. v. Allianz Ins. Co., 413 Mass. 473, 476, 597 N.E.2d 439 (1992), citing Nelson v. Cambridge Mut. Fire Ins. Co., 30 Mass.App.Ct. 671, 673, 572 N.E.2d 594 (1991). “We interpret the words of the standard policy in light of their plain meaning, ... giving full effect to the document as a whole [,] ... consider[ing] ‘what an objectively reasonable insured, reading the relevant policy language, would expect to be covered’ ... [and] interpret [ing] the provision of the standard policy in a manner consistent with the statutory and regulatory scheme that governs such policies.” Golchin I, 460 Mass. at 225, 950 N.E.2d 853, citing Given v. Commerce Ins. Co., 440 Mass. 207, 209, 796 N.E.2d 1275 (2003). “[B]ecause the approved wording of the standard policy is controlled by the Commissioner of Insurance and not by any insurer (see G.L. c. 175, § 113A), we do not construe ambiguities against the insurer.” Golchin I, supra, citing Given v. Commerce Ins. Co., supra at 210, 796 N.E.2d 1275.

The standard policy contains two forms of coverage implicated by Golchin's claim: compulsory PIP benefits of up to $8,000,⁴ and MedPay benefits up to a purchased amount. MedPay is one of eight optional coverages that the auto policy offers insureds.⁵ The question before us relates only to the availability of MedPay benefits when the medical expenses for which the MedPay benefits are sought also have been paid by a health insurance provider under a separate policy of health insurance.⁶ We conclude that under the plain language of the auto policy, MedPay benefits are payable in such circumstances.

Part 6 of the auto policy describes the MedPay coverage. It provides, in relevant part:

“[W]e will pay reasonable expenses for necessary medical and funeral services incurred as a result of an accident.

“We will pay for expenses resulting from bodily injuries to anyone occupying [the insured's] auto at the time of the accident.” (Emphasis added.)

The terms “incur” and “expenses” are not defined in the auto policy. However, the plain meaning of the word “incur” is “[to] sustain,” and the word “expense” is defined as “[a]n expenditure of money” or “a cost.” American Heritage Dictionary of the English Language 625, 889 (4th ed. 2000). The auto policy thus requires only that there be expenses for medical services sustained as a result of bodily injuries suffered in an accident by the owner of the insured vehicle or an occupant of that vehicle; it does not say who must actually pay these expenses in order to trigger the MedPay coverage under Part 6. ⁷ We read this policy language to mean that MedPay is intended to cover, up to the limits of coverage purchased, medical expenses resulting from injuries caused by an accident, regardless of who—whether the claimant or a health insurance provider—actually pays those expenses.⁸ We conclude that this interpretation also represents “what an objectively reasonable...