PSD represents a former insured against Metropolitan Property & Casualty Insurance Company and one of its outside law firms that allegedly retained at least two “independent” chiropractors who were not “independent” because they were paid excessive compensation to categorically deny insurance claims.
A fight at the motion to dismiss stage focused on whether plaintiff had sufficiently alleged injuries for Chapter 93A purposes. The Court stated that plaintiff “alleges that she was injured by the defendants’ conduct because she: (1) experienced delays in the payment of benefits; (2) incurred litigation costs in bringing this action; (3) provided access to her confidential medical records that she would not have provided if she had known of the defendants’ allged scheme; (4) paid premiums for PIP coverage that was, in fact, worthless; and (5) was forced to pay for her chiropractic treatment.” The plaintiff also alleges that the insurer identified claims from low-income and socioeconomically disadvantage communities to challenge. These areas consist of Medicall Underserved Areas in which, by definition, insureds would lack reasonable access to provider care, yet the insurer took steps to shut down provider clinics by using highly-compensated experts to categorically reject claims. The Court found these allegations sufficient to state Chapter 93A injury. Also, the Court found adequate allegations that the outside law firm crossed the line from traiditonal legal representation into active participation in the undelryiing scheme or otherwise enabled unfair and deceptive practices that harmed non-clients.