Massachusetts Injury Lawyers Blog
When an injured worker seeks insurance benefits after a serious accident, the expectation is that coverage will provide timely and adequate support for medical care and recovery. Unfortunately, disputes over insurance obligations can create additional hardship for workers already facing devastating injuries. A recent Massachusetts decision highlights how courts review claims of unfair settlement practices and bad faith under Massachusetts law when an insurer delays or denies benefits. If you were hurt at work, it is important to understand your options, and you should speak to a Massachusetts workers’ compensation attorney.
Factual Background and Procedural History
It is reported that the plaintiff suffered severe injuries in March 2022 while working as an independent contractor for a food delivery service. The injuries included head trauma, facial disfigurement, spinal damage, and hand injuries, among others. At the time of the accident, the plaintiff was covered under an occupational accident policy issued by the defendant insurance company and administered by its third-party claims handler. The policy was intended to provide medical and dental expense benefits of up to $1,000,000 for work-related accidents.
It is further reported that shortly after the accident, the plaintiff attempted to secure treatment for his injuries through the policy but encountered repeated obstacles. The insurer’s adjuster failed to provide a recommended provider list for nearly two months, leaving the plaintiff to attempt to schedule appointments on his own. In some cases, the adjuster suggested the plaintiff pay out of pocket and later seek reimbursement, even though his injuries left him financially vulnerable. When the plaintiff eventually scheduled a specialist appointment, it was canceled due to the adjuster’s inaction, causing additional delays in critical treatment.
It is alleged that the plaintiff later sought to resolve his claims through settlement, submitting medical records and billing statements as proof of loss. His demand for over $600,000 in expenses and damages was met with a counteroffer of just over $21,000, which was later retracted. Additional settlement demands were likewise denied, with the insurer asserting that categories such as pain and suffering were not covered under the policy. Despite this, the plaintiff alleged that insurer representatives previously confirmed that such claims were covered. Frustrated by delays, denials, and mixed messages, the plaintiff filed suit in Massachusetts state court, and the case was removed to federal court. The defendants moved for partial judgment on the pleadings, seeking dismissal of most of the plaintiff’s claims.
Claims for Benefits Outside of Workers’ Compensation
The court reviewed the case under the standards of Rule 12(c), treating the motion similarly to a motion to dismiss and construing the facts in the light most favorable to the plaintiff. The central legal issue involved Massachusetts General Laws Chapter 93A, which prohibits unfair and deceptive business practices, and Chapter 176D, which identifies unfair claim settlement practices in the insurance context. While Chapter 176D does not itself provide a private cause of action, violations of its provisions may form the basis of a Chapter 93A claim.
The court found that the plaintiff had plausibly alleged bad faith practices, particularly with respect to delays in providing a provider list and approval for treatment. Even if the insurer was not strictly obligated under the policy to pre-authorize treatment, the repeated assurances, contradictory communications, and subsequent inaction plausibly demonstrated misrepresentation and unfair practices under Chapter 176D § 3(9). As a result, the court denied dismissal of claims premised on these delays.
With respect to coverage for pain and suffering, the court emphasized that the policy excluded psychological or emotional injuries “not a direct result” of an occupational accident. Because the plaintiff’s allegations tied his emotional and psychological harm directly to the accident, his claim for pain and suffering was not foreclosed as a matter of law. Thus, dismissal was also denied on that count. Conversely, the court dismissed claims for future medical expenses, holding that such expenses were not “covered expenses” under the policy since they had not yet been incurred. Additional negligence and contract claims were also dismissed for lack of factual specificity.
Talk to a Skilled Massachusetts Workers’ Compensation Attorney
If you are facing obstacles in obtaining benefits after a workplace accident or if you believe your insurance company has acted unfairly in handling your claim, it is important to speak to a lawyer. Attorney James K. Meehan of the Law Office of James K. Meehan is an experienced Massachusetts workers’ compensation attorney who fights to protect the rights of injured workers. For a confidential consultation, contact the firm at 508-822-6600 or reach out through the online form.