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Michael  A. Fitzhugh, Fitzhugh & Mariani LLP, Boston,MA,  obtained favorable results in two healthcare provider cases consolidated for trial by the U.S. District Court for the District of Massachusetts.

The plaintiffs sought payment on more than twelve thousand health insurance claims arising out of the interpretation of chiropractic x-rays, with each claim’s dollar value typically ranging from sixty dollars to three-hundred dollars, totaling damages in excess of two million dollars, excluding claims for extra-contractual relief. The plaintiffs alleged breach of contract, negligence, and violation of Chapters 93A and 176D of the Massachusetts General Laws, which regulate unfair business and insurance practices. The insurers raised multiple defenses, including preemption of state law claims made under ERISA-governed benefit plans and other contractual defenses including lack of medical necessity for second interpretations of x-rays and failure to obtain precertification and primary care physician referrals.

In light of the large number of disputed claims and the unwieldy discovery and trial process that would have ensued, the court ordered that the cases be resolved on a set of exemplar claims. The court then provided a formula for identifying exemplars and permitted each party to select an equal number of additional exemplars.  After the parties completed that process, there were a total of 315 exemplars. The respective parties’ exemplar claims would then be applied on a percentage basis to the overall amount in controversy for all claims.

Once the parties concluded their pretrial discovery, they filed cross-motions for summary judgment. The court denied plaintiffs’ motion and granted defendants’ motion regarding all but the Chapter 93A and 176D counts under eleven exemplars. A partial summary judgment was entered for the defendants on all of the breach of contract and negligence claims and on 304 of the 315 claims under Chapters 93A and 176D. 

Thereafter, the court scheduled a bench trial on the remaining eleven exemplars. After completing a four-day trial, the court determined that the defendants had not violated either Chapter 93A or 176D, and it entered judgment in their favor on all eleven remaining claims.

Well done, Michael!       

Do you have news or triumph to share? Send a brief summary with a recent photograph to David Fuqua at dfuqua@fc-lawyers.com


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