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ARTICLE ID 194405

JUDGMENT Breach of Contract – Chapter 93A Violation – Plaintiff imaging companies alleged that defendant insurer breached its contract by failing to make payment on chiropractic x-rays performed

USDC, District of Massachusetts

In this breach of contract matter, the plaintiff imaging companies alleged that the defendant insurance company breached its contract by failing to tender payments for interpretation of chiropractic x-rays. The plaintiffs alleged damages in excess of $________ in unpaid bills. The defendant insurer denied the allegations, and maintained that the plaintiffs were not entitled to payments for a variety of reasons, including failure to obtain pre-certification for the services.

The plaintiffs are two diagnostic imaging companies whose claims were consolidated by the court. The plaintiffs allege that the defendant failed to make payment in accordance with the parties’ respective contracts for radiology interpretation services provided for chiropractic x-rays. The plaintiffs alleged that there were approximately ________ claims, for which they had not received payment totaling approximately $________ in damages. The plaintiffs brought suit against the defendant, alleging breach of contract and violation of Massachusetts Chapter 93A consumer protection statute.The defendant denied the allegations, and maintained that the claims were properly denied. The defendants asserted defenses, including failure of the plaintiffs to obtain the required pre-certification for the services the plaintiffs rendered, ERISA preemption and lack of medical necessity. The defendant denied that there was any monies due to the plaintiffs.The court ordered that a set of exemplar cases be used to resolve the claims. The parties agreed upon and submitted ________ exemplar cases after following the court ordered formula. Based upon which party prevailed on these exemplar cases, the those claims would be applied on a percentage basis to the overall amount in controversy for all of the claims.

At the conclusion of the pre-trial discovery, the parties submitted respective pre-trial summary judgment motions. The court granted the defendant’s summary judgment motions on all claims, except the Chapter 93A claims which went to trial.At the conclusion of the four-day trial, the court concluded that there were no Chapter 93A violations. Judgment was entered accordingly in favor of the defendant.

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