Morales v. Pilgrim Insurance
Morales v. Pilgrim Insurance
Opinion of the Court
The plaintiffs filed an action in the Superior Court under G. L. c. 251, § 2, seeking the appointment of an arbitrator to resolve their claims for uninsured benefits under a standard Massachusetts motor vehicle insurance policy issued by the defendant. The defendant filed a motion for summary
We summarize the facts that are not in dispute. On February 20, 2000, Ramon A. Morales was the operator and Carlos J. Morales a passenger in a vehicle when it was hit in the rear on a public highway by an unidentified vehicle. The driver of the unidentified vehicle left the scene without making his or her identity known. The Morales vehicle was insured under a Massachusetts motor vehicle policy issued by the defendant. The policy contained the following provision:
“We may also require you and any person seeking payment under any part of this policy to submit to an examination under oath at a place designated by us, within a reasonable time after we are notified of the claim.”
The plaintiffs gave notice of their claim to the defendant on February 23, 2000. The defendant responded on February 29, 2000, by acknowledging receipt of the claim, furnishing the plaintiffs with applications for personal injury protection benefits, and requesting that the plaintiffs contact it to arrange a date and time to obtain recorded statements. Subsequently, the plaintiffs underwent independent medical examinations requested by the defendant and the defendant paid both plaintiffs
The submission to an examination under oath is a condition precedent to coverage under a Massachusetts motor vehicle insurance policy. Ellis v. Safety Ins. Co., 41 Mass. App. Ct. 630, 638-639 (1996). A wilful, unexcused failure to submit to an examination under oath constitutes a material breach of the insurance contract without proof of actual prejudice to the insurer’s interests, discharging the insurer’s liability under the contract. Lorenzo-Martinez v. Safety Ins. Co., 58 Mass. App. Ct. 359, 362 (2003).
The plaintiffs argue that their coverage was not forfeited in this case because there is no language in the contract that requires that the examination must be conducted separately and out of the presence of another claimant for benefits under the policy. The plaintiffs are correct that the insurance contract is silent on this subject. However, an insurance contract, like all contracts, must be given a sensible, practical construction. See Cody v. Connecticut Gen. Life Ins. Co., 387 Mass. 142, 146 (1982). The purpose of the examination under oath provision “ostensibly [is] to weed out fraud by providing [the] insurer with a mechanism for obtaining formal corroboration of a claim. This mechanism is particularly important in situations like [a] hit-and-run accident. . . , where information about the claim is primarily or exclusively within the possession of the insured.” Lorenzo-Martinez v. Safety Ins. Co., 58 Mass. App. Ct. at 364.
As the motion judge noted, the use of separate examinations under oath of claimants involved in the same accident allows insurers to ascertain the legitimacy of their claims by determin
The judgment is affirmed.
So ordered.
Reference
- Full Case Name
- Ramon A. Morales & another v. Pilgrim Insurance Company
- Cited By
- 6 cases
- Status
- Published