United States District Court, D. Massachusetts
GARRICK CALANDRO, AS ADMINISTRATOR OF THE ESTATE OF GENEVIEVE CALANDRO, Plaintiff,
SEDGWICK CLAIMS MANAGEMENT SERVICES, Defendant.
FINDINGS OF FACT, CONCLUSIONS OF LAW, AND
B. Saris Chief United States District Judge.
Garrick Calandro, as administrator of the estate of Genevieve
Calandro, alleges that Sedgwick Claims Management Systems,
Inc. (“Sedgwick”) violated Massachusetts General
Laws Chapter 176D (“Chapter 176D”) and
Massachusetts General Laws Chapter 93A (“Chapter
93A”) by failing to make any reasonable attempt -- both
pre-verdict and post-verdict -- to settle the negligence and
wrongful death claims involving his mother who died at a
nursing home in Danvers, Massachusetts.
four-day bench trial, the Court finds that Sedgwick did not
violate Chapters 176D and 93A. The evidence presented at
trial showed that, although both sides engaged in tough
litigation tactics, the element of causation on
Calandro's wrongful death claim was never reasonably
clear. Even though causation was reasonably clear on
Calandro's conscious pain and suffering claim, Sedgwick
made two reasonable settlement offers when causation on that
claim was reasonably clear. Sedgwick also attempted to engage
in negotiations one month before trial, but was rebuffed by
Calandro's attorney. Calandro also alleges statutory
violations stemming from post-verdict or post-judgment
settlement offers. For the reasons set forth below,
Sedgwick's conduct at those times did not violate
Chapters 176D and 93A.
the Court finds that Sedgwick did not violate Chapters 93A
and 176D. Judgment shall enter for Defendant.
plaintiff, Garrick Calandro (“Calandro”), is the
administrator of his mother Genevieve Calandro's estate.
Sedgwick Claims Management Services, Inc.
(“Sedgwick”) is a third-party administrator
(“TPA”) of insurance claims. Hartford Insurance
Company, through its subsidiary, Pacific Insurance Company
(“Hartford”), issued a liability insurance Policy
No. 2Y0004802 naming four out of five of the “Radius
Entities” as insureds excluding Roush & Associates,
Inc. The policy was an occurrence policy in the amount of $1
million, covering the period June 1, 2008 to June 1, 2009.
were five “Radius Entities”: Radium Management
Services, Inc., Radius Management Services II, Inc., Roush
& Associates, Inc., Radius Danvers Operating, LLC, and
Radius BD. For convenience, the Court refers to the entities
collectively as “Radius”. In connection with its
healthcare line of business, Hartford engaged Sedgwick as a
TPA pursuant to written contract(s). Under the terms of those
written contracts, Sedgwick must undertake certain actions in
adjusting claims, and has contractual reporting requirements
vis-à-vis a claim involving a fatality. The operative
contract at the time of Calandro's claim set forth a list
of standards for handling and adjusting that claim and others
similar to it.
David Wahl was Ms. Calandro's personal physician at all
times relevant to Calandro's underlying negligence
Genevieve Calandro's Death
Calandro died on August 16, 2008 at age 91, five weeks after
she last resided at Radius Danvers, a long-term skilled
nursing facility where Ms. Calandro had lived for a six-month
period between late December 2007 and July 10, 2008.
10, 2008, at the Radius Danvers facility, Ms. Calandro fell
from her wheelchair, hit her head, and was taken by ambulance
to Beverly Hospital. Upon her admission to Beverly Hospital,
Ms. Calandro was dehydrated, had undiagnosed acute
appendicitis, renal failure, uncontrolled diabetes, a severe
bed sore, a urinary tract infection (“UTI”), and
a high white blood cell count. She also had dementia. She was
discharged from Beverly Hospital on July 22, 2008 and
admitted to a different nursing home. Ms. Calandro died on
August 16, 2008. Her death certificate lists congestive heart
failure and acute renal failure as the causes of death, along
with various other conditions that contributed to her death.
Timeline of Sedgwick's Pre- and Post-Judgment
The Underlying Lawsuit
August 16, 2011, Calandro filed suit against Radius alleging
negligence, gross negligence, and wrongful death. The
complaint included a prayer for punitive damages. Calandro
served the summons and complaint on Radius in October 2011.
In July 2012, the plaintiff amended the complaint to add Dr.
Wahl as a defendant. Calandro's lead trial counsel was
Sedgwick Claims Management Services
terms under which Sedgwick acted as a TPA for Hartford are
set out in a Third Party Administrator Agreement and the
Service Requirements in that Agreement. After Radius received
service of the summons and complaint in October 2011,
Sedgwick assigned Mary Blair (“Blair”), an
experienced claims adjuster at Sedgwick who had previously
worked at Hartford, to adjust the claim. Blair engaged
Bistany Adjustment Service (“Bistany”) to
investigate the claim. Hartford, via Blair, hired attorney
Lawrence Kenney (“Kenney”) to serve as counsel
for the insureds in the litigation.
filed two investigative reports. At the time of its
investigation, Radius, including the Danvers facility, was
winding up operations or in the process of sale. This fact
made the investigation difficult, both in terms of securing
documents and identifying witnesses. Indeed, no incident
report of Ms. Calandro's fall from her wheelchair was
conducted interviews with two nurses who worked at the
Danvers facility at the time of Ms. Calandro's fall, one
of whom told him that she remembered the fall and stated that
a contemporaneous incident report was prepared. Bistany found
the names of the two nurses in Ms. Calandro's clinical
chart, which Calandro's attorney already had in his
Bistany conducted interviews with the two nurses, Radius --
via Blair and Kenney -- did not disclose their names in
response to Calandro's very-late filed interrogatories in
the underlying case. Instead, Kenney objected to the
interrogatories as untimely (they were), separately writing a
letter to Hoey advising him of the difficulty of obtaining
responsive information in light of the winding up of Radius