USCA1 Opinion

UNITED STATES COURT OF APPEALS

FOR THE FIRST CIRCUIT
____________________
No. 94-1286
BARBARA THOMAS, AS COMMITTEE
FOR FRANCES L. WERNER,
Plaintiff - Appellee,
v.
METROPOLITAN LIFE INSURANCE COMPANY,
Defendant - Appellant.
____________________
No. 94-1287
BARBARA THOMAS, AS COMMITTEE
FOR FRANCES L. WERNER,
Plaintiff - Appellant,
v.
METROPOLITAN LIFE INSURANCE COMPANY,
Defendant - Appellee.
____________________
APPEAL FROM THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF MASSACHUSETTS
[Hon. William G. Young, U.S. District Judge]
___________________
[Hon. David S. Nelson, Senior U.S. District Judge]

__________________________
____________________
Before
Torruella, Chief Judge,
___________
Campbell, Senior Circuit Judge,
____________________
and Stahl, Circuit Judge.
_____________
_____________________

Joseph Trovato, with whom David J. Larkin, Jr. and Sandra

______________
_____________________
______
Parker were on brief for defendant-appellant.
______
Lawrence J. Casey, with whom Scott E. Bettencourt and Crowe,
_________________
____________________
______
Crowe & Vernaglia, P.C. were on brief for plaintiff-appellee.
_______________________

____________________
November 28, 1994
____________________

-2-

TORRUELLA, Chief
TORRUELLA, Chief

Judge.
Judge.

This case

involves a dispute

____________
arising

under an

insurance

policy, part

of

the Empire

Plan,

issued by defendant-appellant Metropolitan Life Insurance Company

("Met Life")
agree with
coverage

to plaintiff-appellee Frances Werner.1

the

district court

here, and

that

Met

that
Life

the policy
acted

in

Because we

terms
good

mandate

faith

and

committed no unfair or deceptive practices, we affirm.

I.
I.
McLean

BACKGROUND
BACKGROUND

Hospital ("McLean")

located in Belmont, Massachusetts.

consists numerous

patient care

is a

psychiatric hospital

Its forty-six building campus

buildings, as well

as buildings

for the hospital's operations, such as offices, laundry, storage,

and

garages.

diagnostic

McLean primarily
and

treatment

and

physicians.

therapeutic
care

McLean

nursing services

to

of
also

provides, on an inpatient basis,

facilities

mentally

ill

provides

its patients

for

the

persons

continuous,

under

diagnosis,
by

licensed

24-hour-a-day

the supervision

of

registered graduate nurse.

Through

its

various facilities

and

programs, McLean

offers its patients a spectrum of care and treatment that aims to

foster less dependence on

institutional support.

These programs

range from the psychotic disorders program, in which patients are

constantly
community

supervised and
residential

and

have

little

treatment

responsibility, to
programs,

which

the

provide

____________________
1 Ms. Werner
Thomas.

brings suit by and through

her Committee, Barbara

-3-

patients with

a structured

environment, a

somewhat independent

living arrangement,

and the same 24-hour-a-day

ancillary

services

hospital

restrictive
Street

treatment

Lodge

are

that

units.

two

are available

in

Hope Cottage

and

the Mill

treatment

programs

The

such

professional and

residential

the

more

available at McLean.
All

of

the

programs

at

residential treatment programs, are

and

all

services provided

through

McLean,

including

the

staffed by McLean employees,

these

programs are

billed

through McLean's central accounting department.

In September 1985, Frances Werner, a diagnosed paranoid

schizophrenic, was admitted to McLean and initially placed in the

psychotic

disorders

improved, and
and

treatment

unit.

she was
program

In

March 1986,

transferred to the
at

McLean.

residential and treatment program,

the

Hope

Street

Cottage building

Lodge

building from

condition had

community residential

While

in

the

community

Werner was assigned a

until March
March

her

1989

1989,

and in

until February

bed in

the Mill

1992.2

Werner was
McLean,

assessed a room and

board charge during her

including the period she

stay at

spent in the

Hope Cottage and

under a group

health insurance

Mill Street Lodge buildings.

Werner is
policy known

as

an enrollee

the Empire

Plan (the

health insurance benefits to

"Plan"), which

provides

New York State Government employees

____________________

2
Werner was transferred back into the psychotic disorders
program for approximately one month during September and October
1989.
-4-

and

their dependents.

receive benefits
to her.

the Plan,

Werner is

for covered medical services

The Plan

services for

Under

provides

that Blue

the first 120 days

eligible to

that are provided

Cross pay

of care, and that

for

covered

Met Life pay

for such services after the initial 120 days.

Blue Cross

paid its liability

that Werner was in McLean.

paid for

After the initial 120

the services received

by Werner

psychotic disorders program (September 5,

and September 14

for the first

to October 10, 1989).

120 days

days, Met Life

while she was

in the

1985 to March 6, 1986,

Met Life denied Werner's

claims for services received while

residential

and

treatment

she was in McLean's community

program,

however,

contending

that

neither the Hope Cottage nor the Mill Street Lodge are within the
scope of the Plan.
The Plan
for certain

specifically provides that Met

covered medical

expenses, including

private proprietary hospitals

______________________________
nervous conditions
further defines

for the

and alcoholism"

"hospital" as

Life will pay

"[s]ervices of

treatment of

(emphasis added).

"only an institution

fully every one" of three tests.

1. It is primarily engaged in providing

on an inpatient basis diagnostic and
therapeutic facilities for surgical or
medical diagnosis, treatment and care of
injured and sick persons by or under the
supervision of a staff of physicians who
are duly licensed to practice; and
2. It continuously provides 24-hours-aday nursing service by or under the
-5-

of

The Plan

which meets

The Plan sets forth these tests

as follows:

supervision
nurses; and

mental and

registered

graduate

3. It is not a skilled nursing facility

and it is not, other than incidentally, a
place of rest, a place for the aged, a
place for drug addicts, a place for
alcoholics or a nursing home.
The phrase "on an

inpatient basis" is defined under the

Plan to

mean that the institution assesses a room and board charge.

Met Life received a letter dated October 18,

1990 from

one of Werner's physicians at

McLean, Dr. Peter Choras.

letter,

Hospital

written

explained

the

on

McLean

urgency

of

letterhead,

Werner's

medical

entreated Met Life to provide coverage

the Mill

Street Lodge, which he

response, Met
because

Life reiterated

houses,"

were not

explained

that

covered

it

"must

Dr.

and

for Werner's treatment at

that no benefits

by

his

Choras

situation,

called a "half-way

residential facilities

In

house."

In

were available,

or programs,

including "halfway

the

Met

adhere

Plan.
to

the

Life

plan

further

provisions

as

stipulated by the contract holder."

After
another

receiving

physician and

requests

an attorney

on

Werner's

behalf

to reconsider its

from

denial of

coverage, Met Life apparently looked for the Mill Street Lodge in
the American Hospital Association accreditation manual.
McLean

Hospital was listed, the Mill

Life responded

to these

additional information
reconsideration.
information that

appeals
about the

According to Met

Street Lodge was not.

on March

5, 1991,

Mill Street

Met

requesting

Lodge to

Life, it never

changed its determination that

-6-

Although

aid its

received any

the Mill Street

Lodge was not a covered facility.

Werner brought

suit against

alleging breach

of contract, breach

good faith and

fair dealing, unfair

violation of

Mass. Gen. L. ch.

Met Life in

August 1991,

of the implied

covenant of

and deceptive practices

93A and 176D, and

in

infliction of

emotional distress.3
Werner
judgment
trial

for

on her breach of

on her

judgment

moved

Werner's

relief,

contract claim, and

other claims.

on all

declaratory

Met

summary

requested a jury

Life cross-moved

claims, contending

for

for summary

that Mill

Street

Lodge and the Hope Cottage were not hospitals under the Plan, and
that it had not engaged in any unfair or deceptive practices.
After

a hearing

on

the motions,

the district

court

granted judgment in Werner's favor on her request for declaratory

relief and
favor

her claim of

on the

remaining

breach of contract,
claims.

Both

appealed.
II.
II.
A.
A.

ANALYSIS
ANALYSIS

Standard of Review
Standard of Review
__________________

Met

and in Met
Life

and

Life's

Werner

Because

the district court granted summary judgment in

Werner's favor regarding the breach of contract claim,

that decision de novo.
__ ____

we review

Serrano-P rez v. FMC Corp., 985 F.2d 625,

_____________
_________

626 (1st Cir. 1993); Pagano v. Frank, 983 F.2d 343, 347 (1st Cir.
______
_____
1993).

We must determine whether the record, viewed in the light

____________________
3
Werner has voluntarily withdrawn her claim for
distress on appeal, but preserves her right to seek
distress damages under Mass. Gen. L. ch. 93A.

emotional
emotional

-7-

most favorable to Met Life and drawing all reasonable

in

Met Life's

favor, presents

fact, and whether Werner is

any genuine

inferences

issues of

material

entitled to judgment as a matter

of

law.

Summary judgment may not be granted if the evidence is such

that

reasonable jury

could return

verdict for

Serrano-P rez, 985

_____________

F.2d at 626.

unsupported in the

record, are insufficient

issue of material fact.

Met Life.

Mere allegations, or conjecture

to raise a

genuine

Wynne v. Tufts Univ. Sch. of Med., 976

_____
_________________________

F.2d

791, 794

(1st Cir. 1992),

cert. denied,
_____ ______

113 S.

Ct. 1845

(1993).
Regarding

Werner's

other claims,

conversely, because

the district court granted summary judgment in favor of Met Life,

we review this

decision de
__

record in

light most

party.

the

favorable to

required to view
Werner, the

the

non-moving

Serrano-P rez, 985 F.2d at 626.

_____________
B.
B.

Werner's Claims for Breach of Contract

Werner's Claims for Breach of Contract
______________________________________

Werner
Cottage

novo, and are

____

claims

that the

Mill

Street

Lodge and

Hope

fully meet each of

the Plan's tests,

and therefore all

services rendered are fully

covered expenses.

Met Life,

on the

other hand, claims that the facilities fail to meet the first two
of

the three

tests

set

forth

"hospital," arguing that they

in

the

Plan's

definition

of

are not "inpatient" facilities and

do not provide 24-hour nursing service.4

____________________

4
Werner claims, and Met Life does not disagree, that the
facilities fully meet the third test of the Plan, i.e., they are
not skilled nursing facilities, a place of rest, a place for the
aged, a place for drug addicts or alcoholics, or a nursing home.
As the record fully supports this claim, we need not address it
-8-

We

first

address a

preliminary

rights and

obligations of parties under

determined

by the

law5 requires that

whether
two or

language

language in a

the policy,

Accident and Indem. Co.,

__________________________

467

1973).

We

agree

Newin Corp. v. Hartford

___________
________

N.E.2d 887,

with the

parties

ambiguities in the relevant language of

the

heart of

facilities

this

case is

at McLean

whether

meet the

instance,

and susceptible to

889

Hartford Accident and Indem. Co. v. Wesolowski,

__________________________________
__________
(N.Y.

the

New York

in the first

contract is ambiguous

more reasonable interpretations.

While

insurance contracts are

contained in

the court determine,

matter.

(N.Y.

1984);

305 N.E.2d 907

that

there are

no

the Plan.

The issue

at

the residential

Plan's three-part

treatment

definition of

"hospital."

Although the dispute arises under the Plan, there is

no

over

dispute

Specifically,

the

the

meaning of

parties

do not

the

disagree

definition of the

term "hospital," nor

constructions

that

of

three-part

terms

contained within.
as

to

the Plan's

do they offer

definition.

differing

Rather,

they

disagree over whether the facts presented by Werner's case -- the

treatment she received in the residential facilities -- fit
unambiguous

definition.

In other

words, this is

that

not a dispute

over the construction of ambiguous terms; rather, it is a dispute

over

the

application

circumstances.

of

clear

terms

to

Therefore, because "the words

somewhat

unusual

in the paragraphs

____________________
here, and assume it true for purposes of this opinion.

5
The parties do not dispute that we are bound to apply New
York law to the construction and interpretation of the Plan.
-9-

of

the

policy under

examination

meaning, unattended by danger of

the policy

difference of

North America,
_____________
matter of

which there is

opinion," Breed v.
_____

413 N.E.2d 1280, 1282

law that there

definite

and precise

misconception in the purport of

itself, and concerning

basis for a

have a

no reasonable

Insurance Co. of
_________________

(N.Y. 1978), we find

is no ambiguity

in the

as a

relevant Plan

terms here.
In the absence of
requires
according

courts to
to

enforce

their plain

ambiguity, well-settled New York law

provisions of
and

an insurance

ordinary meaning.

General Accident Ins. Co. of America, 595 N.E.2d 819,

_____________________________________

policy

Lavanant v.
________

822 (N.Y.

1992) (citations omitted); American Home Prods. Corp. v. Liberty

___________________________
_______

Mut. Ins. Co., 565

_______________

F.

(discussing New York

contracts law).

terms of a policy
moral

Breed, 385
_____

our task

Lodge and Hope Cottage

set

forth

1485,

1491-92

(S.D.N.Y.

Courts may

in the

is to

N.E.2d at 1283.

determine

Plan's definition

of

the

justice or

Applying these

whether the

fully meet each of the

1983)

not vary

to accomplish "notions of abstract

obligation."

principles,

Supp.

Mill Street

unambiguous tests

"hospital."

Met Life

argues first that the Mill Street Lodge and Hope Cottage fail the
first test.
an

It contends that these facilities do not operate "on

inpatient

basis" and

do

not provide

"surgical

diagnosis, treatment and care . . .

by or under the

of

duly licensed

a staff

or physicians

Instead, Met Life

who are

contends that

the two

or medical

supervision

to practice."

facilities are

merely

"community or group residences."

-10-

Under
facilities
"inpatient"

the

plain terms

of

the

Plan, however,

do operate on an "inpatient" basis.

to mean

simply

that a

room

these

The Plan defines

and board

charge

is

assessed

to the patient.

The record establishes that Werner was

assessed such charges for each night of her stay at both the Mill
Street Lodge and Hope Cottage.

Thus, this requirement is clearly

met, and Met Life's contentions to the contrary have no merit.

Met
facilities

Life

further

are not

primarily

diagnosis, treatment,
counsel

conceded in

facilities
the

insists

that

engaged in

same campus

decisions

are

as McLean,
made

and all

by McLean

medical

requires. Met Life's

before this

are staffed and operated by

residential

"surgical or

or care" as the Plan

oral argument

the

court that

the

McLean personnel, are on

operational

doctors

and

and treatment

staff.

Met

Life

nevertheless contends that the facilities are completely separate

and independent
covered
to

entities from

functions.

the fact

as

different, non-

In support of this argument, Met Life points

that they are

Massachusetts

McLean, and have

either

licensed separately by
a

"community

the state of

residence"

or

"group

residence."
We do
scheme

to

Presumably,

the
a

not see the

Plan's
state

has

relevance of the

definition
its

own

licensing and regulating mental health

than

the intentions of parties

case

involves the application

of

state's licensing

covered

purposes and

facilities.
criteria

facilities, far different

to an insurance

contract.

of contractual terms.
-11-

for

This

The label

that

state officials

treatment
"hospital,"
including

may

program

is

and

we see

licensing

place

not

on

part of

a particular
the

Plan's

no reason

to

add any

nomenclature,

to

the

facility

or

definition

of

other elements,

Plan's

unambiguous

three-part definition of covered facilities.6

Furthermore, we
record show that
McLean

Hospital.

treatment
developing

plans

continuum

McLean
for

with

the

from

aim

to

necessarily

meet its

treatment

patient's condition, and as part

patient may be transferred
of these programs are

they are on the

same campus.

however,

and staffed

the

by

supervision and

programs and services provided

Not all

of

offers

commences a

building, although
operated

the

In order

degrees of

McLean patient

ongoing treatment, a McLean

another.

people,

needs, McLean

scheme at the hospital, the

program to

ill

with varying

naturally depend on the

facts in

separate and distinct

living skills.

medical

When

the

provides comprehensive, individualized

mentally

of programs

responsibility.

agree that

the facilities are

independent

patients' diverse

do not

will

of her

from one

in the same

They are all,

same McLean

personnel.

____________________

6
Even if we were to consider the residential facilities'
licenses, they nevertheless do not necessarily prove that the

facilities are "separate and distinct" from McLean. In a sworn

affidavit
explaining the
licenses,
the Director
of the
Massachusetts Department of Mental Health, Michael H. Weeks,
stated that McLean Hospital Corporation is "licensed to conduct
residential programs at McLean Hospital . . . in its Hope Cottage
and Mill Street Lodge buildings." This characterization by the
head licensing official of the state actually contradicts Met
Life's arguments, and supports the finding that the residential
facilities are not distinct entities, but are integral components
of McLean, two of the several treatment programs McLean offers.
-12-

While

the Mill Street Lodge

buildings
services
they

from the

and Hope Cottage

main hospital

are not separate from

constitute just

two

exist in separate

building, their

the hospital.

of these

function and

On the contrary,

various treatment

programs

developed and administered by McLean physicians and staff.

Thus,

they are two of the integral components that comprise the overall
institution of McLean Hospital.
This is not to say that
even

any or all facilities owned or

operated by a hospital are necessarily covered by the Plan.

Modern hospitals

are frequently owned by

own other

healthcare

homes, or

outpatient facilities.

not meet the Plan's

entities, such

coverage terms.

as

corporations that also

laboratories,

These entities

nursing

clearly would

The programs at issue here,

however,

are

diagnosis

part

and

parcel

and treatment

of

McLean's

programs, and

various

medical

thus are covered

by the

Plan.
Met
physically
Hope

Life also

present 24

Cottage,

contends

that because

hours a day

at the Mill

these facilities

fail

"hospital."

nurses are

Street Lodge or

the second

We agree

not

prong

Plan's

definition of

court,

however, that the Plan's terms do not require that nurses

be physically present

24 hours

a day, but

services be available

24 hours

a day.

that

all of

the hospital's

with the

of the

merely that

The record

nursing and ancillary

provided in the residential programs.

district

nursing

establishes

services are

Although those nurses are

not physically present in those buildings and must be summoned if

-13-

needed, the patients in the residential programs nonetheless have

the benefit of the nursing services that are available 24 hours a

day in the

main building.

Thus, the Mill

Cottage fully meet

this element

court's ruling on

Werner's breach

Street Lodge and Hope

of the Plan,

and the

of contract claims

district
must

be

affirmed.
C.
C.

Werner's other claims

Werner's other claims
_____________________

Werner
granting
for

contends

that

the

summary judgment in Met

breach of

violations

the

implied

district

Life's favor as

covenant

of the Massachusetts

court

of

good

unfair and

statutes, Mass. Gen. L. ch. 93A and 176D.

erred

in

to her claims
faith

and

for

deceptive practices

Werner argues that the

record contains sufficient evidence giving rise to genuine issues

of material fact suitable for a jury trial on these claims.
1.
1.

Breach of the covenant of good faith

Breach of the covenant of good faith

Under New
damages for

"bad

York law,
faith"

a plaintiff may

breach

of

contract

recover punitive
where

there

is

evidence of morally reprehensible conduct directed at the general

public,

Halpin
______

v. Prudential Ins. Co., 401

_____________________

N.E.2d

171 (N.Y.

1979), or an extraordinary showing of a disingenuous or dishonest

failure to carry

out a contract.

Gordon v. Nationwide Mut. Ins.

______
____________________

Co., 285 N.E.2d 849, 854 (N.Y. 1972),

___

cert. denied, 410 U.S. 942

_____ ______

(1973).
Regarding
Werner
instant

simply has

her
not

allegations of
shown that

Met

Met

Life's

bad faith,

Life's conduct

in

the

case rises to the level of morally reprehensible conduct

-14-

or

extraordinary

dishonesty.

To avoid

summary

judgment,

nonmoving party must be able to point to some specific, competent

evidence in support of its claim.
allegations
issue
Met

or conjecture

of material fact.
Life of

Wynne, 976 F.2d at

_____

are insufficient
Id.
__

Although

callous indifference

794.

to raise

a genuine

Werner heatedly accuses

to Werner's

predicament, the

record contains no evidence of any bad faith by Met

Life.

Met

to

Life

denied

contention,

Werner's

Mere

claims.

Contrary

True,

Werner's

however, Met Life did state the basis for its denial

-- it concluded

that the charges were

Although this conclusion was

particularly in light of

not covered by

the Plan.

erroneous, it was not unreasonable,

Dr. Choras' own characterization of the

Mill Street Lodge as a "half-way house."

Certainly, an insurance

company

and reasonably believes

may deny claims

that it is
Met Life
McLean

not obligated to pay them.7

Werner also claims that

conducted no investigation of

the relationship between

and the

investigate may
rise

to

if it honestly

the

Mill

Street Lodge.

If

true, this

constitute ordinary negligence, but

level

of

extraordinary

reprehensible conduct directed

dishonesty

at the general public.

failure to

it does not
or

morally

A claims

adjuster in a
an attorney,
extensive

large insurance company is usually not a doctor or

and

cannot

information for

be expected
every claim.

to

compile
We

and

analyze

refuse to

issue a

____________________

7
We also note that Werner's dire medical and financial
situation does not transform Met Life's denial of coverage into a
bad faith act. Met Life honestly and reasonably believed that it
was not legally bound to pay Werner's claims.
-15-

directive

to

insurance

companies

requiring

such

lengthy

procedures.
Moreover, the record
receiving letters
Werner's

matter

on Werner's

claims, and

effect, which
of

supporting

does contain evidence that

behalf, Met Life

requested

it never received.

law,

Werner

its claims of

judgment, and the

has

did investigate

additional information
We therefore

not shown

any

after

to that

find that

specific

as a

evidence

bad faith sufficient

to avoid summary

district court's judgment in

Met Life's favor

on this claim must be affirmed.

-16-

2.
2.

Violation of the
Violation of the
statute
statute

Werner

also claims

Massachusetts unfair
Massachusetts unfair

that Met

Life has

practices
practices

violated Mass.

Gen. L. ch. 93A and 176D, which prohibit unfair or deceptive acts
or

practices in the business

of insurance.

whether, under choice-of-law analysis,

It is questionable

these statutes can fairly

be applied to Met Life in this context, in light of the fact that

the claims arise
York.

under a

contract governed by

the laws of

New

We need not address this issue, however, because assuming

arguendo that
________
Werner has

chapters

93A and

176D can

properly be

applied,

failed to point to sufficient evidence supporting her

claims to avoid summary judgment.

Chapters

93A

deceptive practices in

and

Wynne, 976 F.2d at 794.

_____

176D together

prohibit

the business of insurance,

Section

unfair claim settlement

3 of chapter 176D sets

or

and allow one

injured by such unlawful acts to bring an action for

equitable relief.

unfair

damages and

forth several

practices, including "[r]efusing

claims without conducting a

reasonable investigation based

all available information."

Mass. Gen. L. ch. 176D

to pay

upon

3(9)(d).8

The Massachusettts Supreme Judicial Court has held that

a

plaintiff

deceptive act

may

recover under

that

is the

chapters

result

of the

93A

and

insurance

176D for

company's

____________________

8 Section 3 of chapter 176D lists eleven unfair claim settlement

practices. In her brief, Werner states that Met Life committed
"several" of these, but she does not specify which ones, much
less how they were committed.
The only violation that Werner
specifically alleges is a failure to conduct a reasonable
investigation.
Because we find no hint in the record of any
other possible violations, we only analyze Werner's specific
allegation.
-17-

negligence.
(Mass.

Swanson
_______

1983).

v. Bankers Life Co., 450

_________________

The plaintiff need not

deceive, and an act may

negligence.

negligent act is

under

chapter 93A.

negligence

The court
unfair or

Id.
__

To

of

warned, however, that "not

deceptive" and

determine whether

constitutes "unfairness"

580

show any actual intent to

be deceptive even absent any showing

Id. at 580.
__

every

N.E.2d 577,

for 93A

thus unlawful
an

insurer's

purposes,

a court

must look to several factors, including what the insurer "knew or

should have known" about the circumstances of a particular claim.

Id. (citations omitted).
__
Werner argues that, on the
fact could

reasonably

McLean, look
letterhead on

into the

find

that

facts presented, a trier of

Met Life's

hospital's accreditation, or

which correspondence

was sent, was

egregious" to incur liability under 93A.

according to Werner,

failure

a blanket

denial of

to

call

examine the

"sufficiently

These facts constitute,

coverage without

any

reasonable investigation.
As

we noted

above, the

record does

contain evidence

that after receiving several letters on Werner's behalf, Met Life

investigated
information.

Werner's

claims,

and

requested

additional

We therefore cannot agree with Werner that Met Life

failed altogether to investigate her claim.

Perhaps the Met Life

employees could have been more thorough; perhaps they should have
taken

more

initiative after

McLean letterhead
residential

receiving

and inquired

programs.

As

Dr.

Choras' letter

after the specifics

we have

noted,

on

of McLean's

however,

hospital

-18-

corporations often own and operate healthcare entities that would

not come within the Plan's coverage.
the fact that the Mill Street
accreditation manual,
facility as a

claims, was

Lodge was not listed in a hospital

and that

Dr. Choras himself

"half-way house,"

failure to inquire further,

This reality, combined with

compels us to

labelled the

find that

and their decision to deny

not unreasonable, and certainly

their

Werner's

does not constitute

"unfairness" in violation of 93A and 176D.

III.
III.
For

the

foregoing

CONCLUSION
CONCLUSION
reasons,

the

district

court's

judgment as to each of Werner's claims is hereby affirmed.

________

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