Middlesex, Ss Civil Action No.:: Seven Corners Incorporated, and

Case 1:16-cv-11189-FDS Document 1-1 Filed 06/22/16 Page 1 of 30
COMMONWEALTH OF MASSACHUSETTS
MIDDLESEX, ss SUPERIOR COURT

CIVIL ACTION NO.: � C � /o0 9� e
SUNNY ACHULIFUR
Plaintiff,
V.
CO M P LAI N T
AND JURY T RIAL DEMAND
SEVEN CORNERS INCORPORATED, and

CERTAIN UNDERWRITERS AT LLOYD'S
LONDON SUBSCRIBING TO POLICY-
NUMBER I OVLN10-33915 AND/OR
SRAC557204OG
Defendants
INTRODUCTION
I. In this action Plaintiff seeks to recover his damages associated from the.
refusal of Defendants to honor the contract for travel insurance [the "Contract"]
purchased by Plaintiff. Plaintiff purchased Contract from Seven Corners,
Incorporated ["Seven"] in order to indemnify himself for costs related to injuries
and related medical expenses-he might sustain during an international (outside
the USA) trip. Plaintiff was injured while on vacation in Cameroon and has
submitted numerous claims to Seven for indemnification of such costs. Further,
Plaintiff still suffers spinal disc.disease which has resulted in substantial pain and
suffering by Plaintiff, as'well as loss of earnings. Treating physicians for
Plaintiff have concluded that surgery to repair Plaintiff's affected disc is

appropriate however, Seven has refused claims for indemnification of Plaintiff
for these as well as other such costs related to his injury.
JURISDICTION AND VENUE
2. The jurisdiction of this Court is lawful and proper as to Defendants under
the Massachusetts Long Arm Statute (MGL Ch. 223A §§ 3(a - d) and (f).
.Defendants (a)' regularly and routinely transact business in this Commonwealth
by, among other things, selling insurance policies to persons domiciled in
Massachusetts; (b) contract to supply services . in the commonwealth; (c)
caused tortious injury by an act or omission in this commonwealth; (d) caused
tortious injury in this commonwealth by an act or omission outside this
commonwealth; and (f) contracting to insure any person . . . located within the
commonwealth at the time of contracting. Venue. is proper in Middlesex County
because the acts and omissions of the Defendant' s occurred primarily in
Middlesex County and, Plaintiff is Domiciled in Middlesex County.
PARTIES
3. Plaintiff, Mr. Sunny Achulifur, an individual with domicile at 17 Emerson
Street, Apartment 17A, Medford (Middlesex County), Massachusetts, 02155.
4. Defendant, Seven Corners, Incorporated, a corporate entity organized
under the laws of the state of Indiana, with a principal place of business at 303
Congressional Blvd, Cannel, IN 46032.
5. Defendant, Certain Underwriters At Lloyds London Subscribing To Policy
Number IOVLNIO-33915 and/or SRAC5572040G an entity organized under the
1 Section letters correspond to those in MGL Ch. 223A, § 3
2
laws of Great Britain with a principal place of business at 1 Lime St, London,
EC3M 7HA, United Kingdom and a United States office located at 301
Edgewater Place,. Suite: 100, Wakefield (Middlesex County), Massachusetts
01881.
BACKG ROUND
6. On or about 1.5 March 2013, Plaintiff purchased a policy of insurance
from Defendants with effective dates of 17 March 2013 to 17 April 2013.
: 7. On or about 07 April 2013, Plaintiff sustained a fall while in Cameroon,
such fall resulting in damage to his lumbar vertebrae, nerves, and muscles..
8'. Defendant's contend, among other things, that Contract verbiage ,limits
indemnity to only those injuries or illnesses which are diagnosed within one-
hundred-eighty (180) days from-the date. of the accident or onset of the'illness.
9. Notwithstanding the foregoing, Plaintiff sustained in excess of $20,000 in
medical expenses both while in Cameroon and upon return to the USA.
10.- Plaintiff saw numerous specialists regarding ongoing pain due to disc,
nerve, and muscle damage. Plaintiff underwent physical therapy from'various
periods beginning 26 April 2013 through 02 August 2013.
11. Plaintiff consulted with additional medical specialists, including Dr.
Albert Franchi, MD; on 09 October 2013, whose physical examination showed
damaged to the L4-5 section of his spine as well as muscle tenderness at the Si
joint and iliac crest.
12. Notwithstanding that this diagnosis was made within the six (6) month
time limit upon which Defendants rely, Defendants refused to pay any additional
claims for treatment incurred by Plaintiff. Essentially, Defendants' position is
that not only must the injury be diagnosed during the Contractual six.(6) month
period, all treatment must be completed with that same period in order for the
insured to be eligible for indemnification. There is nothing in the Contract which
states such requirement.
13. Ultimately, Plaintiff underwent a series of epidural steroid injections
which yielded unsatisfactory results. Further MRI examination of Plaintiff
revealed a large, right posteriolateral herniation of the L5-S 1 disc which was
impinging (pressing on) the descending Si nerve. It was this damage that was
causing much of Plaintiff's pain.
14. Again, Defendants refused to indemnify Plaintiff for the costs of
treatment, relying primarily on the logic that Contract required all diagnosis and
treatment to be completed within six (6) months of the effective date of Contract.
This reading of Contract is tortuous at best and, self-serving at least.
15. On 02 July 2014, attorney Kenneth Onyema (Cambridge' Lawyers Group)
sent a letter to Defendants, describing both the injuries sustained by Plaintiff and,
the associated costs which Attorney Onyema contended were subject to
indemnification. A true copy of Attorney Onyema's letter to Seven is attached
hereto as Exhibit A
16. Having received no reply to his (Attorney Onyema) letter of 02 July 2014,
Attorney Onyema sent a MGL Ch. 93A Demand Letter [a "93A Demand
Letter"] to Seven on 25 July, 2014. A true copy of this 93A Demand Letter is
attached hereto as Exhibit B.
4
17. On or about 14 August 2014, Seven issued a response to Attorney
Onyema's 93A demand letter contending, essentially, that "only [those] charges
[that] are incurred within one hundred eighty (sic) (180) days from the date of
the accident or onset of illness and which are not excluded, shall be considered
Covered Expenses.". A true copy of Seven's 14 August 2014 response to
Attorney Onyema's 93A demand letter is attached hereto as Exhibit C.
18. Notwithstanding the foregoing, even if taken as true, correct, and
reasonable that Defendant's contention that Contract requires all injury related
treatment be accomplished within six months, Plaintiff was not afforded a copy
of these Contract terms and conditions until a ter (emphasis added) he completed
the purchase of the Contract. This negligent or intentional withholding of critical
Contract limitations.until after Contract is entered into represents fraud in the
inducement of a contract.
19. More specifically to the foregoing Defendant's non-disclosure of a fact
known to him/her is equivalent to an assertion that the fact does not exist where
he knows that disclosure of the fact would correct a mistake of the other party as
to a basic assumption on which that party is making the contract. Ari assertion
that is not in accord with the facts is a misrepresentation. Further, a
misrepresentation is fraudulent if the maker of the assertion intends his assertion
to induce a party to enter into the contract. And, a misrepresentation is material
if it would be likely to induce a reasonable person to assent to the contract. Had
Plaintiff known that this.policy would not provide the coverage he was seeking,
5
he would have had the ability to knowingly.either accept or reject such
limitations
20. The reasonable basic assumption that Plaintiff made when entering into
Contract was that if he were injured, Contract would provide coverage
(indemnification) for costs required to resolve the medical problem to the fullest
extent reasonable. That the Defendants negligently or intentionally withheld this
information from Plaintiff constitutes fraud in the inducement of a contract.
21. As a result of Plaintiffs' 'fraud in the inducement of a contract, Defendant
has accrued more than $20,000 in direct medical expenses. As well, -because
Defendants' refused to further indemnify Plaintiff, Plaintiff incurred in excess of
$41,000 in lost wages due to his inability to work, coupled with the fact that he
could not obtain the treatment that would have allowed him to return to work
because of Defendants' refusal to indemnify.
22. Because of Defendants' willful disregard of its duties under Contract,
Plaintiff continues to endure pain and suffering; he cannot sit or walk-for more
than a few minutes without enduring substantial pain.
23. Further to the above,,because Defendant has refused further.
indemnification under Contract, Plaintiff has been unable to obtain the. surgical
intervention that has been recommended by his physician and, which his
physician has indicated will resolve Plaintiff's pain and physical limitations
24. ' Defendants' have breached the doctrine of reasonable expectations for a
policy of insurance. The doctrine of reasonable expectations for a policy of
insurance provides that the objectively reasonable expectations of applicants and
6
intended beneficiaries regarding the terms of insurance contracts will be honored
even.though painstaking study of the policy provisions would have negated those
expectations.
25. Even if it is accepted as true that the terms and conditions of Contract
were made available to Plaintiff by Defendant at the time of purchase of
Contract, .merely providing such terms and conditions is insufficient.
Defendants' point to Contract language that they claim limits their liability to
180 days from the date of occurrence of the injury.
26. The (objectively) reasonable expectation of an insured such as Plaintiff, is
that when entering into a policy for insurance (indemnification) against injuries,
that such policy will cover the usual and customary costs of treating such injury
until it is resolved to the fullest extent medically possible, given the nature of the
injury.
27. Notwithstanding that Defendants' point to a contractual term that
purportedly limits their liability to six months, what controls in-this analysis is
not what Defendants' claim to be objectively reasonable. Rather, what controls
here is what an objectively reasonable insured such as Defendant would expect
when entering into a contract for health insurance
COUNT ONE
Fraud in the Inducement of a Contract
28. Plaintiff incorporates by reference all the allegations of his complaint.
29. Defendants' sold Contract to Plaintiff online through its agent in.fact,
"insuremytrip.com." A true copy of the "Confirmation of Coverage"
[Confirmation] is attached hereto as Exhibit D. .

30. Although Confirmation lists some of the information typically found on an
insurance coverage summary page, Confirmation fails to point out the 180• day
limitation within Contract upon which Plaintiff now relies in order to deny
coverage.
31.. Further, while Confirmation contains hyperlinks to important information
such as "Plan Terms," this and hyperlinks to information critical, to the
purchasing decision,were made available to Plaintiff only after Plaintiff
purchased Contract.
32. Because material information upon which a purchasing decision would be
made was purposefully withheld from Plaintiff until a ter (emphasis added)
purchase of Contract, Defendants are liable for fraud in the inducement of a
contract.
COUNT-TWO
Breach of the Doctrine of Reasonable Expectations of a.Contract for Insurance
34. Plaintiff entered into Contract with the objectively reasonable expectation-
that if he were-injured during his trip, Defendants would'indemiiify the costs of
treating any such illness. -
35.. Defendants point to Contract language that, limits indemnification to 180
'days from the occurrence of the illness or injury. Defendants have relied on such
language to repeatedly deny indemnification to Plaintiff.
36. Under the doctrine of reasonable expectations, the objectively reasonable
. expectations of applicants and intended beneficiaries (emphasis added)
regarding the terms of insurance contracts will be. honored even though
painstaking study of the policy provisions would have negated those
expectations..
37. Ignoring for the moment that Plaintiff was not presented with the terms
and conditions of Contract until after he purchased it, an objectively reasonable
international traveler who is purchasing accident and injury insurance for his/her
trip would expect that such insurance would indemnify any illness or injury until
it had been treated to the, best extent possible, given the nature of the illness or
injury and, the current limits of medical technology. V
38. Defendants' interpretation of Contract language as relates to this issue is
entirely. irrelevant. Interpretation related to this doctrine is based on an''
objectively reasonable purchaser acting in a manner similar to that of Plaintiff.
.39. Therefore, because an objectively reasonable purchaser of travel insurance.
would expect such insurance to cover the costs of full treatment.of an injury,
Defendants have breach the doctrine of reasonable expectations
40. As a result of Defendants' breach as described above, Plaintiff has
suffered both financial damage as well ongoing pain and suffering. V
COUNT THREE,
Breach of the Implied Covenant of Good Faith and Fair Dealing
42.. All contracts, regardless of their nature (e.g., whether for services or
goods) carry with them an implied covenant of good faith and fair dealing. This
covenant-can.not be disclaimed by either (or both) party for public policy reasons.
43. By their actions as described above, Defendants have breached the
covenant of good faith and fair dealing that is implied:in every contract.
9
44. As a result of Defendants' breach, Plaintiff suffered financial damage as
well as ongoing pain and suffering.
COUNT FOUR
Violation of M.G.L. ch. 93A, § 9
46. Defendants have engaged in unfair and deceptive acts while engaged in
the conduct of trade or commerce in the. Commonwealth of Massachusetts. The
unfair and deceptive acts involve, but are not limited to fraud in the inducement
of a contract, breach of the doctrine of reasonable expectations for a contract of
insurance, breach of the implied covenant of good faith and fair dealing.
47. Defendant' s unfair and deceptive acts.and practices were done knowingly,
intentionally, and willfully, in violation of M.G.L. ch. 93A, § 9
•48. Defendant's were sent a 93A Demand Letter on 25 July 2014 and given
the 30 days required under this statute to negotiate a reasonable settlement
however, Defendants knowingly, intentionally, and willfully refused to reply to
this demand letter and/or, attempt to negotiate a settlement.
COUNT FIVE
Unjust Enrichment
50. Defendants knowingly, intentionally, and willfully caused a policy for
insurance to be issued under fraudulent circumstances (fraud in the inducement)
and, notwithstanding such fraud, took payment from Plaintiff for this insurance.
51 . • Asa result, Defendants have been unjustly enriched.
10
WHEREFORE, Plaintiff respectfully requests that this Court:
A. Enter judgment in favor of the Plaintiff on his claims against
Defendants for the damages sustained by Plaintiff, plus costs, attorneys' fees, and
interest;
B. Award treble the damages to Plaintiff pursuant to Mass. Gen. L.
ch. 93A, and award Plaintiff his reasonable attorneys' fees; and
C. Grant such additional relief as the Court may deem appropriate and
just.
J UR Y DEMAND
Plaintiff hereby demands a trial by jury on all issues so triable.
11
SIGNED under the pains and penalties of perjury.
DATED: 05 April 2015 Respectfully submitted,

SUNNY ARCHULIFUR
By his attorney
Singer, E
BBO # 684240
ProVobis Law Group
5 Tannery Brook Row, Ste 5
Somerville MA 02144
T: 831-232-0092
E: Lsinger@provobislaw.com
CERTIFICATE OF SERVICE
1, Larry J Singer, hereby certify that I have served a true copy of the foregoing
PLAINTIFF'S COMPLAINT AND JURY TRIAL DEMAND upon Defendant Seven
Corners Incorporated as of the date stated below.
Uw Sing( EX s q. /D ate
BBO # 684240
I, Larry J Singer, hereby certify that I have served a true copy of the foregoing
PLAINTIFF'S COMPLAINT AND JURY TRIAL DEMAND upon Defendant Certain
Underwriters At Lloyds London Subscribing To Policy Number IOVLN 10-33915 and/or
SRAC5572040G as of the date stated below.
.eEt
Lang J Sing&, Esq./Date
BBO # 684240
12.
rE P, ESC
Counselors at Law
BOSTON OFFICE WORCESTER OFFICE LOWELL OFFICE

185 Devonshire Street 340 Main Street 144 Merrimack Street
Suite 302 Suite 800 Suite 401
Boston, MA 02110 Worcester, MA 01608 Lowell, MA 01852
508-753.0668 phone 508-753-0668 phone 978454-0666 phone
508-7534085 fax 5008-753-4085 fax 978454.2066 fax
July 02. 2014
Seven Corners, Inc.

Claims Department
303 Congressional Blvd
Carmel, IN 46032
RE: Our Client: Sunny Achulifur

Certificate #: 10VLN10-33915
DOL: 04/07/2013
Dear Sir/Madam:
As you are aware, this office represents the legal interests of the above-named
claimant, Sunny Achulifur, in'connection with personal injuries he sustained as a result of
a fall on April 07, 2013. Please find enclosed medical records and bills relative to Mr.
Achulifur's injuries.
LIABILITY
The aforementioned incident occurred on April 07, 2013 while Mr. Achulifur was
on vacation in a village in Cameroon. He had a fever and was feeling weak. He went
outside and slipped landing on his back.. This resulted in severe physical pain and injury
to his person, thereby causing him to incur medical expenses.
MEDICAL EXPENSES
1. Star Physical Therapy: $4,835.00

2. Hallmark Health Medical Association: $4,971.57
3. North Suburban Ortho Assoc $575.00.
4. New England Spine Care Associates $5,520.00
5. George Feltin, MID • $1,120.00
1
Counselors at Law

50&753.0668 phone 508-753-0668 phone 978454.0666 phone
508-753-4085 fax 508-753.4085 fax ' 978-454.2066 fax
INJURIES
As a result of -the accident, Mr. Achulifur was transported to a hospital for

treatment due to complaint of pain from his waist evolved through to his buttocks and
then down his right leg. X-rays were taken, and he was prescribe medication to for
malaria and cholera.
When the pain persisted Mr. Achulifur sought further with his primary care
physician, George Felton, MD. He was prescribed Ibuprofen and referred to physical
therapy.
At Star Physical Therapy, Mr. Achulifur underwent evaluation and was diagnosed
with Lumosacral Sprain, Cervical Strain/Sprain, and Thoracic Strain/Sprain. Mr.
Achulifur was put on physical therapy treatment which consisted of endurance, and
strengthening programs, exercises, and therapeutic massages, with the intent to return to
previous level of physical activities without pain, or any limitations. Mr. ' Achulifur
underwent physical therapy treatment three (3) to two (2) times a week for several
sessions between April 26, 2013 and August 02, 2013.
On October 9, 2013, Mr Achulifur was seen at North Suburban Ortho Associates
by doctor Albert Franchi, MD due to complaints of right sided lower back pain' with
radiation and numbness to his right leg. His physical exam showed parasthesias in the
right L5 dermatome with some generalized tenderness at the L4-5 area of his low back
and tenderness .at the right Si joint and right iliac crest. He was diagnosed with
Lumbosacral and right Si strain.. He was referred for an MRI to rule out a herniated
disc.
Mr Achulifur was seen again on 10/30/2013 by doctor Albert Franchi, MD. His
physical exam still reveals paresthesias over the right Si dermatome. He was diagnosed
with large right posterolateral herniation of the L5-S1 disc which deflect the
descending right Si nerve. He was prescribed Flexeril lOmr and referred to nhvsical
Counselors at Law
BOSTON OFFICE WORCESTER OFFICE LOWEL L OFFICE

Boston, MA 02110 Worcester, MA 01608 Lowell,MA 01852
508.753.0668 phone. 508.753.0668 phone 978,4540666 phone
508.7534085 fax 508.753.4085 fax 978454-2066 fax
therapy. Albert Franchi, MD recommends surgical intervention if claimant does not

improve with PT. Claimant was seen on 11/20/2014 complainig of pain and paresthesias
in 'his right leg. He was prescribed percocet 5mg. Mr Achulifur was seen on December
12, 2013 for status. He is still getting radiating pain and numbness in his right leg. His
physical exam still shows paresthesias over the right Si dermatome, and the deep tendon
reflexes are. still equal. He was prescribed percocet 5mg and referred for evaluation for
epidural steroid injections.
On January 8, 2014, Mr Achulifur was seen at New England Spine Care
Associates by doctor Robert A. Rosenberg, MD due to complaint of pain in his right low
back area radiating laterally to his thigh and down to his right lateral thigh with
tingling distally near his ankle, unable to walk for a long time and unable to sit for a
long time without changing position, he has to have his right leg flexed when he lies
down on his back, flexes his right lower extremities when he lies prone and have
difficulty sleeping. His physical assessment showed mild tenderness on the right sciatic
notch verus the left, pain in the right low back area through buttocks and proximal
posterior thigh with lumber flexion and fingertips below knees, worst pain with right
lateral rotation with the pain going down to his calf, pain at the proximal thigh with left
lateral flexion greater than right with left lateral rotation, painan the right posterior thigh with
knee extension combined with ankle plantar flexion and also with dorsiflexion, increased
pain in the posterior thigh In supine straight leg raise on the right at 40 degrees. He was
diagnosed with Si radiculopathy. Robert A. Rosenberg, MD recommend claimant to
undergo trial of epidural steroid injection.
Claimant was seen on 01/09/2014 by Dr.German Levin ASC, MD who performed
series of procedures after anesthesia was obtained. Mr. Achulifur was given epidural
steroid injection.
3
Counselors at Law
Boston,MA 02110 Worcester, MA 01608 Lowell, MA 01852
508.753-0668 phone 508.753.0668 phone 978-454-0666 phone
508.753.4085 fax 508-753.4085 fax 97&454.2066 fax

steroid injection
Mr. Achulifur was seen on 06/05/2014 by George Felton, MD due to pain in the.
right rhomboid muscle which radiates into the axilla down the right triceps if he brings
his shoulder backward and in extension or anteriorly in abduction. Right-sided low back
pain got better with epidural steriod injection.
LOSS OF EARNING
At the time of the accident, claimant was employed with Cambridge Checker Cab
and Cambridge Cab Inc. as an independent Cab driver. Due to the injuries he sustained,
he was unable to work for a total of 9 Months. After 9 months of total disability,
claimant is currently working about 15 hours a week. He is unable to sit, stand or walk
for any extended length of time. At that time of the incident, he was earning
approximately $55,200 per annum. Accordingly, claimant's loss of earnings claim is
$41,400+.
CONCLUSION
Prior to the accident, Mr. Achulifur was a healthy forty-three (43) year old man.
However, as a result of this accident, Mr. Achulifur sustained personal injuries and
extensive pain and suffering that affected his ability to work and carry out his normal
everyday duties.
Claimant has suffered damages due to the significant loss of enjoyment of life,
pain and suffering that she experienced. Taking into consideration the liability factors,
pain and suffering, due to the nature of the injuries sustained, we value our client's claim'
4
Counselors at Law
Ie,
BOSTON OFFICE . WORCESTER OFFICE LOWELL OFFICE
508-753.0668 phone 508-753-0668 phone 978.454-0666 phone
508-753.4085 fax 508.753-4085 fax 978454.2066 fax
in the amount far beyond your policy limits however, she can be persuaded to accept a
settlement offer that would be fair and reasonable.
We hope you' will be mindful of your duties under Insurance Law of

Massachusetts, particularly with regard to those provisions requiring prompt and fair .
settlement when liability is reasonably clear. M.G.L. Cap 176D §3(9)(m). See: Ho kins
v. Liberty Mutual Insurance Co., 434 Mass. 556, 750 NE2d 943 x(2001). [A claim
against an insurance company for unfair settlement practices arising from a single act can
constitute an actionable violation of Chapter 176D and Chapter 93A].
We thank you'in advance for your anticipated cooperation.
Very truly yours,
Kenneth Onyema, Esq.

Enclosures
5
Case 1:16-cv-11189-FDS Document
k<!/,r3if .B 1-1 Filed 06/22/16 Page 18 of 30
CA M
Counselors at Law

Boston, MA 02110 Worcester, MAO 1608 Lowell, MA 01852
508-753-0668 phone 508.753-0668 phone 978454-0666 phone
508.753-4085 fax 508.753-4085 fax 978.4542066 fax
July 25 2014
Seven Corners, Inc.

Claims Department
303 Congressional Blvd
Carmel, IN 46032
RE: Letter of Representation and Request to Adjust A Claim

Our Client: Sunny Achulifur
Certificate #: 10VLN10-33915
DOL: 04/07/2013
93A DEMAND LETTER

Dear Sir/Madam:
As you are aware, this office represents the legal interests of the.above-named
claimant, Sunny Achulifur, in connection with personal injuries he sustained as a result of
a fall on April 07, 2013. We are writing to you under the provisions of Massachusetts
General Laws, Chapter 93A, Section 9, the Consumer Protection Act, to request relief on
behalf of our client Sunny Achulifur as outlined'in that statute. As a threshold matter, do
not contact our client directly again about this matter.
The aforementioned incident occurred on April 07, 2013 while Mr. Achulifur was
on vacation in a village in, Cameroon. He had a fever and was feeling weak. He went
outside and slipped landing on his back.. This resulted in severe physical pain and injury
to his person. His medical bills amounted to $20,521.57.
As has been already detailed to you in previous demand letters, his injuries .
included:
Counselors at Law

Suite 302 Suite 800 Suite.401
508.753-0668 phone 508-753-0668 phone 9784544666 phone
508753-4085 fax 508.753-4085 fa_x 978.454-2066 fax
As a result of the accident, Mr. Achulifur was transported to a hospital for

treatment due to complaint of pain from his waist evolved through to his buttocks and
then down his right leg. X-rays were taken, and he was prescribe medication to for
malaria and 'cholera. '.
When the pain persisted Mr. Achulifur sought further with his primary care
physician, George Felton, MD. He was prescribed Ibuprofen and referred to physical
therapy.
At Star Physical Therapy, Mr. Achulifur underwent evaluation and was diagnosed
with Lumosacral Sprain, Cervical Strain/Sprain, and Thoracic Strain/Sprain. Mr.
Achulifur was put on physical therapy treatment which consisted of endurance, and
strengthening pro grams, exercises, and therapeutic massages, with the intent to return to
previous level of physical activities without pain, or any limitations. Mr. Achulifur
underwent physical therapy treatment three (3) to two. (2) times a week for several
sessions between April 26, 2013 and August 02, 2013.
On October 9, 2013, Mr Achulifur was seen at North Suburban Ortho Associates
by doctor Albert Franchi, MD due to complaints of right sided lower back pain with
radiation.and numbness to his right leg. His physical exam showed parasthesias in the
right L5 dermatome with some generalized tenderness at the L4-5 area of his low back
and tenderness at the right Si joint and right iliac crest. 'He was diagnosed with
Lumbosacral and right S1 strain.. He was referred for an MRI to rule out a. herniated
disc.
Mr Achulifur was seen again'on 10/30/2013 by doctor Albert Franchi, MD. His
physical exam still reveals paresthesias over the right S1 dermatome. He was diagnosed
with large right posterolateral herniation of the L5 -S1 disc which deflect the
descending right S1 nerve. He was prescribed Flexeril 10mg and referred to physical
therapy. Albert Franchi,' MD recommends surgical intervention if claimant does not
.2
LAA '" RS G JP,1. LC:

Cou n selors at Law
BOSTON OFFICE WORCESTER OFFICE LOWELL OFFICE.

185 Devonshire Street 340 Main Street 144 Merrimack Steer
508-753-0668 phone 508-753-0668 phone 978454-0666 phone
508-7534 085 fax 508=7534085 fax 978454.2066 fax
improve with PT. Claimant was seen on 11/20/2014 complainig of pain and paresthesias
in his right leg. He was prescribed percocet 5mg. Mr Achulifur was seen on December
12, 2013 for status. He is still getting radiating pain and numbness in his right leg. His
physical exam still shows paresthesias over the right S 1 dermatome, and the deep tendon
reflexes are still equal. He was prescribed percocet 5mg and referred for evaluation for
epidural steroid injections.
On January 8, 2014, Mr Achulifur was seen at New England Spine Care
Associates by doctor Robert A. Rosenberg, MD due to complaint of p ai n in his right low
back area radiating laterally to his thigh and down to his right lateral thigh with .
tingling distally near.his ankle, unable to walk for a long time and unable to sit for a
long time without changing position, he has to have his right leg flexed when he lies
down on his back, flexes his right lower extremities when he lies prone and have
difficulty sleeping. His physical assessment showed mild tenderness on the right sciatic
notch verus the left, pain in the right low back area through buttocks and proximal
posterior thigh with lumber flexion and fingertips below knees, worst pain with right
lateral rotation with the pain going down to his calf, pain at the proximal thigh with left
lateral flexion greater than right with left lateral rotation, pain an the right posterior thigh with
knee extension combined with ankle plantar flexion and also with dorsiflexion, increased
pain in the posterior thigh In supine straight leg raise on the right at 40 degrees,-.He was
diagnosed with Si radiculopathy..Robert A. Rosenberg, MD recommend claimant to
undergo.trial of epidural steroid injection.
steroid injection. V
3
BOUP,. L LC
Co u n s el o r s at L a w
BOST ON OFF ICE WORCESTER OFFICE LOWELL OFFICE

Suite 302 Suite 800 Lowell,
Suite 401
MA 01852'
Boston, MA 02110 Worcester, MA 01608
508.753-0668 phone 508-753-0668 phone 978-454-0666 phone
508.75344085 fax 508-753-4085 fax 978-4542066 fax `
'Claimant was seen on 02/27/2014 by Dr.German Levin ASC, MD who .performed

series of procedures after anesthesia was obtained.. Mr. Achulifur was given epidural
steroid injection
Mr. Achulifur was seen on 06/05/2014 by George Felton, MD due to pain in the
right rhomboid muscle which radiates into the axilla down the right triceps if he brings
his shoulder backward and in extension or anteriorly in abduction. Right-sided low back
pain got better with epidural steriod injection.
Despite a good faith requests for adjustment of this claim based on objective
standards used by insurance companies, followed with our phone calls, we offered to
amicably settle at a reasonable amount. However, it has been a month and we have not
yet received any reply; you have made no offer, no attempt to settle this case.
The Unfair Claim Settlement Practices Act, Mass. Gen. L., ch. 176 D, § 3(9),°and
under Mass. Gen. L., ch. 93(A) obligates insurers to make a reasonable offer of
settlement when liability and damages become reasonably clear. Bobbick v. United States
Fidelity and Guaranty Trust, 439 Mass, 652, 659 (2003). Mass. Gen. L.,-ch. 176D, § 3(9)
provides that it is. an unfair claim settlement practice to fail to effect a prompt, fair and
equitable settlement of claims in which liability has become reasonably clear. It is our
belief that your failure to make an offer amounts to-an unfair settlement practice given
the facts of this case. Please note that a violation of Mass. Gen. L., ch. 176D is a violation
of Mass. Gen. L., ch. 93(A), which entitles the injured person to the remedies available,
including the possibility of treble damages and attorney's fees.
Our client has suffered injury or loss of money in an amount in excess of the .
policy, which you refused to disclose, for pain and suffering, lost earnings and emotional
distress and reasonable amount in attorneys' fees to pursue an amicable resolution of his
claim without any success.
This letter serves as our client's request for the following'relief:'
C A B _ -... . . . . . . ' s . `.......

Counselors a t L a w
BOS T ON O FFI CE WORCESTER OFFICE. LOWELL OFFICE

Boston, MA 02110 Worcester, MA 01608 Lowell,'MA 01852
508.753-0668 phone 508-753-0668 phone 978.454-0666 phone
5084534085 fax 508.753=4085 fix 978454.2066 fax
1). Substantial damages for emotional distress.

2). Damages for pain and suffering, lost earnings and future pain and suffering.
3). Attorneys fees. -.
As stated above, my client would be willing to execute a release in favor of your
insured for the policy limit. Demand is made upon you for payment of the amount of
your policy limits. Under the provisions of § 9 Chapter 93A, you are hereby provided
with the opportunity to make a written offer of settlement of this claim within 30 days. If
you fail to make a good faith offer of settlement in response to this request, and this
office shall institute legal action against you and seek double or triple damages,
attorney's fees and costs if the court finds' in our client's favor.
We may be reached at 508-753-0668 between the hours of 9:00a m to 4:00pm
EST. Please forward all correspondences to our Worcester office location, "340 Main
Street Suite 800, Worcester MA 01608". We thank-you and look forward to hearing from
you.
Very truly yours,
Kenneth Onyema, Esq.
5
C
Seven Comers,'Inc. Case 1:16-cv-11189-FDS Document 1-1 Filed 06/22/16 Page 23 of 30
303 Congressional Boulevard CXH� ,L3� G
Carmel, IN 46032 USA
800-335-0811
p:317-575-2652
f: 317-575-2256
www.sevencorners.com
August 14, 2014
Mr. Kenneth Onyema, Esq.

Cambridge Lawyers Group, LLC
185 Devonshire Street, Suite 302
Boston, MA 02110
RE: Insured: Sunny Achulifur

Patient Name: Sunny Achulifur
Policy Number: LON09-090101-01TM-Z
Certificate Number:10VLN10-33915
Date of Accident: 04/07/2013
Dear Mr. Onyema:
This will serve to acknowledge receipt of your correspondence dated July 25, 2014 and
received by Seven Corners, Inc., Claims Department, 303 Congressional Blvd., Carmel, IN
46032 on July 28, 2014 and your telephone call on July 31, 2014 with Claims Director:
Dennis Wood.
Seven Corners is an administrator for Certain Underwriters at Lloyd's London

(Underwriters). This response is on behalf of Seven Corners, Inc. and Underwriters
subscribing to the above referenced policy.
Sunny Achulifur purchased a Liaison International plan on March 15, 2013; with policy
effective dates: March 17, 2013 to April 17, 2013. Please.be aware that this is not a general
health insurance policy, but an interim, limited benefit period, travel medical plan intended
for use while the insured party is away from their home country.
The Liaison International plan was purchased online with InsureMyTrip.com; therefore
Seven Corners, Inc. obtained a copy of your client's online application/purchase
confirmation from InsureMyTrip.com. Mr. Achulifur was provided this information via
confirmation email from lnsureMyTrip.com
Per your telephone call with Mr. Wood, you requested a Personal Injury Protection (PIP)
application for your client; however Seven Corners, Inc. is not a PIP carrier, as we do not
sell this line of business. Sunny Achulifur has completed an Injury and Illness Proof of Loss
form regarding his accidental injuries sustained from a fall.
Seven Corners, Inc. has evaluated the presented claims for medical expenses resulting from
a fall. Claim payments have been issued directly to the member or to the provider per the
471
o-f1ix
S E V E N CORNERS
terms and conditions of the purchased plan. For your review, please see the enclosed
Explanation of Benefit Notices that verifies the claim payment detail.
Policy language that is pertinent to this matter:
Eligibility: Liaison International plan provides coverage for individuals and families
provided You are either:
Class 1: U.S. or Canadian citizens traveling outside the United States
Class 2: Non-U.S. citizens traveling to the United States
Class 3: Non U.S. citizens traveling outside of their Home Country
(No travel inside of the U. S.)
...It is the Insured Person's responsibility to maintain all records regarding travel history,
age and provide any documents to the Administrator, which would verify Eligibility
Requirements... -
** These benefits are only available for Class 1 and/or Class 3, as specified.
DESCRIPTION OF BENEFITS
Medical Expenses: Liaison® International plan shall pay Reasonable and Customary
charges for Covered Expenses, excess of the chosen Deductible and Coinsurance up to the
selected Medical Maximum, incurred by You due to an Accidental Injury or Illness which
occurred during the Period of Coverage outside Your Home Country (except as provided
under the Home Country Coverage). All bodily disorders existing simultaneously which are
due to the same or related-causes shall be considered one Disablement. If a Disablement is
due to causes which are the same or related to the cause of a prior-Disablement, the
Disablement shall be considered a continuation of the prior Disablement and not a separate
Disablement. The initial treatment of an Injury or Illness must occur within thirty (30) days
of the date of Injury or onset of Illness.
Only such expenses which are specifically enumerated in the following list of charges are
incurred within one hundred eighty (180) days from the date of accident or onset of Illness
and which are not excluded, shall be considered Covered Expenses...
In review of Mr. Achulifur's presented claim documents, it was found that there was no
plan coverage for the medical services provided to the insured party on March 11, 2014.
Medical expenses that are not incurred within one hundred eighty (180) days after the date
of the accident are not covered by the Liaison International plan. -
Should you have any further questions, please contact me directly; thank you for your time
and cooperation in this matter.
SEVENC0RNER5
3borah Jackson To:11r.Case
Kenneth Document 1-1 Filed 06/22/16 Page11:81
Onyema,. Esq. (15087534085)
1:16-cv-11189-FDS 25 of08/14/14 EST Pg 4-51
30
Sincerely;
Deborah Jackson
ClaimsAnalyst
Enclosures: Policy; Explanation of Benefit Notices; Online Application/ Purchase

Confirmation
;E vt .t' C O W,Vn7,
Dear Sunny M Achutifur,
Thank you for your purchase from InsureMyTrip and Seven Corners. Your credit card has been
charged $61 .76 for the Liaison International plan.
Please be sure to review the details of Your plan thoroughly and contact us if you have any
questions about your coverage. Below you'll find a summary of your benefits, as well as important
contact information. Since you may need these contact numbers while on your trip, we suggest
you print this email in full and keep it with you while traveling. You may also consider printing the
details of your plan to carry with you.
...It-has been'our please

for taking us with you!
InsureMyTrip.com
customercareCinsuremYtrip.cbm
800-487-4722 (inside U.S.)
+1401-773-9300 (outside U.S.)
Hours: Mon -Fri: 7AM - midnight, Sat-Sinn: 9AM - 9PM (Eastern Time
Order Information
Purchase Date
03/15/2013
Order Number : SRAC557204OG
Plan Name -
Seven Corners Liaison International
Plan Number IOVLNIO-33915
Effective Date
03/17/2013
Expiration Date -.
04/17/2013
Fulfillment
Email
Total Cost :
$61.76
Customer Information
Insured(s)
Sunny M Achulifur
Address i.. .__....,,...,_ ...... ......_...
17 Emerson st,
ApT #17A
Medford, Massachusetts 02155
Daytime Phone
857-251-6330
Evening Phone
857-251-6330
Email Address
W a nmalex@yahoo.com
Coverage Information
For detailed coverage information, click any of the links below.
Company
% _qp
f i D
SEVEN CORNERS
Plan Name
- Liaison International !
Plan Terms
Full Details
Plan Type
Sin lg e_Trip Medical
Total'Policy Cost 61.76
Available to
Travelers from Any Country - No U.S. Visit
Customer Rating
118 plan reviews
Trip Interruption .
$5.000 max.
Travel Baggage Q 2
Medical $100,0002
Complications of
Pregnancy Not Available
Terrorism --
Not Available
Dental
500 max: 2
Emergency Medical
12yacuation $300 004 2
24-Hour Emergency
Assistance Yes
Sudden Recurrence
of Pre-Existing S Citizens Only Outside U.S. and Canada $20,000 max.
g
Conditions
Pre-Existing
Condition Period 1 Year (U.S. Citizens)
3 Years (Non-U.S. Citizens)
Renewable
es
Insurance Company
Llo3d s
A.M. Best Rating
Refund Policy prior to Effective Date
Accidental Death -
24-Hour $25.000 max.
Accidental Death -
Common Carrier $50,000 max.
Accidental Death -
Included in Accidental Death - Common Carrier
Flight
Policy Fulfillment
Email .
Additional Options $250 ded.
Additional Notes
ffl= Coverage Limitations 2 = Secondary Coverage

Coverage limits are per person. Plan cost is for all persons.
Beneficiaries
Beneficiary Name Relationship
Jazmyn N Achulifur Dependent
1-rip D e t a i l s
Primary Destination -
Cameroon
Departure Date ;
03117/2013.
Return Date
04/17/2013
Initial Trip '

Payment Date 0311 S/2013
Tour Operator
None
Airline
Air France
Cruise Line
.. None
Provider Information
Address s Seven Corners

303 Congressional Blvd.
Carmel, IN 46032
Claims • • Claims
o (800) 335-0477
o (317) 818-2808 (If overseas, call collect.)
• 24 Hour Emergency Assistance

o (800) 690-6295
o (317) 818-2808 (If overseas, call collect.)
o assistA@s, evencorners.com
• Mailing Address
o Seven Comers
303 Congressional Blvd.
Carmel, IN 46032
Underwriter
Coverage is underwritten by Certain Underwriters at Lloyd's
Innsuranrc potic.ics purrhascd tror In.,weMyTr'ip,corn are sold by IMT'Serv icos Cu uraU n; an instm nCO agency
bas d in V arwick, Rhode [stand, USA.
- • %ddress .,.. •• . .
InsuieMyTrip.boni:-::.:.
100 CommerceDrive.:::
Warwic1C=RI'02886'USA'-: -
Customer Care
800-487-4722 (inside U.S)
+1401-773-9300 (Outside U.S.)
customercare tr.insuremytrip.com
Hours (Eastern Time)

Monday-Friday: lam - midnight
Saturday-Sunday: gam - 9pm
® 2014 IMT Services Corporation
GN009363-2
TO PLAINTIFF'S ATTORNEY: PLEASE CIRCLETYPE OF ACTION INVOLYI 111L
TORT- - MOTOR VEHICLE TORT CONTRACT
EQ UITABLE RELIEF -OTHER
COMMONWEALTH OF MASSACHUSETTS
SUPERIOR COURT
DEPARTMENT
...... MIDDLESEX , ss
OF THE
TRIAL COURT
CIVIL ACTION
No.
... . ... : 'NV MAIM laintiff(s)
V.
.... 'Defendant(s)
SUMMONS
To the above-named Defendant:

You are hereby summoned and required to serve upon .... ? . . . G'D,Q!Y '.` , rN .
VA -A KY Z'Z plaintiff's attorney, whose address is

. ....A. answer to the complaint which is herewith
99
served upon you, within 20 days after service of this summons upon you, exclusive of the day of service. If you
fail to do so, judgment by default will be taken against you for the relief demanded in the complaint. You are also
required to.file your answer to the complaint in the office of the Clerk of this court at . -4 .. ... x . . . . : Y! . ( .
a�•G
.. /. 9 ..............................:................... either before service upon plaintiff 's attorney or within a
I� reasonable time thereafter.
- - - . Unless-otherwise-provided-by-Rule-13(a); your-answer=must=state-as=a-countercleiiti-any-claim-which-you-may - ---
have against the plaintiff which arises out of the transaction or occurrence that is the subject matter of the plaintiff's
F: I
claim or you will thereafter be barred from making such claim in any other action.
zt Witness,Judith Fabricant, Esquire, at... `. x ........................................................
the ....... . . . . .,t ....
?- ............. .................... day of ..J .................................................
...................... in the year of our Lord . . . , 2. / ........................ .....
-jDeputySheriffSuffolk County
Clerk
NOTES. . •
1. This summons is issued pursuant to Rule 4 of the Massachusetts Rules of Civil Procedure.
2. When more than one defendant is involved, the names of all such defendants should appear in the caption. If it separate summons is used
for each defendant, each should be addressed to the particular defendant.
FOAM NO. S UP . - tWt

PROOF OF SERVICE OF PROCESS
I hereby certify and return that on ..........................................................................................

20........., I served: a copy of the within summons, together with a copy of the complaint in this action,
upon the within-named defendant, in the following manner (See Mass. R. Civ. P. 4 (d) (1-5)):
..........................................................................................................................................
Dated: ................ : ... .............................................................. ...., 20 ....... :..
N.B. TO PROCESS SERVER:

PLEASE PLACE DATE YOU MAKE SERVICE ON DEFENDANT IN THIS BOX
ON THE ORIGINAL AND ON COPY SERVED ON DEFENDANT.
( )
................................................ 20......... )
Case
Case 1:16-cv-11189 Document
1:16-cv-11189-FDS 1-31-3Filed
Document 06/22/16
Filed 06/22/16Page 1 of1 2of 2
Page
JS 44 (Rev. 11/15) CIVIL COVER SHEET
The JS 44 civil cover sheet and the information contained herein neither replace nor supplement the filing and service of pleadings or other papers as required by law, except as
provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is required for the use of the Clerk of Court for the
purpose of initiating the civil docket sheet. (SEE INSTRUCTIONS ON NEXT PAGE OF THIS FORM.)
I. (a) PLAINTIFFS DEFENDANTS

Sunny Achulifur Seven Corners, Inc. and Certain Underwriters at Lloyd's, London
Subscribing to Policy Number LON09-090101-01TM-Z
(b) County of Residence of First Listed Plaintiff Middlesex County of Residence of First Listed Defendant
(EXCEPT IN U.S. PLAINTIFF CASES) (IN U.S. PLAINTIFF CASES ONLY)
NOTE: IN LAND CONDEMNATION CASES, USE THE LOCATION OF
THE TRACT OF LAND INVOLVED.
(c) Attorneys (Firm Name, Address, and Telephone Number) Attorneys (If Known)
Larry J. Singer, Esq., ProVobis Law Group, 5 Tannery Brook Row, Suite Thomas B. Farrey, III, Burns & Farrey, PC, 446 Main Street,
5, Somerville, MA 02144 tel: 831-232-0092 Worcester, MA 01608 tel: 508-756-6288
II. BASIS OF JURISDICTION (Place an “X” in One Box Only) III. CITIZENSHIP OF PRINCIPAL PARTIES (Place an “X” in One Box for Plaintiff
(For Diversity Cases Only) and One Box for Defendant)
u 1 U.S. Government u 3 Federal Question PTF DEF PTF DEF
Plaintiff (U.S. Government Not a Party) Citizen of This State u 1 u 1 Incorporated or Principal Place u 4 u 4
of Business In This State
u 2 U.S. Government u 4 Diversity Citizen of Another State u 2 u 2 Incorporated and Principal Place u 5 u 5
Defendant (Indicate Citizenship of Parties in Item III) of Business In Another State
Citizen or Subject of a u 3 u 3 Foreign Nation u 6 u 6

Foreign Country
IV. NATURE OF SUIT (Place an “X” in One Box Only)
CONTRACT TORTS FORFEITURE/PENALTY BANKRUPTCY OTHER STATUTES
u 110 Insurance PERSONAL INJURY PERSONAL INJURY u 625 Drug Related Seizure u 422 Appeal 28 USC 158 u 375 False Claims Act
u 120 Marine u 310 Airplane u 365 Personal Injury - of Property 21 USC 881 u 423 Withdrawal u 376 Qui Tam (31 USC
u 130 Miller Act u 315 Airplane Product Product Liability u 690 Other 28 USC 157 3729(a))
u 140 Negotiable Instrument Liability u 367 Health Care/ u 400 State Reapportionment
u 150 Recovery of Overpayment u 320 Assault, Libel & Pharmaceutical PROPERTY RIGHTS u 410 Antitrust
& Enforcement of Judgment Slander Personal Injury u 820 Copyrights u 430 Banks and Banking
u 151 Medicare Act u 330 Federal Employers’ Product Liability u 830 Patent u 450 Commerce
u 152 Recovery of Defaulted Liability u 368 Asbestos Personal u 840 Trademark u 460 Deportation
Student Loans u 340 Marine Injury Product u 470 Racketeer Influenced and
(Excludes Veterans) u 345 Marine Product Liability LABOR SOCIAL SECURITY Corrupt Organizations
u 153 Recovery of Overpayment Liability PERSONAL PROPERTY u 710 Fair Labor Standards u 861 HIA (1395ff) u 480 Consumer Credit
of Veteran’s Benefits u 350 Motor Vehicle u 370 Other Fraud Act u 862 Black Lung (923) u 490 Cable/Sat TV
u 160 Stockholders’ Suits u 355 Motor Vehicle u 371 Truth in Lending u 720 Labor/Management u 863 DIWC/DIWW (405(g)) u 850 Securities/Commodities/
u 190 Other Contract Product Liability u 380 Other Personal Relations u 864 SSID Title XVI Exchange
u 195 Contract Product Liability u 360 Other Personal Property Damage u 740 Railway Labor Act u 865 RSI (405(g)) u 890 Other Statutory Actions
u 196 Franchise Injury u 385 Property Damage u 751 Family and Medical u 891 Agricultural Acts
u 362 Personal Injury - Product Liability Leave Act u 893 Environmental Matters
Medical Malpractice u 790 Other Labor Litigation u 895 Freedom of Information
REAL PROPERTY CIVIL RIGHTS PRISONER PETITIONS u 791 Employee Retirement FEDERAL TAX SUITS Act
u 210 Land Condemnation u 440 Other Civil Rights Habeas Corpus: Income Security Act u 870 Taxes (U.S. Plaintiff u 896 Arbitration
u 220 Foreclosure u 441 Voting u 463 Alien Detainee or Defendant) u 899 Administrative Procedure
u 230 Rent Lease & Ejectment u 442 Employment u 510 Motions to Vacate u 871 IRS—Third Party Act/Review or Appeal of
u 240 Torts to Land u 443 Housing/ Sentence 26 USC 7609 Agency Decision
u 245 Tort Product Liability Accommodations u 530 General u 950 Constitutionality of
u 290 All Other Real Property u 445 Amer. w/Disabilities - u 535 Death Penalty IMMIGRATION State Statutes
Employment Other: u 462 Naturalization Application
u 446 Amer. w/Disabilities - u 540 Mandamus & Other u 465 Other Immigration
Other u 550 Civil Rights Actions
u 448 Education u 555 Prison Condition
u 560 Civil Detainee -
Conditions of
Confinement
V. ORIGIN (Place an “X” in One Box Only)
u 1 Original u 2 Removed from u 3 Remanded from u 4 Reinstated or u 5 Transferred from u 6 Multidistrict
Proceeding State Court Appellate Court Reopened Another District Litigation
(specify)
Cite the U.S. Civil Statute under which you are filing (Do not cite jurisdictional statutes unless diversity):
28 USC 1332
VI. CAUSE OF ACTION Brief description of cause:
Plaintiffs alleges damages following denial of claim for travel medical plan benefits
VII. REQUESTED IN u CHECK IF THIS IS A CLASS ACTION DEMAND $ CHECK YES only if demanded in complaint:
COMPLAINT: UNDER RULE 23, F.R.Cv.P. JURY DEMAND: u Yes u No
VIII. RELATED CASE(S)
(See instructions):
IF ANY JUDGE DOCKET NUMBER
DATE SIGNATURE OF ATTORNEY OF RECORD
06/22/2016 /s/ Thomas B. Farrey, III
FOR OFFICE USE ONLY
RECEIPT # AMOUNT APPLYING IFP JUDGE MAG. JUDGE

JS 44 Reverse (Rev. 11/15) Case
Case 1:16-cv-11189 Document
1:16-cv-11189-FDS 1-31-3Filed
Document 06/22/16
Filed 06/22/16Page 2 of2 2of 2
Page
INSTRUCTIONS FOR ATTORNEYS COMPLETING CIVIL COVER SHEET FORM JS 44
Authority For Civil Cover Sheet
The JS 44 civil cover sheet and the information contained herein neither replaces nor supplements the filings and service of pleading or other papers as
required by law, except as provided by local rules of court. This form, approved by the Judicial Conference of the United States in September 1974, is
required for the use of the Clerk of Court for the purpose of initiating the civil docket sheet. Consequently, a civil cover sheet is submitted to the Clerk of
Court for each civil complaint filed. The attorney filing a case should complete the form as follows:
I.(a) Plaintiffs-Defendants. Enter names (last, first, middle initial) of plaintiff and defendant. If the plaintiff or defendant is a government agency, use
only the full name or standard abbreviations. If the plaintiff or defendant is an official within a government agency, identify first the agency and
then the official, giving both name and title.
(b) County of Residence. For each civil case filed, except U.S. plaintiff cases, enter the name of the county where the first listed plaintiff resides at the
time of filing. In U.S. plaintiff cases, enter the name of the county in which the first listed defendant resides at the time of filing. (NOTE: In land
condemnation cases, the county of residence of the "defendant" is the location of the tract of land involved.)
(c) Attorneys. Enter the firm name, address, telephone number, and attorney of record. If there are several attorneys, list them on an attachment, noting
in this section "(see attachment)".
II. Jurisdiction. The basis of jurisdiction is set forth under Rule 8(a), F.R.Cv.P., which requires that jurisdictions be shown in pleadings. Place an "X"
in one of the boxes. If there is more than one basis of jurisdiction, precedence is given in the order shown below.
United States plaintiff. (1) Jurisdiction based on 28 U.S.C. 1345 and 1348. Suits by agencies and officers of the United States are included here.
United States defendant. (2) When the plaintiff is suing the United States, its officers or agencies, place an "X" in this box.
Federal question. (3) This refers to suits under 28 U.S.C. 1331, where jurisdiction arises under the Constitution of the United States, an amendment
to the Constitution, an act of Congress or a treaty of the United States. In cases where the U.S. is a party, the U.S. plaintiff or defendant code takes
precedence, and box 1 or 2 should be marked.
Diversity of citizenship. (4) This refers to suits under 28 U.S.C. 1332, where parties are citizens of different states. When Box 4 is checked, the
citizenship of the different parties must be checked. (See Section III below; NOTE: federal question actions take precedence over diversity
cases.)
III. Residence (citizenship) of Principal Parties. This section of the JS 44 is to be completed if diversity of citizenship was indicated above. Mark this
section for each principal party.
IV. Nature of Suit. Place an "X" in the appropriate box. If the nature of suit cannot be determined, be sure the cause of action, in Section VI below, is
sufficient to enable the deputy clerk or the statistical clerk(s) in the Administrative Office to determine the nature of suit. If the cause fits more than
one nature of suit, select the most definitive.
V. Origin. Place an "X" in one of the six boxes.

Original Proceedings. (1) Cases which originate in the United States district courts.
Removed from State Court. (2) Proceedings initiated in state courts may be removed to the district courts under Title 28 U.S.C., Section 1441.
When the petition for removal is granted, check this box.
Remanded from Appellate Court. (3) Check this box for cases remanded to the district court for further action. Use the date of remand as the filing
date.
Reinstated or Reopened. (4) Check this box for cases reinstated or reopened in the district court. Use the reopening date as the filing date.
Transferred from Another District. (5) For cases transferred under Title 28 U.S.C. Section 1404(a). Do not use this for within district transfers or
multidistrict litigation transfers.
Multidistrict Litigation. (6) Check this box when a multidistrict case is transferred into the district under authority of Title 28 U.S.C. Section 1407.
When this box is checked, do not check (5) above.
VI. Cause of Action. Report the civil statute directly related to the cause of action and give a brief description of the cause. Do not cite jurisdictional
statutes unless diversity. Example: U.S. Civil Statute: 47 USC 553 Brief Description: Unauthorized reception of cable service
VII. Requested in Complaint. Class Action. Place an "X" in this box if you are filing a class action under Rule 23, F.R.Cv.P.
Demand. In this space enter the actual dollar amount being demanded or indicate other demand, such as a preliminary injunction.
Jury Demand. Check the appropriate box to indicate whether or not a jury is being demanded.
VIII. Related Cases. This section of the JS 44 is used to reference related pending cases, if any. If there are related pending cases, insert the docket
numbers and the corresponding judge names for such cases.
Date and Attorney Signature. Date and sign the civil cover sheet.
UNITED STATES DISTRICT COURT
DISTRICT OF MASSACHUSETTS
1. Title of case (name of first party on each side only) Achulifur v. Seven Corners, Inc.
2. Category in which the case belongs based upon the numbered nature of suit code listed on the civil cover sheet. (See local
rule 40.1(a)(1)).
1. 410,441,470,535, 830',891, 893, 895, R.23, REGARDLESS OF NATURE OF SUIT.
II. 110, 130, 140, 160, 190, 196, 230, 240, 290,320,362, 370, 371, 380, 430, 440, 442, 443, 445, 446, 448, 710, 720,
740, 790, 820*, 840*, 850, 870, 871.
III. 120, 150, 151, 152, 153, 195, 210, 220, 245, 310, 315, 330, 340, 345, 350, 355, 360, 365, 367, 368, 375, 376, 385,
400, 422, 423, 450, 460, 462, 463, 465, 480, 490, 510, 530, 540, 550, 555, 625, 690, 751, 791, 861-865, 890, 896,
899, 950.
*Also complete AO 120 or AO 121. for patent, trademark or copyright cases.
3. Title and number, if any, of related cases. (See local rule 40.1(g)). If more than one prior related case has been filed in this
district please indicate the title and number of the first filed case in this court.
4. Has a prior action between the same parties and based on the same claim ever been filed in this court?
YES NO
5. Does the complaint in this case question the constitutionality of an act of congress affecting the public interest? (See 28 USC
§2403)
YES E l NO V
If so, is the U.S.A. or an officer, agent or employee of the U.S. a party?
YES ❑ NO F I
6. Is this case required to be heard and determined by a district court of three judges pursuant to title 28 USC §2284?
YES NO I /
7. Do all of the parties in this action, excluding governmental agencies of the United States and the Commonwealth of
Massachusetts ("governmental agencies"), residing in Massachusetts reside in the a division? - S Local Rule 40.1(d)).
YES E i NO
A. If yes, in which divisi o all of the non-governmental parties reside?

Eastern Division I Central Division Western Division
B. If no, in which division do the majority of the plaintiffs or the only parties, excluding governmental agencies,
residing in Massachusetts reside?
Eastern Division Central Division Western Division 1-1
8. If filing a Notice of Removal - are there any motions pending in the state court requiring the attention of this Court? (If yes,
submit a separate sheet identifying the motions)
YES NO
(PLEASE TYPE OR PRINT)

ATTORNEY'S NAME Thomas B. Farrey, Ill
ADDRESS 446 Main Street, W orcester, MA 01608
TELEPHONE NO. 508-756-6288
(C at eg or yF or m 3 -2016.wpd I

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Case 1:16-cv-11189-FDS Document 1-1 Filed 06/22/16 Page 1 of 30

MIDDLESEX, ss SUPERIOR COURT

SEVEN CORNERS INCORPORATED, and

purchased by Plaintiff. Plaintiff purchased Contract from Seven Corners,

Incorporated ["Seven"] in order to indemnify himself for costs related to injuries

and related medical expenses-he might sustain during an international (outside

submitted numerous claims to Seven for indemnification of such costs. Further,

suffering by Plaintiff, as'well as loss of earnings. Treating physicians for

Plaintiff have concluded that surgery to repair Plaintiff's affected disc is

appropriate however, Seven has refused claims for indemnification of Plaintiff

for these as well as other such costs related to his injury.

JURISDICTION AND VENUE

2. The jurisdiction of this Court is lawful and proper as to Defendants under

.Defendants (a)' regularly and routinely transact business in this Commonwealth

by, among other things, selling insurance policies to persons domiciled in

Massachusetts; (b) contract to supply services . in the commonwealth; (c)

caused tortious injury by an act or omission in this commonwealth; (d) caused

tortious injury in this commonwealth by an act or omission outside this

commonwealth at the time of contracting. Venue. is proper in Middlesex County

because the acts and omissions of the Defendant' s occurred primarily in

Middlesex County and, Plaintiff is Domiciled in Middlesex County.

3. Plaintiff, Mr. Sunny Achulifur, an individual with domicile at 17 Emerson

Street, Apartment 17A, Medford (Middlesex County), Massachusetts, 02155.

4. Defendant, Seven Corners, Incorporated, a corporate entity organized

Congressional Blvd, Cannel, IN 46032.

5. Defendant, Certain Underwriters At Lloyds London Subscribing To Policy

Number IOVLNIO-33915 and/or SRAC5572040G an entity organized under the

1 Section letters correspond to those in MGL Ch. 223A, § 3

Edgewater Place,. Suite: 100, Wakefield (Middlesex County), Massachusetts

6. On or about 1.5 March 2013, Plaintiff purchased a policy of insurance

from Defendants with effective dates of 17 March 2013 to 17 April 2013.

: 7. On or about 07 April 2013, Plaintiff sustained a fall while in Cameroon,

hundred-eighty (180) days from-the date. of the accident or onset of the'illness.

9. Notwithstanding the foregoing, Plaintiff sustained in excess of $20,000 in

nerve, and muscle damage. Plaintiff underwent physical therapy from'various

periods beginning 26 April 2013 through 02 August 2013.

11. Plaintiff consulted with additional medical specialists, including Dr.

Albert Franchi, MD; on 09 October 2013, whose physical examination showed

joint and iliac crest.

claims for treatment incurred by Plaintiff. Essentially, Defendants' position is

insured to be eligible for indemnification. There is nothing in the Contract which

states such requirement.

13. Ultimately, Plaintiff underwent a series of epidural steroid injections

which yielded unsatisfactory results. Further MRI examination of Plaintiff

causing much of Plaintiff's pain.

14. Again, Defendants refused to indemnify Plaintiff for the costs of

This reading of Contract is tortuous at best and, self-serving at least.

15. On 02 July 2014, attorney Kenneth Onyema (Cambridge' Lawyers Group)

the associated costs which Attorney Onyema contended were subject to

indemnification. A true copy of Attorney Onyema's letter to Seven is attached

attached hereto as Exhibit B.

17. On or about 14 August 2014, Seven issued a response to Attorney

Covered Expenses.". A true copy of Seven's 14 August 2014 response to

Attorney Onyema's 93A demand letter is attached hereto as Exhibit C.

18. Notwithstanding the foregoing, even if taken as true, correct, and

the purchase of the Contract. This negligent or intentional withholding of critical

Contract limitations.until after Contract is entered into represents fraud in the

19. More specifically to the foregoing Defendant's non-disclosure of a fact