In a recent decision in Turnpaugh Chiropractic Health & Wellness Ctr., P.C. v. Erie Ins. Exch., 2023 PA Super 99 (June 8, 2023), the Superior Court of Pennsylvania considered, among other things, whether the Pennsylvania Motor Vehicle Financial Responsibility Laws allow for recovery of attorneys’ fees in first party medical benefits cases involving peer reviews.
In Turnpaugh, the claimant was injured in a motor vehicle accident and sought first party medical benefits under her personal auto policy. Her insurer paid for certain treatment but submitted other bills to a peer review organization for review to determine whether said treatment was reasonable or necessary. The peer review doctor determined that any chiropractic treatment rendered after August 31, 2017, was not reasonable or necessary and the insurer refused to pay for any bills after that date, accordingly. Plaintiff initiated suit alleging that Erie Insurance Exchange improperly referred Plaintiff’s bills for peer review and then used an invalid procedure to wrongfully deny payment of medical bills to Plaintiff. After finding in favor of the Plaintiff, the trial court awarded attorney’s fees and costs in addition to compensatory damages.
The Superior Court reversed the award of attorney’s fees and costs, explaining that plaintiff was not entitled to extracontractual damages pursuant to 75 Pa. C.S.A. §1797 because the Pennsylvania Supreme Court in Herd Chiropractic Clinic, P.C. v. State Farm Mut. Auto. Ins. Co., 64 A.3d 1058 (Pa. 2013) and Doctor’s Choice Physical Med. & Rehab. Ctr., P.C. v. Travelers Pers. Ins. Co., 128 A.3d 1183 (Pa. 2015) held that attorneys’ fees may only be awarded when the insurance provider has not submitted the bills to a Peer Review Organization under the 75 Pa. C.S.A. §1797. The Plaintiff argued that 75 Pa. C.S.A. §1716 and 75 Pa. C.S.A. §1798 allow for independent avenues of extracontractual damages. The Superior Court rejected the argument, explaining that “[l]aws which apply to the same persons or things or the same class of persons or things are in pari materia and, as such, should be read together where reasonably possible.” Therefore, the Superior Court noted, “In light of the ambiguity in Section 1797, we must construe this statutory section together with Section 1798 and 1716 of the MVFRL, as all three sections pertain to the payment of first party benefits under the MVFRL.” In doing so, the Superior Court explained that an insurer does not “refuse to pay” benefits under Section 1798 when it submits a case to peer review. Rather, the insurer employs peer review to conduct a professional assessment of the challenged treatment to determine whether the care is necessary and reasonable consistent with the directive from the MVFRL.
In an effort to not mince words, the Superior Court definitively reiterated the Supreme Court’s holding in Doctor’s Choice that “[t]here is … simply no express statutory authorization for fee shifting on provider challenges to peer-review determinations.” Therefore, the Superior Court rejected the availability of extracontractual damages under 75 Pa. C.S.A. §1716 and 75 Pa. C.S.A. §1798 in cases involving peer reviewed bills and concluded that the trial court erred in awarding attorneys’ fees and costs.
The Turnpaugh decision can be found here.
For additional questions, please contact Regan Curran, Esq., Glen Shikunov, Esq. and/or Scott Tredwell, Esq.
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