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w . v i l l a no va . e du/thir dc ir c uit_2003/205NOT PRECEDE NTIAL UNITED STATES COURT OF APPEALS FO R T HE TH IRD CIR CU IT
No. 02-4353

KATHRYN ROCHE,

Appellant
v. NEW JE RSEY MANUF ACTURER S I NSURANCE COMPANY

ON APPEAL FROM THE UNITED STATES DISTRI CT COURT FOR THE M IDDLE DIST RIC T O F PE NN SY LV AN IA (Dist. Court No. 00-cv- 02051) Distric t Cou rt Judg e: Ho n. M alcolm M uir
Submitte d Under Third Circ uit LAR 34.1(a)

September 11, 2003 Be for e: A LIT O, B AR RY and AM BR O, Circuit Judges
. (Opinion Fi led: Oct ober 15, 2003)

OPINI ON OF THE COURT-2-

AL ITO , Circuit

Judge : After suffering exte nsive i njuri es in an automobile acci dent, Kathry n Roche filed th is action in the U nited S tates D istrict Co urt for the M iddle D istrict of P enns ylvania aga in st New Je rs eyManuf

act ur er s I nsu ra nce Compa ny (“ NJMIC” ) c la imi ng that NJMIC, by fai ling to pay her

insurance clai m, had breached i ts cont ractua l obli gations under an insurance contr act and i ts duty of good fai th. Afte r a bench trial , the Distri ct Court f ound that Roche was entitl ed to $24, 910.44 plus interest fr om NJM IC, that NJMIC had not breached i ts duty of good fai th, and that Roche was not entitled to attorney’ s fees. The District Court concluded that t he amount ow ed to Roche w as limited bythe cost contai nment provis ions of the Pennsy lvania Motor Vehicle Fi nancialResponsibi lit y Act (he rein afte r “A ct 6” ), 75 Pa.C .S.A . § 17 97. I. On appeal, Roche fi rst argues that the cost cont ainment pr ovisi on of Act 6 does not apply to h er situatio n. W e do n ot agre e. Ra ther, w e belie ve tha t the ex plana tion in Pitt sburgh Neurosur gery Assocs., Inc. v. Danner , 733 A.2d 1279 (Pa. Super. 1999) , of the legis lati ve inte nt behind Act 6 strongl y suppor

ts the District Court ’s interpret ation. In Pittsburgh N eurosurge ry , the co urt ob serve d that, “[ i] n enacting § 1797 our legislature sought t o reduce i nsurance premiums by capping medicalcosts. Medical provi ders who treat au tomo bile ac ciden t victims and w ho w ill receive their pa yments f rom certain deline ated f orm s of in suran ce ne cessa rily receive le ss com pens ation f or their s ervice s to-3-

achie ve the legislatu re’s go al. Th e legisla ture in e nactin g this leg islature [ sic] sou ght to favor the general public’ s int erest in reduci ng automobil e insur ance premiums at the expense of heal th care provider s . . . .” Id. at 12 85. Roche argues, however, that 31 Pa. Code § 69. 22(f) al lows fullreimburs ement of her medicalcosts. According to Roche, this regulat ion is substant

ially si milar to Sections 306(f.1) (3)(1) and 319 of the Workers ’ Compensation Act (herei nafter

“WCA ”), 77 Pa. C.S.A. §§ 531(3) (I) and 671 , which the Penn sylvania courts have interpreted to requ ire full reim burse men t of the amo unt p aid by a h ealth c arrier. In m aking this arg um ent, Roche reli es on Villanova Universi ty v. WCAB (Mantle) , 783 A .2d 36 6 (Pa . Com mw . Ct. 2001). However, we do not find the provisi ons of WCA to be subst antia lly simil ar to 31 Pa. Code § 69.22( f) because, among other things, neithe r Secti on 69.22(f) nor any other app licab le reg ulati on c ont ains a su bro gatio n pr ovi sion like t hat f oun d in the W CA
. The subroga tion provision o f Act 6 found at 75 Pa.C .S.A. § 17 20 also do es not supp ort Ro che ’s po sition
. II. Roche contends t hat NJMIC failed t o conform to Pennsy lvania Insuranc e De partm ent R egula tions an d N JM IC’s o wn interna l regula tions b y not pro viding a firstpar ty med ical a ppl icatio n fo rm to Ro che upo n no tifica tion of th e ac cide nt an d injurie s. However, Roche has not i dentif ied anyspecifi c provis ion of the Pennsyl vania Ins urance Department Regulations that NJMIC violated, and our own revi ew of those regul ations-4-

has not di sclose d any s uch requirement. The t esti mony in t he record to which Roche points as indicating such an internal policy at NJM IC also do es not supp ort Roch e’s argu men t. III. Roche’s thi rd argument i s that the Dist rict Court plac ed the burde n of determining the c ost c ont ainm ent a mo unt s pa yable upo n R och e he rself rath er th an u pon NJ M IC. Ho we ver, this a rgum ent is w ithout m erit. The Distric t Cou rt did no t require Ro che to make this determination. R ather, it merely found tha t Roche had no t supplied N JM IC with the requisi te inf

ormation upon whic h it coul d make a determi nation of the amount of the medicalbill s that

were payabl e. IV. Roche’s next argument is that t he District Court

did not pr operlyenforce 75 Pa.C.S. A. § 1716, which provi des in part that “[b]enefi ts ar e overdue i f not pai d within 30 days afte r the ins urer re ceive s reaso nable proo f of th e am oun t of the bene fits.” T his pro visio n als o sta tes th at 12 % inter est w ill acc rue on o ver due ben efits
. Id. The Distri ct Court awarded i nteres t from January 1, 2001. Roche beli eves the date from which interest shoul d have accrued to be earl ier. The determination of when NJMIC received reasonabl e proof of theamount of the bene fits due is one of fa ct. Our examinati on of the Distric t Cou rt’s deter mina tion sh ow s no c lear erro r on its p art. Th erefo re, its determi nation must

stand.-5- V. Roche argues that theDistri ct Court e rred i n its applic ation of Act 6 to her i niti al hos pital izatio n. 31 Pa. C ode § 69 .12 e xem pts c ertai n tre atm ents fro m th e co st lim itatio ns. Th ese treat me nts in clud e ac ute c are a nd s erv ices for life- thre aten ing or u rge nt injurie s. Even where the inj uries are not urgent or l ife-t hreate ning, t

he exemption can applyto the initia l asse ssm ent. See 31 Pa. Code § 69.12. Here, however, there i s no evidence in the record that such an initial assessment was made or that an assessment at this initi al phase ind icate d w heth er R och e’s in jurie s w ere o r w ere n ot lif e-th reate nin g an d ur gen t. Therefore, we conclude that the District Court did not err in applyi ng Act 6 cost contai nment provis ions t o the ini tialhospit aliz ation. VI. Roche argues that theDistri ct Court e rred i n apply ing the l aw of the case. Roche does not i ndicat e what she bel ieves t he law of the cas e to have been or how it became the law of the case. N or does sh e cite any authority to support her arg umen t. We theref ore rejec t this a rgu me nt. VI I. Roche’s next argument is that t he District Court

erred i n awarding only the sum of $21,151.04 and in fai ling to heed what Roche clai ms are admiss ions on the part of NJMIC that the act

ual tot al was $42,672. 56. But the record i ndicat es that NJMIC did not make such admissi ons. The document to which Roche points , NJMIC’s Supplemental-6-

Find ings o f Fa ct and Co nclus ions o f La w, sim ply takes iss ue w ith Ro che’s ow n exh ibit and s tates w hat the correc t unp aid tota l wo uld b e und er this ex hibit. A fter statin g this
cor recte d am oun t, NJ M IC d enie s tha t it ow es th is am oun t. See Ap pellan t’s Ap pend ix Vol. IIat C-8. Therefore, we cannot find t hat the Distri ct Court e rred. VIII. Roch e’s final argum ent is that the District Co urt erred in refusing to awa rd exemplarydamages. Act 6 pr ovides t hat an i nsured may chall enge an insur ance provider ’s ref

usal t o pay for

medical care and that conduct that i s conside red “wanton sha ll be s ubj ect to paym ent o f tre ble d am age s to th e inju red par ty.” 75 Pa. C .S.A . § 1797(b)(4) . Roche argues that NJMIC’s behavi or was a clear example of bad faith and ther efo re v iolat ed § 179 7(b )(4). We have defined bad fai th as a “f rivol ous or unfounded r efusal to pay, lack of investigati on into t

he facts , or a failure to communicat e with theinsure d.” Frog, Swit ch, & M fg. Co. v. Traveler s Ins. Co. , 193 F.3d 742, 751 n.9 (3d Cir . 1999). Here we cannot conclude that such bad f aith was present. NJMIC never denied Roche coverage but rather request ed more information t o make the necess ary cost cont ainment cal culations under Act 6. It did not make frivolous refusal s to paybut conti nued to reque st the proper doc um ents so th at it co uld fulf ill its ob ligat ion s un der its po licy w ith R och e’s s tepf athe r. Accordingly , we find that theDistri ct Court di d not err in deny ing Roche’s cl aim for exemplary damages.-7- IX. We h av e r ev i ew edal l of Ro ch e’ s ar gu me nt s and se e n o g r ou nd s f or r ev er sa l
. We affirm the D istrict Co urt in fu ll.-8-

TO THE CLERK OF THE CO URT: Kindly file the fore going Opinion.

/s/ Sa mu el A . Ali to, Jr. Circuit Judge