Court Opinion

ID: 9762201
Source: CourtListenerOpinion
Date Created: 2023-08-29 02:15:46.177463+00
Date Added: 2024-06-11T07:27:07.306551
License: Public Domain

McEWEN, P.J.E.,
dissenting:
¶ 1 While the author of the majority opinion provides a perceptive expression of rationale, I am compelled to dissent from that erudite analysis of Sections 1716 and 1797 of the Motor Vehicle Financial Responsibility Law (MVFRL), because I believe the statute does bestow a legal right upon medical providers to recover interest on overdue payments from insurance companies. The medical providers provide medical treatment at reduced rates pursuant to the requirements of Section 1797 of the MVFRL, and in an obvious exchange for the imposition of these reduced fees, the legislature has determined that their properly filed claims are to be paid promptly.6
¶ 2 Section 1716 specifically provides, inter alia:
Overdue benefits shall bear interest at the rate of 12% per annum from the date the benefits become due. In the event the insurer is found to have acted in an unreasonable manner in refusing to pay the benefits when due, the insurer shall pay, in addition to the benefits owed and the interest thereon, a reasonable attorney fee based on actual time expended.
75 Pa.C.S. § 1716 (emphasis supplied).
¶ 3 The majority concludes that despite the clear, legally enforceable duty of the carrier prescribed in Section 1716, the legislature could not have meant to sanction a court action for the interest due a medical care provider against an insurer writing motor vehicle coverages in Pennsylvania. The majority so concludes based upon findings that (1) “Section 1797 specifically deals with unpaid bills[,] and overdue bills cánnot be shoe-horned into this section”, *7and (2) the amounts which could be recoverable as interest are such that “it seems unlikely that the legislature intended to encourage a spate of lawsuits for $10.00, especially when it limits the payment of attorney’s fees to a finding [of] unreasonableness in delay of payment.”
¶ 4 However persuasive this rationale of the majority, I am compelled to a differing view, namely that Section 1797 was primarily drafted (1) to establish the maximum permissible charges medical providers could bill for treating patients injured in motor vehicle accidents, 75 Pa.C.S. § 1797(a), see, e.g., Pittsburgh Neurosurgery Asso., Inc. v. Danner, 733 A.2d 1279, 1283 (Pa.Super.1999), appeal denied, 561 Pa. 699, 751 A.2d 192 (2000), and (2) to create an administrative system to efficiently adjudicate challenges by insurers to the reasonableness or necessity of healthcare professionals’ treatments, charges, products; or accommodations provided to individuals injured in motor vehicle accidents. 75 Pa.C.S. § 1797(b). The references to the courts in Section 1797(b)(4), (6) and (7), must, in my view, be read with reference to all of the provisions of Section 1797 and are specifically restricted to disputes involving the reasonableness or necessity of treatment. See: Terminato v. Pennsylvania National Insurance Co., 538 Pa. 60, 70, 645 A.2d 1287, 1292 (1994) (“Nor does the statutory provision [1797(b)] provide a remedy for the nonpayment of medical benefits.”)
¶ 5 Section 1716 on the other hand, requires that benefits be paid within 30 days of receipt of “reasonable proof’. If there is a disagreement as to the reasonableness or the necessity for the services, the insurer must proceed pursuant to Section 1797. If there is no dispute as to the reasonableness or necessity for the treatment, but the bill is paid more than 30 days after the insurer receives “reasonable proof’ of the claim, then pursuant to Section 1716, the medical care provider is owed 12% interest on the bill. While the 12% interest is mandatory, and automatic, the court is given discretion to award “a reasonable attorney fee based upon actual time expended” ... if “the insurer is found to have acted in an unreasonable manner in refusing to pay the benefits when due .... ” 75 Pa. C.S. § 1716 (emphasis supplied).
¶ 6 The majority cites to, and appellant relies upon, the panel decision of this Court in Solomon v. U.S. Healthcare Systems of Pennsylvania, Inc., et al, 797 A.2d 346 (Pa.Super.2002), appeal denied, 570 Pa. 688, 808 A.2d 573 (2002), wherein a panel of this Court studied the Healthcare Act and concluded that summary judgment for the defendant insurer was properly entered on the plaintiffs’ action seeking interest on uncontested medical bills paid more than 30 days after submission, because the statute did not specifically create a private cause of action. While the Motor Vehicle Financial Responsibility Law bears little resemblance to the statute at issue in Solomon, I must, most respectfully, differ with my distinguished colleagues who decided Solomon, since I believe that Solomon (1) misinterpreted the three-pronged test pronounced by the United States Supreme Court in Cort v. Ash, 422 U.S. 66, 95 S.Ct. 2080, 45 L.Ed.2d 26 (1975),7 and (2) overlooked the applicable provisions of the Statutory Construction Act8 in reaching its decision. More specifically, I am mindful of the mandate of Section 1929 of *8the Statutory Construction Act directing that “[t]he provision in any statute for a penalty or forfeiture for its violation shall not be construed to deprive an injured person of the right to recover from the offender damages sustained by reason of the violation of such statute.” 1 Pa.C.S. § 1929 (emphasis supplied).
¶ 7 Nor am I persuaded by the majority that actions by healthcare providers for interest on properly submitted claims not paid within the requisite thirty (30) days would be for de minimis amounts. If a provider were to institute one suit each year against an insurer for all interest due on all claims which the .insurer had failed to pay in timely fashion, substantial sums would likely be at issue. The website of the Pennsylvania Insurance Commission9 provides data gathered on bill payment practices of managed care plans licensed in Pennsylvania, so as to ascertain the level of compliance with the 45-day payment requirement of the Quality Healthcare and Accountability and Protection Act (Act 68). The data collected by the Commission suggests that the failure to timely remit sums due may be a practice rather than an oversight on the part of certain insurers.10 Thus, private actions to recover “interest only” claims will insure that the provisions of the statute are followed by insurers selling policies to Pennsylvania residents.
¶ 8 As I am convinced that the legislature clearly envisioned private actions by healthcare providers for interest due them under the statute, I would affirm the order entered by the trial court per the learned Judge John F. Cherry.

. The statute requires payment within 30 days of receipt of appropriate proof of the claim by the insurer, provided that the claims for uncontested treatments have been properly documented. 75 Pa.C.S. § 1716,

. The three prong test enunciated by the United States Supreme Court in Cort v. Ash, 422 U.S. 66, 95 S.Ct. 2080, 45 L.Ed.2d 26 (1975), was adopted by our Supreme Court in Estate of Witthoeft v. Kiskaddon, 557 Pa. 340, 346, 733 A.2d 623, 626 (1999).

. See Act of December 6, 1972, No. 290 § 3, Pa.C.S. §§ 1501, etseq.

. See: www.insurance.state.pa.us (PA Dept. of Insurance).

. The report, while tabulating the late payments by the insurers, makes no mention of administrative action of any kind by the Insurance Commissioner against any insurers.