Tuesday, June 17, 2014

Attorney's Fees Still Available If Peer Review Process Found Invalid




In their recent May 2, 2014 Opinion in the case of Doctor’s Choice Physical Medicine and Rehabilitation Center, P.C. v. Travelers Personal Insurance Co., No. 1419 MDA 2013, 2014 Pa. Super 92 (Pa. Super. May 2, 2014 Dononhue, J., Allen, J., and Mundy, J.) (Opinion by Mundy, J.), the Pennsylvania Superior Court addressed a case involving attorney’s fees awarded after a peer review process. 

Overall, the court ruled that an insurance company’s reliance upon a peer reviewer’s recommendation to deny claims does not protect that carrier from liability for attorney’s fees if the peer review is ultimately found to be invalid.  

Stated otherwise, the Superior Court ruled that by simply instituting a peer review process before denying a claim did not serve to guarantee that an insurance company would not be liable for attorney’s fees under the Motor Vehicle Financial Responsibility Law.   Rather, the Superior Court construed the relevant language of §1797(b)(4) of the MVFRL to mean that a completed, compliant, and valid peer review determination would be required.  

Anyone wishing to review a copy of this decision may click this LINK.

I send thanks to Attorney Joe Thomas of the Panowicz Law Office in Wilkes-Barre, Pennsylvania for bringing this case to my attention.  

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