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No Reduction of Future Medical Bills Under Pennsylvania MVFRL

November 22, 2019
Paulina Kathopoulis
Posted in: Automobile & Trucking

In a recent decision, a three-judge panel of the Pennsylvania Superior Court ruled 2-1 that the Motor Vehicle Financial Responsibility Law’s (“MVFRL”) cost containment provision does not cap jury awards for future medical expenses. In Farese v. Robinson, No. 145 EDA 2018 (Pa. Super. November 8, 2019), the panel considered many issues raised by the defense, with one of the issues dealing with the MVFRL. The medical cost containment provision of Section 1797 of the MVFRL states that medical providers cannot charge injured insureds more than 110% of what Medicare would pay for comparable services, or the provider’s usual and customary charge; whichever is less. The law also prohibits medical providers from charging insureds for the difference between their full charge and the amount covered by insurance.

The defendants argued that Section 1797 limits the amount of future medical expenses plaintiffs can recover. Judge James Gardener Collins, writing for the majority, used unpublished Superior Court rulings and Middle District federal court decisions to conclude that Section 1797 does not apply to future medical expenses. The panel found the Kansky v. Showman, No. 3:09-cv-1863 (M.D.Pa. April 11, 2011) case to be instructive. In Kansky, the parties argued over the definition of the word “payable” in Section 1797(a)’s provision that medical “providers subject to this section may not bill the insured directly but must bill the insurer for a determination of the amount payable. The Kansky court determined that the word “payable” as used in the statute does not apply to future medical expenses and defendants cannot guarantee that any future expenses will be paid. The Kansky court found that, therefore, plaintiffs’ future medical bills are not “payable” under Section 1797.

Using the Kansky court’s reasoning, the panel, here, likewise found that Section 1797 does not apply to future medical expenses. Judge Collins further noted that the defendants were unable to cite any Pennsylvania case law, and the court itself was unable to find any case law, supporting the proposition that jury awards for future medical expenses in motor vehicle cases should be molded under Section 1797.