The injured person finally won a battle in the ongoing fight against insurance company. Over the course of the last five years, the law in Pennsylvania governing personal injury actions has become increasingly insurance company friendly, making it harder and harder for injured people to be compensated for the negligence of others.
The Pennsylvania Superior Court in Herd Chiropractic Clinic v. State Farm Mutual Insurance recently issued a decision that is very favorable to injured people. The decision of this court specifically dealt with payment of medical bills when someone is injured in a car accident.
In Pennsylvania, when someone is injured in a car accident, regardless of who caused the accident, it is his or her own car insurance that is responsible to pay for any medical treatment for injuries sustained in that accident. When a person purchases car insurance and pays premiums for that insurance, they are paying for coverage for medical insurance in the event of a car accident.
If a person is involved in a car accident and injured, they must then contact their own insurance company and open a claim for what are called First Party Benefits. These First Party Benefits can include medical benefits and potentially wage loss benefits. The insurance company is then required to begin paying for any medical treatment needed as a result of injuries from the car accident.
As can be suspected, the insurance companies, even when you have paid insurance premiums, still do not want to pay for anything, including medical treatment. As a result, the insurance industry lobbied the Pennsylvania Government for certain protections when it comes to paying for medical treatment. As a result, the law states that if an insurance company suspects that the requested treatment is not for injuries resulting from the accident in question, then they can have the treatment reviewed through a process called a Peer Review to determine whether or not the treatment is reasonable and necessary for the accident injuries. However, as can be imagined, this process is jaded in favor of the insurance company. The insurance company selects the Peer Review Organization and pays them for the review. This organization, without seeing the injured person, reviews the records in question and issues a report finding whether the treatment under review is reasonable and necessary for the alleged injuries.
If a peer review determination is made that the treatment in question is not reasonable and necessary, then the injured person has a right to challenge that finding in court. A lawsuit can be filed, requesting the court to make a determination of whether the insurance company has to pay for the treatment in question. The law in this situation was that the injured person had to pay their own attorneys fees unless they could convince the Court that the insurance company s denial of the bills was unreasonable.
The Superior Court however, has now made it much more manageable for an injured person to bring a lawsuit in the even their insurance company goes through this process and stops paying their bills. In Herd Chiropractic, the Superior Court held that if the treatment in question is found to be reasonable and related, then the injured person is automatically entitled to attorneys fees regardless of whether the insurance company s actions were unreasonable.
In Herd Chiropractic, the injured party had chiropractic treatment for injuries she had in an automobile accident. Her insurance company, State Farm, then had this treatment reviewed and subsequently denied payment for the treatment. The injured person was then stuck with a bill for the treatment in the amount of $1,380.68. On her behalf, the chiropractic clinic sued State Farm. The trial court found that the treatment was reasonable, directed State Farm to pay the bills, and awarded attorneys fees in the amount of $27,047.50. The Superior Court affirmed the decision of the trial court. Thus, the law in Pennsylvania now is that an injured person can be awarded attorneys fees, regardless of the amount of the bills as long as the treatment is found to be reasonable for the accident injuries.
This is a very important decision for injured people. Perhaps now the insurance companies will think twice before denying a bill. If not, we are here to help and the insurance companies will have to pay our fees!