Allen v. Reliance National Insurance

821 A.2d 651, 2003 Pa. Commw. LEXIS 191
CourtCommonwealth Court of Pennsylvania
DecidedApril 7, 2003
StatusPublished
Cited by4 cases

This text of 821 A.2d 651 (Allen v. Reliance National Insurance) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Allen v. Reliance National Insurance, 821 A.2d 651, 2003 Pa. Commw. LEXIS 191 (Pa. Ct. App. 2003).

Opinions

OPINION BY

Judge LEAVITT.

Reliance National Insurance Company (Reliance) and Yellowbird Bus Company (Yellowbird) (collectively Appellants) appeal from an order of the Court of Common Pleas of Philadelphia County (trial court) that denied Appellants’ Petition to Open the Judgment, which judgment the trial court had certified upon praecipe of Mark T. Allen, M.D. (Dr. Allen).1

On December 12, 1999, Chance McCall (Claimant) sustained a back and neck injury while in the course and scope of his employment with Yellowbird. On December 16, 1999, Claimant began treatment with Dr. Allen, an “orthopedic consultant” for University Medical Center, and these [652]*652treatments continued until April 5, 2000. Thereafter, treatments then resumed on August 25, 2000, when Dr. Allen began to use specialized equipment, known as non-surgieal decompression equipment (VAX-D), to treat Claimant’s neck and back injuries.

Dr. Allen had contracted with Cubitrol Management Services (CMS) to provide all administrative and management services, including billing, for his medical practice. CMS contacted the Pennsylvania Department of Labor and Industry, Bureau of Workers’ Compensation (Bureau) to learn the identity of Yellowbird’s insurer so it could properly invoice the insurer for the services provided to Claimant by Dr. Allen. The Bureau advised CMS that Yel-lowbird’s insurer was Reliance and that it was located at 77 Water Street, 21st Floor, New York, New York. Accordingly, CMS sent the invoices for Claimant’s treatment to that address.

In accordance with Section 306(f.l)(5) of the Workers’ Compensation Act (Act), Act of June 2, 1915, P.L. 736, as amended, 77 P.S. § 531(5)2 and 34 Pa.Code § 127.203,3 CMS, on behalf of Dr. Allen, submitted three separate bills to Reliance, on three separate dates, seeking compensation for Dr. Allen’s treatment of Claimant. However, these bills were not paid.

The first invoice was submitted to Reliance on November 3, 2000, for the VAD-X [653]*653treatments rendered to Claimant between August 25, 2000 and November 3, 2000, for a total of $39,270. Reliance had thirty days to make payment or to contest Dr. Allen’s invoices,4 but it did not respond. Accordingly, on December 10, 2000, Dr. Allen filed an Application for Fee Review with the Bureau contending that the payment of $39,270 invoice was not timely made as required by the Act.5 The Bureau issued an administrative decision6 that determined that Reliance had not made timely payment. The decision was sent to Reliance and Yellowbird, and it included an explanation of the appeal process.7 However, Reliance did not appeal.

Thereafter, two more claims forms were submitted to Reliance for Dr. Allen’s treatment of Claimant for the period between November 14, 2000 and January 26, 2001. Again, Reliance neither paid nor contested the invoices, and Dr. Allen filed two more fee applications with the Bureau. One application asserted a right to payment of $28,005, the second asserted a right to payment of $6,345. The Bureau issued two more administrative decisions finding that Reliance had been untimely in its handling of Dr. Allen’s claims for payment.

Dr. Allen then obtained certifications of the Bureau’s above-described three administrative decisions, which he used, on June 4, 2001, to support a Praecipe to Enter Judgment filed with the trial court. Specifically, the Bureau certifications were attached to the Praecipe as evidence of Dr. Allen’s “judgment” against Appellants.

On June 29, 2001, Appellants filed a Petition to Open the Judgment for the reason that the administrative decisions issued by the Bureau did not effect a money judgment against them, and therefore, the trial court had not been presented with a judgment to certify. It also asserted that Dr. Allen violated the Act by making self-referrals; that the claim forms were sent to the incorrect Reliance address; that the Application for Fee Reviews were incorrect; and that Dr. Allen had not provided proper medical documentation to Reliance. On July 30, 2001, Dr. Allen filed a response denying the allegations.

[654]*654On September 18, 2001, the trial court issued an order denying the Petition to Open Judgment. After Appellants appealed the trial court’s decision,8 the trial court issued an opinion on April 17, 2002 explaining its September 18, 2001 order. The trial court reasoned that,

As set forth above, Dr. Allen filed three (8) Applications for Fee Review to obtain payment for services rendered to Mr. McCall. In each instance, [Appellants] failed to respond to the investigation performed by the Bureau and, even after the Bureau issued its findings, failed to appeal the administrative decisions. Not only do [Appellants] lack a defense to the judgment obtained by Dr. Allen, but they also have failed to present any evidence as to why they chose to ignore the administrative procedures followed by Dr, Allen. Accordingly, [Appellants] were not entitled to avail themselves of the equitable relief they now seek.
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Finally, as the underlying judgment9 in this matter was entered in another county, this Court is without jurisdiction even to address the merits, should there have been any, raised in [Appellants’] Motion.

Trial Court Opinion, 5-6, R.R. 318a-319a. Appellants then brought this appeal.

On appeal, Appellants contend that the trial court’s refusal to open judgment is defective on its face. Again, they note that the Bureau’s determinations only found that Reliance had not made timely payment, not that Dr. Allen’s claims were meritorious; accordingly, the decisions cannot support a judgment of $74,200. They also contend that the judgment of $74,200 is excessive in any case; that Dr. Allen lacks standing to have a judgment issued against insurer, a course only available to a claimant; and that Dr. Allen violated the Act by failing to submit proper documentation and by making self-referrals.

In order to decide these issues, we must first determine whether this Court may decide them in light of the fact that Reliance is in liquidation. For the following reasons, we conclude that the liquidation of Reliance has divested this Court, of any court, to decide the merits of Dr. Allen’s claim.

On May 29, 2001, this Court entered a rehabilitation order against Reliance.10 This order defines “Reliance” to include Reliance National Insurance Company, which had been merged into Reliance prior to rehabilitation. The order directs that “all actions currently pending against Reliance in the Courts of the Commonwealth of Pennsylvania or elsewhere are hereby stayed.” Order, ¶ 22. The Rehabilitation Order also stayed actions pending “in the Courts of the Commonwealth of Pennsylvania or elsewhere against an insured of Reliance....” Order, ¶ 22. Nevertheless, on June 4, 2001, Dr. Allen, in derogation of [655]*655this Court’s Rehabilitation Order, filed a Praecipe to Enter Judgment against Reliance and against its insured, Yellowbird. R.R. 5a-8a.

On October 3, 2001, this Court entered a Liquidation Order against Reliance pursuant to Article V of The Insurance Department Act of 1921, Act of May 17, 1921, P.L. 789,

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Bluebook (online)
821 A.2d 651, 2003 Pa. Commw. LEXIS 191, Counsel Stack Legal Research, https://law.counselstack.com/opinion/allen-v-reliance-national-insurance-pacommwct-2003.