Applied Medico-Legal Solutions Risk Retention Group, Inc. v. ProAssurance Specialty Ins. Co., Inc. & the Mcare Fund

CourtCommonwealth Court of Pennsylvania
DecidedJune 26, 2026
Docket193 M.D. 2025
StatusUnpublished
AuthorFizzano Cannon

This text of Applied Medico-Legal Solutions Risk Retention Group, Inc. v. ProAssurance Specialty Ins. Co., Inc. & the Mcare Fund (Applied Medico-Legal Solutions Risk Retention Group, Inc. v. ProAssurance Specialty Ins. Co., Inc. & the Mcare Fund) 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
Applied Medico-Legal Solutions Risk Retention Group, Inc. v. ProAssurance Specialty Ins. Co., Inc. & the Mcare Fund, (Pa. Ct. App. 2026).

Opinion

IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Applied Medico-Legal Solutions : Risk Retention Group, Inc., : Petitioner : : v. : : ProAssurance Specialty Insurance : Company, Inc. and the Medical Care : Availability and Reduction of : Error Fund, : No. 193 M.D. 2025 Respondents : Submitted: May 12, 2026

BEFORE: HONORABLE RENÉE COHN JUBELIRER, President Judge HONORABLE CHRISTINE FIZZANO CANNON, Judge HONORABLE STACY WALLACE, Judge

OPINION NOT REPORTED

MEMORANDUM OPINION BY JUDGE FIZZANO CANNON FILED: June 26, 2026

This action in our original jurisdiction is an insurance coverage dispute among the Petitioner, Applied Medico-Legal Solutions Risk Retention Group, Inc. (AMS), and the Respondents, ProAssurance Specialty Insurance Company, Inc. (ProAssurance) and the Medical Care Availability and Reduction of Error Fund (Mcare) regarding the payment of settlement funds in an underlying medical malpractice action against Daniel Nam, M.D. (Dr. Nam) and Advanced Inpatient Medicine Associates, LLC d/b/a Adfinitas Health at Wilkes-Barre (Adfinitas). Presently before the Court are the preliminary objections of ProAssurance and Mcare to AMS’s second amended petition for review (Petition). We sustain ProAssurance’s preliminary objection to paragraphs 10(7), 78(5), and 81 and to demand for relief 5 in Count II and otherwise overrule the preliminary objections of ProAssurance. We overrule Mcare’s preliminary objections.

I. Background The Petition pleads the following facts, which we take as true for purposes of disposing of the preliminary objections. This case arises from the settlement of an underlying medical malpractice action, Cadden v. Nam (C.P., No. 2021-05726) (Malpractice Action) filed in the Luzerne County Court of Common Pleas. Pet. at 1. In the Malpractice Action, the plaintiff, Joann Cadden (Cadden), sued Adfinitas, a health care management practice, and its employed physician, Dr. Nam, alleging negligence by Dr. Nam in medical care he provided to Cadden in December of 2019. Id. AMS is a risk-retention group providing primary medical malpractice insurance to its members. Pet. at 5. ProAssurance is a primary medical malpractice insurer that insures physicians in Pennsylvania. Id. at 6. The Petition alleges that Mcare “is a special fund within Pennsylvania’s State Treasury that was established to safeguard reasonable compensation for victims of medical negligence.” Id. (citing https://www.insurance.pa.gov/SpecialFunds/MCARE/Pages/default.aspx) (last visited June 25, 2026). Mcare “is a unit of the Commonwealth of Pennsylvania, created by Section 712 of the Medical Care Availability and Reduction of Error Act (Mcare Act),[1] 40 P.S. §1303.712.” Id. Mcare collects and retains assessments from physicians and other health care providers. Pet. at 6. Mcare uses those funds to pay claims against participating healthcare providers and eligible entities for medical malpractice losses

1 Act of March 20, 2002, P.L. 154, as amended, 40 P.S. §§ 1303.101-1303.910.

2 or damages that are in excess of basic insurance coverage provided by primary professional liability insurance companies or self-insurers. Id. In order to practice medicine in Pennsylvania, a physician must maintain the required coverage amount of basic primary professional liability insurance or have an approved self-insurance plan. Id. A physician must also pay the required assessments to Mcare. Id.; see also Sections 711 and 712 of the Mcare Act, 40 P.S. §§ 1303.711 & 1303.712; 49 Pa. Code § 16.32. Mcare notifies primary insurers annually of the assessment amounts owed by the insured physicians; the physicians pay the Mcare assessments directly to their primary insurers, who then remit the funds to Mcare. Pet. at 7-8. From December 1, 2017 to December 30, 2020, Dr. Nam worked for Adfinitas as an employee on an as-needed basis. Pet. at 8. AMS provided primary insurance coverage to Adfinitas for a policy period of March 1, 2021 to March 1, 2022 “with a retroactive date of January 1, 2007.[]” Id. ProAssurance provided insurance to Adfinitas for three periods from January 1, 2018 to January 1, 2019, from January 1, 2019 to January 1, 2020, and from January 1, 2020 to March 1, 2020. Id. The period of Dr. Nam’s alleged negligent treatment of Cadden is December 24 to December 29, 2019. Id. at 9. According to AMS, ProAssurance was responsible to collect the Mcare assessment for each physician employed by Adfinitas, including Dr. Nam; to notify Mcare that each physician had the required basic primary professional liability insurance; and to remit the collected Mcare assessments to Mcare. Pet. at 8-9 (citing 31 Pa. Code § 242.6). Although Adfinitas purchased the requisite insurance coverage and remitted the required assessments to ProAssurance, ProAssurance failed to provide the requisite notice and assessment payments to Mcare on behalf of Adfinitas. Id. at 9. Although Dr. Nam was continuously employed and insured

3 by Adfinitas, his work on an as-needed basis led a former Adfinitas employee to inform ProAssurance incorrectly that there was a “gap” in Dr. Nam’s employment for a period where no as-needed work was offered. Id. at 10. However, Adfinitas corrected its error and directed ProAssurance to add Dr. Nam back to its list of covered employee physicians almost three months before the events that led to the Malpractice Action. Id. Despite Adfinitas’s directive, ProAssurance failed to add Dr. Nam back to the Adfinitas policy as a covered employee and to remit a timely assessment payment for Dr. Nam to Mcare. Id. at 11. ProAssurance later corrected its error and sent payment to Mcare for the period relevant to the Malpractice Action. Id. at 11-12. ProAssurance’s conduct led Mcare to conclude erroneously that Dr. Nam was not insured with the required basic primary malpractice insurance and that the required Mcare assessment had not been paid for Dr. Nam. Pet. at 9. As a result, when a settlement was reached with Cadden in the Malpractice Action, Mcare refused to contribute $500,000 that AMS alleges Mcare owed toward the settlement of the Malpractice Action. Id. AMS then paid the $500,000 that Mcare refused to pay toward the settlement. Id. at 12. AMS filed its Petition against ProAssurance and Mcare, seeking recovery of the $500,000 AMS asserts should have been paid by one or both of them toward the settlement of the Cadden claim. The Petition contains six counts as follows. Count I is a declaratory judgment claim against Mcare. AMS alleges that Mcare funds in the amount of $500,000 are due and owing toward the settlement of the Cadden claim because Dr. Nam was insured through ProAssurance and had paid his Mcare assessment prior to the relevant dates of alleged malpractice for the

4 Cadden claim. Thus, AMS asserts that Mcare should have contributed $500,000 towards settlement of the Cadden claim. Count II is a declaratory judgment claim against ProAssurance. AMS alleges that ProAssurance breached its Insurance Policies with Adfinitas and its duties to Adfinitas and Dr. Nam under Pennsylvania law by: (1) failing to properly add Dr. Nam back to the Adfinitas policy as of October 1, 2019; (2) failing to properly inform Mcare that Dr. Nam had been placed back on the ProAssurance policy as of October 1, 2019; (3) failing to properly inform Mcare that Dr. Nam’s Mcare Assessment had been paid to ProAssurance; and (4) failing to correct the matter with Mcare when it learned of these errors. This led Mcare to conclude erroneously that Dr. Nam was not insured through ProAssurance, and that he had not paid his assessment prior to the relevant dates of alleged malpractice for the Cadden claim, and thus caused Mcare to refuse to contribute its $500,000 towards settlement of the Cadden claim. Count III is a claim for indemnity against both Mcare and ProAssurance.

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Applied Medico-Legal Solutions Risk Retention Group, Inc. v. ProAssurance Specialty Ins. Co., Inc. & the Mcare Fund, Counsel Stack Legal Research, https://law.counselstack.com/opinion/applied-medico-legal-solutions-risk-retention-group-inc-v-proassurance-pacommwct-2026.