Dougherty v. State Automobile Insurance

10 Pa. D. & C.3d 668, 1978 Pa. Dist. & Cnty. Dec. LEXIS 57
CourtPennsylvania Court of Common Pleas, Northampton County
DecidedDecember 27, 1978
Docketno. 1978C-2081
StatusPublished

This text of 10 Pa. D. & C.3d 668 (Dougherty v. State Automobile Insurance) is published on Counsel Stack Legal Research, covering Pennsylvania Court of Common Pleas, Northampton County primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dougherty v. State Automobile Insurance, 10 Pa. D. & C.3d 668, 1978 Pa. Dist. & Cnty. Dec. LEXIS 57 (Pa. Super. Ct. 1978).

Opinion

FRANCIOSA, J.,

— This matter comes before the court on a petition for no-fault benefits. From a stipulated record we make the following

FINDINGS OF FACT

1. Petitioner, Dennis R. Dougherty, is an individual residing at RD #3, in Bethlehem, Northampton County, Pa.

2. Respondent, State Automobile Insurance Association, is a corporation in the Commonwealth of Pennsylvania.

3. Respondent regularly conducts business through its agent, Weiss-Shantz Agency, 1053 Main Street, Hellertown, Northampton County, Pa.

4. Petitioner had been issued an insurance policy by respondent, and such policy was in effect on May 19, 1978.

5. On May 19, 1978, petitioner was informed that his son, John Dougherty, had been struck in the mouth by a softball and was injured.

6. On May 20, 1978, petitioner’s son was treated by Doctors Miller and Zahm. At that time petitioner was informed that further therapy and orthodontic work was necessary.

7. On May 22, 1978, petitioner learned that John had, in fact, been injured in an automobile accident.

8. Petitioner informed Weiss-Shantz Agency on June 5, 1978, of the automobile accident and told them that a police report had been filed. Petitioner also informed defendant’s agent of the conflicting report given to him earlier by his son.

9. On July 5,1978, proof of the amount of loss was requested by respondent from Saint Luke’s Hospi[670]*670tal which replied that treatment had been for a softball accident. Their bill for $21 was subsequently received and paid by respondent on September 14, 1978.

10. On August 4, 1978, petitioner telephoned the agency to inform them that Doctor Cook wanted an advance payment of $300 before he would begin work.

11. On August 7, 1978, a bill was submitted to respondent by Doctor Arnold Cook for services rendered on June 9,1978, in the amount of $125 which was paid on September 14, 1978. He also provided an estimate for future work for $2,140.

12. On August 8, 1978, respondent ascertained from an interview with Bonnie Sherer and Jeffrey Rowe, passengers in the automobile, that the loss had occurred in an automobile accident.

13. On September 1, 1978, petitioner was informed by Doctors Miller and Zahm that a bill for $15 was submitted to respondent, but respondent, to date, has no record of receiving it.

14. On September 6, 1978, respondent was informed by letter that petitioner had retained the law firm of O’Hare and Heitczman in regard to this claim.

15. On September 14, 1978, a bill was submitted by Doctor Bruce M. Wechtler, to respondent, for two billings totalling $38 and these bills were paid on September 14, 1978.

16. On September 25, 1978, Doctor Cook called up again to inform respondent he needed a down payment of $300 before he could begin work. Respondent refused to pay before completion of the work.

17. On October 13, 1978, Doctor Cook, by telephone, agreed to accept payment as he completed [671]*671the work. This was confirmed by respondent by letter of October 18, 1978.

18. This action was instituted by petitioner on October 13, 1978.

19. On October 25, 1978, respondent paid a bill presented by Saint Luke’s Hospital to respondent in the amount of $172, which counsel concludes covered a $15 bill of Doctor Whitman.

DISCUSSION

The primary issue presented for decision is whether an insurer, pursuant to the Pennsylvania No-fault Motor Vehicle Insurance Act of July 19, 1974, P.L489,40P.S. §1009.101 et seq., is required to pay an estimated down payment which a doctor demands prior to providing any medical treatment and whether such refusal constitutes a penalty under the act by which the insurer may be surcharged, or whether the insurer need not pay until the medical treatment is completed. The issue basically concerns the interpretation to be placed upon several sections of the act.

In reviewing the meaning of the statute we are mindful of the legislative intent of the no-fault act, i.e., to establish “ . . . a Statewide system of prompt and adequate basic loss benefits for motor vehicle accident victims ...” section 1009.102(b). As stated by former Chief Justice Jones in Singer v. Sheppard, 464 Pa. 387, 401, 346 A. 2d 897, 904 (1976), the purpose of the No-fault Act is to substitute, “in the case of relatively minor accidents, the prompt and sure recovery of economic loss for the delayed and uncertain awards of the courts.” We are also aware, however, of the arduous task placed upon the courts when confronted with an issue of [672]*672statutory construction. As stated by Justice Frankfurter: “statutory implications . . . are of a Delphic nature, to be translated into concreteness by the process of litigating elucidation.” International Asso. Machinists v. Gonzales, 356 U.S. 617, 619, 78 S.Ct. 923, 2 L.Ed. 2d 1018 (1958). In that vein, we turn to the merits of the issue presented.

Section 1009.106(a)(1) of the No-fault Act provides that: “No- fault benefits are payable monthly as loss accrues. Loss accrues not when injury occurs, but as allowable expense ... is sustained.” And “‘[a]llowable expense’ means reasonable charges incurred for, or the reasonable value of (where no charges are incurred), reasonably needed and used products, services, and accommodations for: (A) professional medical treatment and care ...” section 1009.103. When presented with a claim for no-fault benefits, an insurer must pay such a claim within 30 days or be surcharged at a rate of 18 percent per annum: section 1009.106(a)(2).

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Related

International Ass'n of MacHinists v. Gonzales
356 U.S. 617 (Supreme Court, 1958)
Singer v. Sheppard
346 A.2d 897 (Supreme Court of Pennsylvania, 1975)
Maros v. Transamerica Insurance
375 A.2d 272 (New Jersey Superior Court App Division, 1977)

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Bluebook (online)
10 Pa. D. & C.3d 668, 1978 Pa. Dist. & Cnty. Dec. LEXIS 57, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dougherty-v-state-automobile-insurance-pactcomplnortha-1978.