Pennsylvania Medical Society Liability Insurance v. Commonwealth, Medical Professional Liability Catastrophe Loss Fund

804 A.2d 1267
CourtCommonwealth Court of Pennsylvania
DecidedSeptember 18, 2002
StatusPublished
Cited by6 cases

This text of 804 A.2d 1267 (Pennsylvania Medical Society Liability Insurance v. Commonwealth, Medical Professional Liability Catastrophe Loss 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
Pennsylvania Medical Society Liability Insurance v. Commonwealth, Medical Professional Liability Catastrophe Loss Fund, 804 A.2d 1267 (Pa. Ct. App. 2002).

Opinions

OPINION BY

Judge PELLEGRINI.

Before this Court are preliminary objections filed by the Medical Professional Liability Catastrophe Loss Fund (CAT Fund) to a two-count petition for review filed by the Pennsylvania Medical Society Liability Insurance Company (Insurance Company) requesting us to dismiss the petition because the Insurance Company failed to file its claim within the requisite 180 days and the petition does not make out a claim for bad faith.

[1269]*1269This case involves the CAT Fund which provides coverage in excess of a health care provider’s basic liability insurance coverage. The Insurance Company is a corporation that issues professional liability insurance policies to physicians and other health care providers. The Insurance Company filed a petition for review in the nature of a two-count complaint against the CAT Fund seeking, inter alia, coverage for non-party health care providers under Section 605 of the Health Care Services Malpractice Act (Act) after the CAT Fund denied its request for Section 605 status on the grounds that it failed to file a claim within 180 days.1 In Count I of the complaint, the Insurance Company alleged that its request could not be denied unless the CAT Fund had been prejudiced by an untimely request. In Count II of the complaint, the Insurance Company alleged bad faith by the CAT Fund based upon its denial of the Section 605 status. The CAT Fund preliminarily objects in the nature of a demurrer to both counts of the petition for review, arguing that the Insurance Company did not provide it with notice within the 180-day requirement and, therefore, it was not required to make payment of the Insurance Company’s claim, and it was not guilty of bad faith for refusing to make payment.

I.

Section 605 of the Act provides:

In the event that any claim is made against a health care provider subject to the provisions of Article VII more than four years after the breach of contract or tort occurred which is filed within the statute of limitations, such claim shall be defended and paid by the fund if the fund has received a written request for indemnity and defense within 180 days of the date on which notice of the claim is given to the health care provider or his insurer.

The Insurance Company argues that notwithstanding the 180-day requirement in Section 605 of the Act, Section 702(c) of the Act adds the requirement that the CAT Fund could not deny its request unless it had been prejudiced by the untimely request. The CAT Fund, however, argues that Section 702(c) did not remove the 180-day limitation, and if the legislature had intended a requirement of prejudice with respect to untimely claims under Section 605, it would have provided for one.

Section 702(c) of the Act provides:

The basic coverage insurance carrier of self-insured provider shall promptly notify the director of any case where it reasonably believes that the value of the claim exceeds the basic insurer’s coverage or self-insurance plan or falls under section 605.... Failure to so notify the director shall make the basic coverage insurance carrier or self-insured provider responsible for the payment of the entire award or verdict, provided the fund has been prejudiced by the failure of notice.

40 P.S. § 1301.702(c). (Emphasis added.) Despite the CAT Fund’s contention that it was the intent of the General Assembly that 180 days would be the absolute cut-off for requesting coverage under Section 605 of the Act, the plain language of Section 702(c) provides that any notification requesting coverage under Section 605 will not make the basic insurance carrier liable unless prejudice is shown.

Not only is the CAT Fund’s interpretation not in accord with the plain language [1270]*1270of Section 702(c), but it is at variance with how notice provisions are interpreted when contained in insurance policies and notice requirements contained in legislation. In Brakeman v. Potomac Insurance Company, 472 Pa. 66, 371 A.2d 193 (1977), our Supreme Court stated:

The function of the notice requirements is simply to prevent the insurer from being prejudiced, not to provide a technical escape-hatch by which to deny coverage in the absence of prejudice nor evade the fundamental protective purpose of the insurance contract to assure the insured and the general public that liability claims will be paid up to the policy limits for which premiums were collected. Therefore, unless the insurer is actually prejudiced by the insured’s failure to give notice immediately, the insurer cannot defeat its liability under the policy because of the non-prejudicial failure of its insured to give immediate notice of an accident or claim as stipulated by a policy provision.

Id. at 197 (quoting Miller v. Marcantel, 221 So.2d 557 (La.App.1969)).

Additionally, 42 Pa.C.S. § 55222 requires a party to file a claim against a government unit within six months or be barred unless the party shows a reasonable excuse for failing to timely file. Even though this section does not have a provision similar to Section 702(c) of the Act, this section has been interpreted by this Court to also require a showing of prejudice in order for the government unit to refuse to accept a claim filed against it after the six-month time frame. See Leedom v. Commonwealth, Department of Transportation, 699 A.2d 815 (Pa.Cmwlth. 1997). Because no prejudice was alleged in this case, the Insurance Company’s claims are not barred as a matter of law and the CAT Fund’s preliminary objections to Count 1 of the complaint are overruled.

II.

As to Count II of the complaint, the Insurance Company alleged that the CAT Fund acted in bad faith by unreasonably withholding benefits under Section [1271]*1271605 of the Act, and that the CAT Fund acted in violation of Section 8371(2) of the Judicial Code, 42 Pa.C.S. § 8371(2) and/or the Pennsylvania Unfair Trade Practices and Consumer Protection Law (UTPCPL).3 In its preliminary objections, the CAT Fund argues that because there exists no common law remedy for a claim of bad faith against an insurer in Pennsylvania, the Insurance Company’s bad faith claim can only be based upon Section 8731 of the Judicial Code, and the Insurance Company has failed to plead several essential elements required by that statute.

In Williams v. Nationwide Mutual Insurance Company, 750 A.2d 881 (Pa.Super.2000), the Superior Court held that common law claims for bad faith on the part of insurers were not remediable in Pennsylvania, and only statutory claims of bad faith were actionable under Section 8371 of the Judicial Code. Section 8371 of the Judicial Code provides:

In an action arising under an insurance policy, if the court finds that the insurer has acted in bad faith toward the insured, the court may take all of the following actions:

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Bluebook (online)
804 A.2d 1267, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pennsylvania-medical-society-liability-insurance-v-commonwealth-medical-pacommwct-2002.