September 28, 2015

A Statutory Interpretation That Limits First Party Medical Benefits

 

On May 27, 2015, The Honorable Robert J. Mellon granted a summary judgment motion in the matter of Piszel, D.C. d/b/a Graham Chiropractic vs. Erie Insurance Exchange, No. 2013-09740. An Erie insured was involved in a motor vehicle accident. As required in Pennsylvania, she had a first party medical benefit of at least $5,000. She first notified Erie that she would seek treatment over 21 months after the accident. 75 Pa.C.S.§ 1712, states, in pertinent part:

An insurer issuing or delivering liability insurance policies covering any motor vehicle of the type required to be registered under this title… shall make available for purchase first party benefits with respect to injury arising out of the maintenance or use of a motor vehicle as follows:

(1) Medical benefit—… coverage to provide for reasonable and necessary medical treatment… all without limitation as to time, provided that, within 18 months from the date of the accident causing injury, it is ascertainable with reasonable medical probability that further expenses may be incurred as a result of the injury….

Borrowing a mirror statute in New York with case law in favor of limiting an availability of benefits, it was argued under 75 Pa.C.S.§ 1712, first party medical benefits cannot be sought unless the insurer is given notice of the need for at least some treatment within 18 months of the accident. Judge Mellon granted the motion without an opinion, with the implication he agreed with the 18th month rule. The claim was dismissed.

What It Means to You

If you are an insurer, note if the claim was made within 18 months of the accident. There may be time limitations as to coverage.