Last week, a trial level Pennsylvania court has ruled that $148,000 in expenses for medical care rendered outside of Pennsylvania are exempt from the cost containment provisions of Pennsylvania’s Motor Vehicle Financial Responsibility Law (MVFRL), 75 Pa. C.S. § 1797(a). See Yurek v. Bauer, CCP, Allegheny County, July 3, 2024.
Often referred to as “Act 6,” the provisions limit the amount a medical provider may charge for “products or services to an injured person for an injury covered by liability or uninsured and underinsured benefits or first party medical benefits.”
In Yurek v. Bauer, Judge Alan Hertzberg presided over the jury trial. The case involved an intersection accident which occurred in a suburb north of Pittsburgh in which the then 15-year-old plaintiff sustained a concussion and cervical injuries. Trial occurred six years after the date of the accident and less than six months after the plaintiff underwent a cervical fusion, performed by a neurosurgeon in Florida. Evidence at trial included testimony that no surgeon in Pittsburgh would perform the surgery, the neurosurgeon who performed the surgery was not licensed in Pennsylvania, and the cost of the surgery was $148,000.
At trial, the only issue was damages, since the defense admitted to liability. The jury awarded the plaintiff $375,000 in damages, including past medical expenses in the amount of $150,000. Judge Hertzberg denied both parties’ post-trial motions, including the defense motion to mold the $150,000 amount to $9,882 under the cost containment provision of the MVFRL. Instead, the judge reduced the $150,000 award to $148,000, the exact amount of the plaintiff’s surgery. Both parties filed appeals with the Pennsylvania Superior Court.
In his opinion addressing the parties’ matters complained of on appeal, Hertzberg explained his reasoning—that 31 Pa. Code § 69.11 only applies to medical providers licensed in Pennsylvania:
§ 69.11. Payment limitation applicability.
(a) The payment limitations of Act 6 apply to a provider rendering services to an injured person whose medical costs are covered by automobile insurance issued under the MVFRL. The payment limitations of Act 6 also apply to providers not currently participating in Medicare.
(b) The payment limitations of Act 6 apply in cases when care is rendered by a Pennsylvania licensed provider to a Pennsylvania resident covered by automobile insurance for injuries arising out of the maintenance or use of a motor vehicle, irrespective of where the injuries occurred or where the care is rendered.
This case could have a significant impact on Pennsylvania motor vehicle accident cases. If the cost containment provisions in Act 6 do not apply to medical procedures performed by providers not licensed in Pennsylvania, more plaintiffs will seek treatment performed by such providers. We often see these attempts in Philadelphia, where claimants seek treatment in neighboring states, such as New Jersey or Delaware. If medical bills for such treatment are no longer reduced, carriers will face significantly increased medical costs in these cases.
