Levine v. Travelers Property Casualty Insurance
69 A.3d 671
Pa. Super. Ct.2013Background
- Levine was injured in a 2003 rear-end collision; initial medical bills were paid under first-party medical coverage.
- Travelers denied McKenzie physical therapy after a PRO peer review concluded it was not reasonable/necessary.
- An IME in 2005 determined Levine had reached MMI and carpal tunnel was unrelated to the accident, supporting denial of related charges.
- Levine settled Levine I (2007–2008) with payment of bills through Feb 13, 2008 and a release allowing future treatment and further suit.
- Levine re-treated starting Nov 2008; Travelers refused payment; Levine filed Levine II (2009); the trial court held Travelers breached MVFRL and awarded attorneys’ fees under MVFRL §1797(b).
- Travelers appeals the attorneys’ fee award, arguing fees were not authorized by statute, contract, or recognized exception, and that Herd affects fee availability after PRO involvement.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether fee award under MVFRL §1797 was proper | Levine contends MVFRL authorizes fees for reasonable/necessary treatment. | Travelers argues fees not authorized where peer review was used. | Yes; fee award upheld under §1797(b)(4)/(6). |
| Whether PRO/IME precluded fee liability after peer review | Levine asserts the 2008–2010 charges were not peer reviewed. | Travelers contends IME/PRO interplay falls under §1797(b) preclusion. | Fees remain recoverable because 2008 charges were not peer reviewed; IME not peer review. |
Key Cases Cited
- Herd Chiropractic Clinic, P.C. v. State Farm Mut. Auto Ins. Co., 64 A.3d 1058 (Pa. 2013) (Supreme Court reversal; fees limited when PRO used)
- Herd Chiropractic Clinic, P.C. v. State Farm Mut. Auto Ins. Co., 29 A.3d 19 (Pa. Super. 2011) (Pa. Super. decision on when fees may be awarded under MVFRL §1797(b)(4)/(6))
- Stoloff v. Neiman Marcus Group, Inc., 24 A.3d 366 (Pa. Super. 2011) (statutory interpretation framework for MVFRL provisions)
- Jack A. Danton, D.O., P.C. v. State Farm Mut. Auto Ins. Co., 769 F.Supp.174 (E.D. Pa. 1991) (federal interpretation of MVFRL procedures for challenging charges)
- St. Elizabeth's Child Care Ctr. v. Department of Public Welfare, 963 A.2d 1274 (Pa. 2009) (statutory interpretation principle for clear statutory language)