Pennsylvania Superior Court Holds that Future Medical Expenses in Motor Vehicle Litigation Are Not Subject to Act VI Cost Containment Provisions

The Pennsylvania Superior Court recently addressed the unsettled issue of whether a plaintiff’s claims for future medical expenses in an automobile case must be reduced pursuant to the cost containment provisions of Act VI of the Pennsylvania Motor Vehicle Financial Responsibility Law (MVFRL). The court in Farese v. Robinson, 2019 Pa. Super. LEXIS 118 (Pa.Super. Nov. 8, 2019) considered a number of topics, however, the issue in Act VI specifically dealt with an area of Pennsylvania law with no current appellate guidance. In the end, the court held that future medical expenses do not need to be reduced under Act VI before being presented to a jury.

The underlying case involved a two-car motor vehicle accident. The case proceeded to trial, where the jury awarded the plaintiffs compensatory damages in the amount of $2,579,000. A total of $900,000 was awarded for future medical expenses. On appeal, the defendants alleged that the trial court erred in failing to reduce the plaintiffs’ claimed future medical expenses as required under Act VI.

The defendants’ arguments were based on Section 1797 of the MVFRL, which provides that medical providers cannot charge injured plaintiffs more than 110% of what Medicare would pay for comparable services or the provider’s usual and customary charge, whichever is less. The law also prohibits medical providers from charging injured plaintiffs for the difference between their full charge and the amount covered by insurance. Pennsylvania courts have routinely held that these provisions require a plaintiff’s current unpaid medical bills to be reduced before being offered into evidence. However, defense and plaintiff attorneys have disagreed about whether the cost containment requirements of the MVFRL apply to future medical expenses. The defendants in Farese argued that Act VI should limit the amount of future medical expenses the plaintiffs could recover.

Judge James Gardner Colins wrote the majority opinion for the Superior Court and stated that the defendants were unable to cite any case law supporting the assertion that jury awards for future medical expenses should be molded pursuant to Act VI. In reaching its conclusion, the court reviewed multiple unpublished rulings, as well as two decisions from the federal District Court for the Middle District of Pennsylvania, for guidance. Judge Colins wrote, “[u]pon our review of these cases, we have discovered that, whenever courts have considered the question of whether 75 Pa.C.S. Section 1797 applies to future medical expenses, they have unanimously concluded that it does not.”

The court specifically discussed the district court case of Kansky v. Showman, 2011 U.S. Dist. LEXIS 38814 (M.D. Pa. Apr. 11, 2011). The Farese majority agreed with the court’s reasoning in Kansky, which held that, because future medical expenses are not currently due and outstanding, it would be speculation to assume future expenses will be paid. See Kansky, 2011 U.S. Dist. LEXIS 3881, at *6. The Kansky court opined, “[p]laintiff’s insurer could become bankrupt, or deny future medical bills for a variety of reasons.” Therefore, the Farese court held that the plaintiffs’ future medical bills were not “payable” under Section 1797 of the MVFRL and, thus, not subject to Act VI’s reductions.

While the case may be appealed to the Pennsylvania Supreme Court, for the time being, counsel for defendants should expect plaintiff attorneys to raise the Farese decision in support of allowing the introduction of non-reduced future medical expenses. Plaintiff counsel will undoubtedly use this as a means to inflate the value of their motor vehicle cases, with experts opining that future care will be needed. As such, defense counsel and defense experts will need to place a greater emphasis on disputing whether the alleged future expenses are reasonable, necessary and related to the underlying accident.

*Brad is an associate working in our Pittsburgh, Pennsylvania office. He can be reached at (412) 803-2448 or behaas@mdwcg.com.

_{Defense Digest, Vol. 26, No. 1, Spring 2020 is prepared by Marshall Dennehey Warner Coleman & Goggin to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. ATTORNEY ADVERTISING pursuant to New York RPC 7.1. © 2020 Marshall Dennehey Warner Coleman & Goggin. All Rights Reserved. This article may not be reprinted without the express written permission of our firm. For reprints, contact tamontemuro@mdwcg.com.}