Pennsylvania Supreme Court determines that attorneys’ fees are not recoverable damages if the insurer challenges a provider’s invoice via a peer review process.

The insurer denied reimbursement for those treatments found to be unnecessary by way of a peer review. The chiropractor challenged this denial as a violation of the mandates of the MVFRL by way of lawsuit and included a specific demand for attorneys’ fees. The trial court granted attorneys’ fees, but upon reconsideration, denied attorneys’ fees. The Superior Court reinstated the award of attorneys’ fees. On appeal, the Supreme Court reiterated that attorneys’ fees cannot be recovered absent express statutory authorization, clear agreement by the parties or some other established exception, and so denied the award of attorneys’ fees. The court reasoned that the Superior Court’s construction of the statutory term “challenged before a PRO” to include an implicit requirement that the peer review be valid incorrectly applied the explicit language of the MVFRL. Thus, so long as an insurer challenges a provider’s invoices utilizing the statutory peer review process, attorneys’ fees cannot be a valid component of damages to be awarded to the provider or the insured, even if the peer review is later determined to be faulty.

_{Case Law Alerts, 2^nd Quarter, April 1, 2016}

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