MEDICAL MALPRACTICE-MCARE ACT-COLLATERAL SOURCE RULE

April 29th, 2022 by Rieders Travis in Uncategorized

Reed v. Sossong, 2022 U.S. Dist. LEXIS 66064 (W.D. Pa. April 8, 2022) (Haines, U.S. D.J.)  Plaintiffs assert that as a direct and proximate result of the Defendants’ conduct, Daniel Reed “was forced to expend large sums of monies for doctors, hospitals, and other items necessary for proper care and treatment”. Defendants move for partial summary judgment to preclude Plaintiffs from recovering damages in the form of a recoverable lien for past medical expenses paid by a private insurer, Highmark Delaware. Defendants contend that Plaintiffs have failed to show that the plan in question was a self-funded plan under the Employee Retirement Income Security Act (ERISA), which would exempt the plan from the requirements of the Pennsylvania Medical Care Availability and Reduction of Error Act (“MCARE”). Instead, Defendants argue that because the plan was insured, the provisions of the MCARE Act apply, precluding as a matter of law the recovery of damages for past medical expenses to the extent those expenses were covered by the insurer. In response, Plaintiffs argue that the plan in question is an HMO, which is exempt from the provisions of the MCARE Act. Alternatively, Plaintiffs argue that they qualify for one of the statutory enumerated exceptions set forth in the MCARE Act because there is “some evidence” that the plan in question “may be covered by ERISA.” Upon careful consideration of the parties’ papers, the argument by both sides at oral argument, and a review of the relevant statutes and case law, the Court finds that the MCARE Act does apply in this case, that it is not preempted by ERISA, and that none of the statutory exceptions apply. Accordingly, Defendants are entitled to summary judgment as a matter of law on the issue raised in their motion.

 

Here, Pennsylvania law precludes a claimant from recovering damages for past medical expenses incurred to the time of trial to the extent that the loss is covered by a benefit that the claimant has received prior to trial, unless the statute is preempted by ERISA, or unless the claimant can show that the plan otherwise is exempt from the MCARE Act, or one of the four statutory exceptions applies. Here, Plaintiffs have produced no evidence that the plan at issue was a self-funded health care plan exempt from the collateral source and anti-subrogation provisions of the MCARE Act under the ERISA deemer clause. Nor has Plaintiff shown that the plan is an HMO, which might render it exempt from the MCARE Act under the Pennsylvania HMO Act. Finally, Plaintiffs have failed to show that any of the exceptions to the collateral source and anti-subrogation provisions enumerated in the MCARE Act apply. Accordingly, because Plaintiffs are precluded as a matter of law from recovering damages related to past medical expenses paid by a private insurer prior to trial under the MCARE Act, Defendants are entitled to partial summary judgment on this issue. An appropriate order follows.

Attorney Cliff Rieders

Attorney Cliff RiedersCliff Rieders is a Nationally Board Certified Trial Lawyer practicing personal injury law. A large part of his practice involves multi-district litigation, including cases related to pharmaceuticals, vitamin supplements and medical devices. He is admitted in several state and federal courts, as well as the Supreme Court of the United States. Rieders is the past regional president of the Federal Bar Association and is a life member of the distinguished American Law Institute, which promulgates proposed rules adopted by many state courts. He is a past president of the Pennsylvania Association for Justice, formerly Pennsylvania Trial Lawyers Association. As a founder of the Pennsylvania Patient Safety Authority, he served on the Board for 15 years.

Not only has Rieders held many highly esteemed, leadership positions, he authored legislation related to the Patient Safety Authority and the Mcare Act, which governs medical and hospital liability actions in Pennsylvania. He authored texts upon which both practitioners and judges rely, including Pennsylvania Malpractice Laws and Forms, and Financial Responsibility Law Issues in Pennsylvania, the latter governing auto and truck collisions in Pennsylvania. In addition, he wrote several books on the practice of law in Pennsylvania regarding wrongful death and survivor actions, insurance bad faith, legal malpractice claims and worker rights, among others. Rieders also serves as a resource to practitioners as a regular speaker for Celesq, an arm of the world’s largest legal publisher, Thomson Reuters West Publishing.

As recognition of his wide range of contribution to his profession and of his dedication to protecting the rights of his clients, he received numerous awards, among them the George F. Douglas Amicus Curiae Award, the Milton D. Rosenberg Award, the B’nai B’rith Justice Award, and awards of recognition from the Pennsylvania Trial Lawyers. [ Attorney Bio ]

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