Paying Medical Bills Does Not Mean Paying An Uninsured Motorist Claim

One would think that if an insurance company paid for medical bills that it would also be willing to pay an uninsured motorist claim. Not so in the case of Pantellis v. Erie Insurance Company. The plaintiff in that case was a woman who was injured when a stolen van sideswiped her car. As a result of the accident, the plaintiff submitted her medical bills which were paid by Erie Insurance. She also submitted an uninsured motorist claim to Erie which Erie disputed by stating her injuries were not related to the accident with the uninsured van. This assertion was made by Erie even though they had already paid her medical bills relating to the same accident.

Unfortunately, the Pennsylvania Superior Court sided with Erie. The Court reasoned that just because an insurance company pays medical bills does not mean it is on the hook for paying an uninsured motorist claim. The Court reasoned that the statute regarding payment of first party benefits, i.e. medical bills, has a different standard under which an insurance company must meet its obligations to pay a claimant than it does to pay for under the uninsured motorist statute. Payment of medical bills, according to the Court, can be “triggered by something as simple as submission of a bill by a medical provider.” Payment of an uninsured motorist claim, however, requires “the wrongful conduct of a third party.” The Court is wrong for a number of reasons. First, an insurance carrier can deny payment of a medical bill if it does not think the care is related to the injury by having an independent medical exam conducted. Secondly, the insurance carrier can also submit the medical provider’s bill to peer review for denial. Submission of a bill, therefore, does not necessarily “trigger” payment of the bill by the carrier.

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