Bad Faith

The U.S. District Court in the case of Robin Perkins v. State Farm addresses issues inquired about by many providers.  The main issue addressed was bad faith.
Robin Perkins was struck by a car while she was walking in a grocery store parking lot.  She was insured by State Farm (her motor vehicle insurance policy covered her even though she was a pedestrian) who refused to pay for her chiropractic care based on a peer review performed by another chiropractor well known to do this type of work.
The Court said, and it is correct, that there has been conflicting results in Pennsylvania as to whether Act 6 provides the exclusive remedy for the patient’s claim against State Farm, or whether she can bring a bad faith claim under the Bad Faith Statute (Section 8371), which provides for punitive damages.
Although the Pennsylvania Supreme Court has not weighed in yet to resolve the conflict, the U.S. District Court, following the Schwartz opinion in the Third Circuit, ruled that each case is fact dependent to determine whether the patient can bring a bad faith action.  In this case, the patient argued that the peer reviewer does substantial work for State Farm and therefore has a financial interest in providing a biased peer review.  Further, the patient alleged that the peer reviewer repeatedly gave negative peer reviews to State Farm in order to maintain its relationship with State Farm.  These allegations are not part of what Act 6 covers and therefore the patient could go forward with her bad faith claim.
Advertisements

Comments are closed.

%d bloggers like this: