Pennsylvania Medical Society Liability Ins. v. Commonwealth

CHIEF JUSTICE CAPPY

DISSENTING.

As I believe that the reasoning employed by the majority is not in accord with the Health Care Services Malpractice Act (“HCSMA”), 40 P.S. §§ 1301.701 et seq., and also runs counter to the very purpose of the Medical Professional Liability Catastrophe Loss Fund (the “CAT Fund”), I must respectfully dissent.

The majority declares that the CAT Fund may summarily deny a request for § 605 status where the request was made more than 180 days after the health care provider or insurer first received notice of the claim, even when the CAT Fund concedes that it suffered not one iota of prejudice.1

There are two reasons why this reasoning greatly disturbs me. First, it does not fully integrate § 702’s dictate that a dilatory claim may be denied only when the CAT Fund suffered prejudice due to the untimely notice. This runs counter to the legislature’s exhortation that to the extent *102possible, we are to read statutes which relate to the same subject matter in pari materia. 1 Pa.C.S. § 1932.

In my opinion, we can honor the legislature’s directive to read these statutes in pari materia as §§ 605 and 702 of the HCSMA can readily be interpreted in such a fashion as to be in harmony with one another. Section 702 states that a self-insured health care provider or basic coverage insurance carrier must “promptly notify” the director of the CAT Fund “where it reasonably believes that ... the claim ... falls under section 605.” 40 P.S. § 1301.702(c).

While § 702 does not further elucidate the concept of prompt notice, § 605 does. Section 605 directs that requests for § 605 status must be made within 180 days. 40 P.S. § 1301.605. In my opinion, that 180 day provision defines what is “prompt notice”. If a health care provider or insurer notifies the CAT Fund within 180 days of receiving notice of the claim, then, per § 702, the notice is prompt and § 605 status must be conferred. If, however, notice is given beyond the 180 day window, then notice is not prompt. Per § 702, where notice is not promptly given, the CAT Fund may deny the claim, but only if it can establish that it was prejudiced by the dilatory notice. 40 P.S. § 1301.702(c).2 This interpretation is the more sound one as it gives effect to both § 605 as well as § 702.

This interpretation also happens to be in harmony with the purpose of the CAT Fund. The CAT Fund was created to provide liability coverage in the medical arena. See 40 P.S. § 1301.102. In my opinion, the CAT Fund’s provision of coverage has thus provided a welcome modicum of stability in the sometimes unhinged arena of medical malpractice litigation. The CAT Fund in these matters, on the other hand, seems to believe that the primary goal of the Fund is not to ensure the *103provision of medical liability coverage in this commonwealth, but rather is merely to perpetuate its own existence, divorced from its purpose of ensuring the provision of medical liability coverage in this commonwealth.

Furthermore, the CAT Fund’s interpretation also strikes me as unreasonable. Health care providers are compelled by statute to pay a surcharge to the CAT Fund. Yet, the CAT Fund contends that it should be allowed to avoid providing statutorily-mandated coverage on the basis that notice of a claim went beyond a 180 day period, even when the CAT Fund concedes that it was not prejudiced by receiving notice beyond this 180 day window. Thus, per the CAT Fund’s interpretation, the health care provider pays for coverage it will not receive, and then potentially pays again if the claim against it (which the CAT Fund ought to cover) is found to be meritorious.

Thus, in these matters sub judice, I would find that the requests for § 605 status were not prompt for purposes of § 702 as they were made beyond the 180 day window established in § 605. Yet, per § 702, I would find that the CAT Fund may not deny Appellees § 605 status as the CAT Fund has conceded that Appellees’ failure to provide prompt notice did not prejudice the CAT Fund. Accordingly, I dissent.

Justice NEWMAN and Justice EAKIN join this dissenting opinion.

. I note that this interpretation of §§ 605 and 702 is also in accord with our decision in Brakeman v. Potomac Ins. Co., 472 Pa. 66, 371 A.2d 193 (1977). In that matter, we reasoned that an insurer may not deny a claim simply because it did not receive prompt notice of a claim. Rather, the insurer must establish "not only that the notice provision was breached, but also that it suffered prejudice as a consequence.” Id. at 196.