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Why You Need A Pa Personal Injury Lawyer When You Are Injured

Posted on September 23rd, 2015

Why You Need A Pa Personal Injury Lawyer to Have Your Back when Your Own Insurance Company Doesn’t:  Injured Victim’s Insurance Company contests Responsibility For Medical Bills.

We all appreciate the right of a defendant’s driver’s insurance company to dispute responsibility and to want proof of an injured victim’s injuries and medical treatment but rarely we realize how common it is for the insurance company we paid for to protect us from injury, to dispute responsibility and fail to pay for our first party medical bills and treatment.  Under the Pennsylvania Motor Vehicle Financial Responsibility Law, the first party insurance company ( your own insurance company) is to provide a a minimum of Five Thousand Dollars ($5,000.00) of medical coverage.  This is important because without first party coverage or personal injury protection, a responsible party could dispute responsibility and you could be left injured with out the means to pay for medical treatment.

However, built into the Pa MV Financial Responsibility Law is a “loophole” that allows your own insurance company to dispute your coverage.  Recently a Bucks County Pennsylvania injured victim had to file suit because his insurance company disputed that his medical treatment was reasonable, necessary and related to his accident.

In this case, the driver was in a car crash and Progressive was not cooperative in providing coverage for his injuries. Progressive avoided payment by conducting a “peer review” of his subsequent medical care and the “peer review” determined that his treatment was not covered.  Under the Law, a peer review organization is:   professional organization with which HCFA or the Commonwealth contracts for medical review of Medicare or Medical Assistance services, or a health care entity approved by the Commissioner, that engages in reviewing medical files for the purpose of determining that medical and rehabilitation services are medically necessary and economically provided.

While this sounds like a favorable law, it typically allows insurance companies to dispute responsibilities for an injured insured medical bills and there is reason for concern that the “peer review organization” that are paid by the insurance companies for performing the peer reviews may have a financial incentive in ruling in favor of the same insurance company that compensates them for their services.

In this recent case, Progressive’s decision not to compensate the injured victim’s medical providers treatment for the car accident, led to Mr. Gibson filing a lawsuit seeking the court’s to intervene with claims of bad faith, breach of contract and violation of Pennsylvania’s Unfair Trade and Consumer Protection Law.  In this case, Progressive sought to dismiss the case but the Federal Magistrate ruled that the injured insured could proceed on a claim of Bad Faith.

This case continues a disturbing trend of insurance companies using their leverage to dispute or deny coverage to their own insureds.  Again, the last problem an injured person wants to deal with is money from his or her own insurance company. These companies, like Progressive, should have a fiduciary duty to their clients like Mr. Gibson. A company with a fiduciary duty holds an ethical relationship of trust with their clients. Often there is a financial connection as well.

Progressive made the decision on whether Mr. Gibson’s injuries very quickly, in just over 2 weeks, when the full extent of his injury may not have even been known yet. Injuries could be long lasting or masked by pain in other parts of your body.

Every insured should be entitled to the insured they have paid for and that an insurance company is legally obligated to pay for under the law.   Your insurance company should be there to help you, not get in the way of your medical recovery from injuries. This is rarely an easy task with the insurance companies constantly trying to find the loophole.

Having a law firm assist you in receiving the compensation you deserve from your insurance company could make a significant difference. Ciccarelli Law Offices provide a combination of experience and a tremendous work ethic to fight for your rights.

At Ciccarelli Law Offices, our Pennsylvania Automobile Accident lawyers are both passionate in what they do and compassionate in their treatment of their clients.    Based in suburban Philadelphia at 304 North High Street, West Chester PA 19380, we make your choice all the clearer with locations throughout the metropolitan Philadelphia Pennsylvania, including Center City Philadelphia, West Chester PA, Malvern (serving Downingtown/Exton PA), Kennett Square PA, Lancaster PA, King of Prussia PA, Plymouth Meeting PA, Radnor and Springfield PA. We serve Downingtown, Paoli, Media, Norristown, Harrisburg, Lancaster, Lebanon, Reading and Allentown. For more information or to schedule an appointment with an experienced Pennsylvania Personal Injury Attorney at Ciccarelli Lawyers, by contacting us at (610) 692-8700 or toll free at (877) 529-2422.