A Message to Insurance Companies, Self-Insureds and Others: Some of Your Lawyers Aren’t Always On Your Side

Imagine that one of the law firms that you hire to defend you and your insureds wants you to pay more, a lot more. It’s true.

One law firm proudly states that it defends employers, self-insureds, and [insurance] carriers in matters involving workers’ compensation, auto claims, slips and falls, and many other types of personal injury lawsuits.

But whose side are they really on? After all, this law firm wants to void and eliminate all medical fees schedules based on Medicare and other non-Pennsylvania guidelines, thus increasing the amount that its clients would have to pay for medical care, and even for future medical care in some cases.

You don’t have to imagine it. It’s true.

This Pennsylvania-based insurance defense firm is arguing in a case in the Commonwealth appeals Court that every fee schedule based on an outside formula is unconstitutional. This means that according to a law firm that exclusively represents insurance companies, employers and self-insureds, the fee schedules that they use to determine how much to:

• Pay for medical bills
• Pay for hospital bills
• Pay for medical tests
• Pay for diagnostic tests
• Pay for medical equipment
• Pay for pharmaceuticals, and
• Pay for every other type of medical care

would be void (in other words – all of these fee schedules would be eliminated) if they were based on a Medicare fee schedule, the Red Book for medications/pharmaceuticals, and any other guidelines that the Pennsylvania legislature did not create.

That’s right, every doctor, every hospital, and every type of medical provider could charge and would be entitled to be paid whatever amount it asked for based on this logic. I am certain that insurance companies would be thrilled to know that their lawyers are taking a position that would cost them millions, all because they don’t like how a small group of pharmacies is compensated under the Pennsylvania Workers’ Compensation Act for dispensing medication to help injured workers deal with pain without exposing them to cheap, addictive opioids.

Here is what the firm wrote in their Commonwealth Court brief:

It was unconstitutional for the legislature to delegate the law on pricing of pharmaceuticals to a private company without providing that company with any policy direction, limits, or guidance, and with the ability of that private company to change the rules at rates at its whim, in secrecy, and without legislative review.

Analogously, this also means that it is unconstitutional for the legislature to delegate the law on pricing of medications and other care to Medicare without providing any policy direction, limits, or guidance, and with the ability of Medicare to change rates at its whim, in secrecy, and without legislative review.

Our office does not and never will represent insurance companies, we represent injured workers, victims of auto accidents, slips and falls and other negligence. We also recognize that fee schedules are necessary, and that they are best when derived from reputable sources like Medicare and the Red Book. Otherwise, the cost of medical care would have no boundaries.

Imagine that.