OPINION BY Judge PELLEGRINI.
Southeastern Pennsylvania Transportation Authority (SEPTA) appeals from an order of the Court of Common Pleas of Philadelphia County, Civil Division (trial court) granting Claudette Houston and Louise Board's (together, Appellees) motion for partial summary judgment and injunctive relief and declaring that SEPTA is required to comply with the mandates of Section 1797 of the Motor Vehicle Financial Responsibility Law (MVFRL)
The facts of this case are not in dispute. SEPTA is a regional transportation authority, created by an act of the General Assembly, and provides transportation within the city of Philadelphia and its four contiguous counties. It is an agency and instrumentality of the Commonwealth and qualifies as a "self-insurer" under the MVFRL.
On December 16, 2002, Appellees were both injured when the SEPTA bus on which they were passengers collided with a car. Both women received medical treatment and, because neither had their own insurance, their medical providers submitted bills directly to SEPTA for payment. Houston's medical bills totaled $6,864 and Board's totaled $5,800. SEPTA paid the medical providers' bills without adjusting them first, and capped payment for each Appellee at $5,000. Appellees then filed a class action complaint
SEPTA filed preliminary objections to the class action complaint. The trial court sustained the preliminary objections as to Count II only, which alleged a violation of the Pennsylvania Unfair Trade Practices and Consumer Protection Law, Act of December 17, 1968, P.L. 1224, as amended, 73 P.S. §§ 201-1—201-9.3, and this Count was dismissed. SEPTA also filed a motion for judgment on the pleadings, which the trial court denied. The trial court certified the order denying SEPTA's motion for judgment on the pleadings for interlocutory appeal, and the matter was stayed pending appeal. In an order dated January 12, 2006, this Court denied SEPTA's petition for review pursuant to Pa. R.A.P. 1311(b)
On January 5, 2010, the trial court held a class action certification hearing as required by Pa. R.C.P. No. 1702. Appellees then filed a motion for issue-only class certification, declaratory and injunctive relief, and partial summary judgment as to liability. SEPTA filed a cross-motion for summary judgment claiming that as a statutory self-insurer it was not subject to Section 1797(a) of the MVFRL.
The trial court issued an opinion and order granting Appellees' motion for class certification, defining the class as "all persons as to whom SEPTA has not paid or will not pay personal injury protection benefits in accordance with 75 Pa.C.S.[] § 1797(a) of the [MVFRL], during the period beginning July 2000 and continuing through the date of final appellate review." The trial court also granted Appellees' motion for partial summary judgment and injunctive relief and declared that SEPTA is required to comply with the mandates of Section 1797 of the MVFRL. The trial court denied SEPTA's cross motion for summary judgment and stayed the injunction pending SEPTA's appeal. SEPTA did not seek permission for interlocutory appeal of the limited class certification; therefore, that issue is not presently before this Court.
On appeal,
Id. (Internal citations omitted). Our Supreme Court has also recently explained that if a party's immediate interest is not apparent, the court may utilize a zone of interests analysis in determining whether
SEPTA first argues that Houston and Board lack standing because they both settled their personal injury claims against SEPTA, for $12,500 and $10,000 respectively, and, therefore, are no longer personally aggrieved. SEPTA's Director of Claims, Francis Cornely, testified in his deposition that SEPTA fully considered the amount of both women's outstanding medical bills, in excess of the PIP benefits SEPTA had already paid on their behalf, in determining the settlement value of their claims, and this practice is typical for SEPTA. According to SEPTA, Appellees would reap a windfall if they were entitled to damages in the amount of this excess in their class action suit, as the damages settlement of their personal injury lawsuits already reimbursed them for these expenses.
However, the agreements entered into by the parties in the previous personal injury lawsuits do not support SEPTA's claims. While Appellees both signed general releases discharging SEPTA from all manner of actions and demands of whatsoever kind, the releases also contained the express proviso "except with respect to proper payment of PIP benefits." The intent of this language is clear—the parties did not contemplate that any damages regarding the proper payment of PIP benefits were included in the settlements. If we were to accept SEPTA's argument that Appellees were already compensated on this issue it would render the language of the proviso mere surplusage without any meaning.
SEPTA makes several additional arguments as to why Appellees lack standing to pursue this class action. It points out that Appellees took the position that their alleged financial losses are not to be measured by any amount they themselves were required to pay out-of-pocket as a result of SEPTA's failure to comply with Section 1797(a). Rather, they assert the damages are to be measured by the amount that SEPTA allegedly overpaid medical providers by failing to reduce the gross amounts of the providers' bills to 110% of the allowance under the Medicare program before paying the bills. According to SEPTA, the fact that it may have paid medical providers more than it was legally obligated to pay does not mean that Appellees personally suffered damages equal to this overpayment. SEPTA also argues that the assertion that putative class members have suffered such harm is purely hypothetical and speculative at this stage. Given these reasons, SEPTA claims that Appellees failed to prove they were personally harmed, aggrieved, or otherwise adversely affected by the manner in which SEPTA paid PIP benefits; therefore, they lack standing. We disagree.
It is clear that Appellees and the putative class members they represent are personally aggrieved by SEPTA's actions and, therefore, have standing to pursue this matter. SEPTA paid the unadjusted medical bills submitted by Appellees' medical providers and capped each Appellee's medical benefits at $5,000 based upon the unadjusted rates. As a direct result of this action, Appellees incurred and paid out-of-pocket medical expenses, which would have been paid directly by SEPTA if it had followed the medical benefit payments requirements of Section 1797(a) and adjusted the bills to not more than 110% of the applicable Medicare allowance before issuing payment. Appellees also received less "medical benefit" as a result of SEPTA's handling of PIP benefit claims as a lower percentage of their medical bills was covered. Appellees' interest in this litigation
SEPTA's argument that any harm to the putative class members is hypothetical and speculative at this stage is unavailing. SEPTA does not dispute the fact that its policy is to pay PIP medical benefits at an unadjusted rate—it does not comply with the cost containment provisions of Section 1797 when calculating payment of PIP benefits on behalf of eligible claimants. In addition, Appellees' un-rebutted expert review and audit of approximately 270 individual files revealed that SEPTA failed to pay PIP benefits in accordance with the cost containment provisions of Section 1797 in all but one case.
As to the substantive issue in this case, SEPTA argues that the trial court erred in declaring that it must comply with Section 1797(a) of the MVFRL when calculating payment of PIP benefits on behalf of eligible claimants. SEPTA argues that the MVFRL treats self-insurers, such as itself, differently than insurers and insurance companies, and that the obligations of self-insurers with respect to the payment of benefits are set forth exclusively in Section 1787. According to SEPTA, Section 1787 requires it to provide the first-party benefits outlined in Section 1711, subject only to certain provisions of Subchapter B. SEPTA points out that Section 1711 makes no direct reference to Section 1797; Section 1797 refers only to insurers and not self-insurers; and Section 1797 is found in Subchapter I, not Subchapter B. Therefore, SEPTA argues that the statutory language clearly and unambiguously demonstrates that self-insurers are not subject to the cost reduction provisions found in Section 1797(a).
However, we rejected a similar argument raised by SEPTA in a recent case, In re: SEPTA MVFRL Interest Litigation, 996 A.2d 1099 (Pa.Cmwlth.2010). That case involved a class action brought by a group of medical service providers against SEPTA for payment of overdue bills. Id. at 1101. Specifically, the medical providers argued that SEPTA was liable for interest on overdue benefit payments pursuant to Section 1716 of the MVFRL, which states that interest shall be due at a rate of 12% per annum on benefits that are "not paid within 30 days after the insurer receives reasonable proof of the amount of the benefits." 75 Pa.C.S. § 1716. One of SEPTA's main arguments
SEPTA's argument in the present case again overlooks the fact that the section at issue, the cost containment provision of Section 1797, is indirectly encompassed in the statutory obligations of self-insurers. The fact that Sections 1711 and 1797 refer to insurers rather than self-insurers is not dispositive. Section 1787 clearly mandates that a self-insurer provide evidence to the department that it has the financial ability to "[p]rovide the benefits required by section 1711 (relating to required benefits)." 75 Pa.C.S. § 1787(a)(1). The required benefit outlined in Section 1711 is a "medical benefit" in the amount of $5,000. 75 Pa.C.S. § 1711(a). As we indicated in In re: SEPTA, Section 1787(a)(1) also states that the benefits required by Section 1711 must be provided "subject to the provisions of Subchapter B (relating to motor vehicle liability insurance first party benefits)." 75 Pa.C.S. § 1787(a)(1). Section 1712, entitled "Availability of benefits" is located within Subchapter B, and subsection (1) specifically states that medical benefits are "[s]ubject to the limitations of section 1797 (relating to customary charges for treatment)." 75 Pa.C.S. § 1712(1).
SEPTA correctly points out that not all of the provisions of Subchapter B are applicable to self-insurers. Section 1787 specifically states that, for self-insurers, the required benefits outlined in Section 1711 are subject to the provisions of Subchapter B, "except the additional benefits and limits provided in sections 1712 (relating to availability of benefits) and 1715 (relating to availability of adequate limits)." 75 Pa. C.S. § 1787(a)(1). (Emphasis added). SEPTA argues that given these exceptions, none of the benefits outlined in Section 1712 are applicable, including that section's description of medical benefits. However, the statute specifically refers to "the additional benefits and limits" provided in Section 1712. The use of this specific language must have meaning—our interpretation of the statute should not render the language mere surplusage. In re: SEPTA, 996 A.2d at 1106. The benefits discussed in Section 1712 include the following: (1) Medical benefit; (2) Income loss benefit; (3) Accidental death benefit; (4) Funeral benefit; (5) Combination benefit; and (6) Extraordinary medical benefits. 75 Pa.C.S. § 1712. Section 1711 lists "medical benefit" as a required benefit, and it is clear that all insurers are required to provide a medical benefit under the MVFRL. Therefore, it appears that the additional benefits and limits exempted by Section 1787 include all of the other benefits, such as income loss and funeral benefits—but not a medical benefit, as this is mandatory. When reading Sections 1711, 1712, 1787 and 1797 together, it is clear that self-insurers are subject to the cost containment provisions found in Section 1797(a).
In addition, the statutory interpretation advanced by SEPTA is contrary
For all of the foregoing reasons, the order of the trial court is affirmed.
AND NOW, this 10th day of March, 2011, the order of the Court of Common Pleas of Philadelphia County, Civil Division in the above-captioned matter is hereby affirmed.
Pa. R.A.P. 1311(b).