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DAVID G. PAVELIC AND ANNE MARIE PAVELIC v. NATIONWIDE INSURANCE (02/14/86)

filed: February 14, 1986.

DAVID G. PAVELIC AND ANNE MARIE PAVELIC, HIS WIFE, AND BETTE RUBIN WEINBERGER, ACSW, AND ALL THOSE SIMILARLY SITUATED, APPELLANTS,
v.
NATIONWIDE INSURANCE, APPELLEE



Appeal from the Order Entered March 26, 1985 in the Court of Common Pleas of Dauphin County, Civil No. 4265 S 1983.

COUNSEL

Neil J. Rovner, Harrisburg, for appellants.

Stephen A. Moore, Harrisburg, for appellee.

Wieand, Olszewski and Watkins, JJ.

Author: Olszewski

[ 352 Pa. Super. Page 12]

This matter comes before this court on appeal from an order of the lower court granting appellee's Motion for Judgment on the Pleadings and holding that appellants were not entitled to reimbursement for counseling services provided by a social worker. Appellants contend that the No-Fault Act should not prevent an insurer from paying for rehabilitation services provided by a social worker who is not obligated to fulfill any state accreditation or licensing requirements. We disagree.

Appellant David Pavelic was involved in a fatal automobile accident in which his close personal friend had been killed. Pavelic was twenty-four years old at the time of the accident and suffered severe hip injuries as well as emotional trauma. As a result of the accident, Mr. Pavelic and his wife sought psychological counseling from Bette Weinberger, a social worker and counselor. Appellants sought reimbursement for these counseling services under the Pennsylvania No-Fault Act, but the insurer refused payment. First, they contended that Mrs. Weinberger was not a licensed practitioner and therefore was not entitled to reimbursement under the No-Fault Act. Second, they argued that Mrs. Pavelic was not injured in the accident and therefore was not entitled to reimbursement for her rehabilitation expenses. Consequently, appellants filed a class action suit on behalf of similarly situated emotionally and sociologically traumatized accident victims and their sociological counselors. The lower court concluded that under the applicable section of the Pennsylvania No-Fault Motor

[ 352 Pa. Super. Page 13]

Vehicle Insurance Act, 40 Pa.C.S.A. Sec. 1009.103 (Purdon 1984-85 supp.) (now repealed) which defines compensable medical and vocational rehabilitative services as "services necessary to reduce disability and to restore the physical, psychological, social and vocational functioning of a victim," the appellants' treatments for emotional trauma would be included. Nevertheless, the court found that regardless of whether the social worker was or was not required to be accredited by the state, an insurer is only obligated to provide coverage for those treatments conducted through an accredited facility. Thus, the court concluded that appellee was not obligated to bear the costs. We agree with this result.

It is noteworthy that this is a case of first impression before this court. The dilemma confronting us gravitates around the legislative intent of the following section of the Pennsylvania No-Fault Motor Vehicle Insurance Act.

MEDICAL AND VOCATIONAL REHABILITATION SERVICES means services necessary to reduce disability and to restore the physical, psychological, social, and vocational functioning of a victim. Such services may include, but are not limited to, medical care, diagnostic and evaluation procedures, physical and occupational therapy, other necessary therapies, speech pathology and audiology, optometric services, nursing care under the supervision of a registered nurse, medical social services, vocational rehabilitation and training services, occupational licenses and tools, and transportation where necessary to secure medical and vocational rehabilitation services. A basic loss obligor is not obligated to provide basic loss benefits for allowable expense for medical and vocational rehabilitation services unless the facility in which or through which such services are provided has been accredited by the Department of Health, the equivalent governmental agency responsible for health programs, or the accrediting designee for such department or agency of the state in which such services are provided, as being in accordance with applicable requirements and regulations.

[ 352 Pa. Super. Page 1440]

Pa.C.S.A. Sec. 1009.103 (Purdon 1984-85 supp.) (now repealed) ...


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