NOW, January 17, 2013, it is ordered that the above-captioned Memorandum Opinion, shall be designated OPINION and shall be REPORTED.
IN THE COMMONWEALTH COURT OF PENNSYLVANIA
Community Hospital Alternative for Risk Transfer,
Joel Ario, in his official capacity as Insurance Commissioner of the
Commonwealth of Pennsylvania, and the Pennsylvania Insurance
Department, Medical Care Availability and Reduction of Error Fund
Argued: November 19, 2012 :
BEFORE: HONORABLE ROCHELLE S. FRIEDMAN, Senior Judge
OPINION BY SENIOR JUDGE FRIEDMAN
Community Hospital Alternative for Risk Transfer (CHART) has filed a motion for summary judgment with respect to CHART's petition for review in the nature of a complaint for declaratory judgment and restitution, filed in this court's original jurisdiction against Joel Ario, in his official capacity as Insurance Commissioner of the Commonwealth of Pennsylvania, and the Pennsylvania Insurance Department, Medical Care Availability and Reduction of Error Fund (together, "Mcare"). We grant CHART's motion for summary judgment.
On February 15, 2012, the parties filed a joint stipulation of facts (Stip.) and a three-volume joint appendix (J.A.) of exhibits (Ex.) to the motion for summary judgment. The relevant facts of this case, as agreed to by the parties, are as follows. On January 30, 2007, Vernetta Cooper and Dennis Cooper (together, Cooper) filed a writ of summons in their own right and on behalf of their minor daughter, Darlene Cooper, against Waynesboro Hospital (Hospital), in the Court of Common Pleas of Franklin County (trial court) with the title "Civil Action - Medical Professional Liability," which the Hospital received on February 1, 2007. (Stip. ¶ 27; J.A., Ex. H.) The Hospital's primary medical professional liability insurer is CHART. (Stip. ¶ 3.)
On January 29, 2007, the Hospital sent a CHART Medical Malpractice Reporting Form to ProClaim America, Inc. (ProClaim), its third-party administrator of claims, regarding a "Potentially Compensable Event." (Stip. ¶¶ 6, 26; J.A., Ex. G.) ProClaim reported the matter to Mcare on a C-416 form dated May 1, 2007, which Mcare received on May 7, 2007. (Stip. ¶¶ 6, 38; J.A., Ex. S.) The C-416 form indicated that the claim was first reported to the Hospital on January 29, 2007.*fn1 (J.A., Ex. S.)
On June 7, 2007, Cooper filed a complaint in the trial court, alleging that the Hospital was liable for treatment rendered on January 5, 2003. (Stip. ¶ 42; J.A., Ex. W.) On August 17, 2007, ProClaim sent a revised C-416 form to Mcare, which Mcare received on August 20, 2007, requesting that Mcare assume the defense of the lawsuit and agree to provide primary liability coverage pursuant to section 715 of the Medical Care Availability and Reduction of Error Act (Act),*fn2 which governs claims made more than four years after the alleged tort. (Stip. ¶ 47; J.A., Ex. AA.) By letter dated September 11, 2007, Mcare denied section 715 coverage, asserting that it did not receive the request within 180 days of the date on which the Hospital and CHART had notice of the section 715 claim. (Stip. ¶ 48; J.A., Ex. CC.)
On November 21, 2007, CHART submitted a revised C-416 form for section 715 coverage, indicating that the lawsuit was filed in June 2007. (Stip. ¶ 51; J.A., Ex. FF.) On November 29, 2007, Mcare rejected the submission, referencing the September 11, 2007, determination. (Stip. ¶ 52; J.A., Ex. GG.) On December 21, 2007, CHART requested a formal administrative hearing on the rejection of section 715 status. (Stip. ¶ 53; J.A., Ex. HH.) By letter dated January 2, 2008, Mcare indicated that it stood by its refusal. (Stip. ¶ 54; J.A., Ex. II.)
CHART then filed its petition for review in this court's original jurisdiction seeking: (1) a declaration that CHART is entitled to section 715 coverage pursuant to Cope v. Insurance Commissioner, 955 A.2d 1043 (Pa. Cmwlth. 2008); and (2) restitution for the costs CHART incurred in defending ...