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Pennsylvania’s Supreme Court’s Decides Whether To Allow Insurers to Withhold All Medical Records

Earlier in March, the Pennsylvania Supreme Court refused to hear an appeal from an insurance company that its investigation records of a medical procedure should be withheld for confidentiality reasons under the Peer Review Protection Act. Pennsylvania’s Superior Court had previously found that the insurer was unable to claim protection under this Act because insurers, unlike doctors and medical facilities, are not health care providers. The ruling reaffirmed the Supreme Court’s decision from two decades earlier, holding that these types of protection were not available to HMOs and noted that the only way an insurer’s records would be afforded these protections is when the review is performed at the request of a physician or other health care provider or when the insurer’s review committee is investigating for very specific purposes such as to improve health care or manage costs.

Privacy Protection Available To Insurers Only Under Specific Circumstances – But Not These

The Pennsylvania Supreme Court concluded that the Peer Review Act only applies to insulate records in certain factual circumstance. And those circumstances did not apply in the case before it. The facts before the Supreme Court involved a patient that had undergone a knee replacement surgery during which the doctor allegedly blocked an artery; this required the patient to have additional immediate surgery to correct the issue. When the patient subsequently sued over the matter, she sought her medical records, including investigative records, from the insurer. The insurer had been conducting its own review of the alleged botched surgery to determine whether the provider should be kept as a contracted health care provider and, because the insurer itself was not a health care provider, its review committee’s report was not entitled to the same level of privacy as would have been available if it had been ordered by a health care provider.

So What Does This Mean?

Under Pennsylvania malpractice law, breaches and violations of the applicable standard of care would be classified as medical negligence, which would also be considered medical malpractice. When a medical malpractice case is filed, the plaintiff must be able to prove that a medical professional’s medical negligence not only occurred, but that it caused the plaintiff’s injuries. Typically this means that a medical expert will need to be brought in to provide expert testimony about the standard of care and the medical professional’s failure to provide services that meet it. In fact, in most medical malpractice cases brought in Pennsylvania courts, expert witnesses are brought in to provide this testimony. To this end, investigative records obtained from insurers would be something that an expert witness could be asked to consider as part of the testimony they provide. An expert witness would normally establish what the appropriate medical standard of care is with respect to a specific procedure and could then use these types of investigative records to show that there is a reasonable probability that the defendant breached that standard of care.

What Gives An Expert The Authority To Testify About A Standard Of Care During A Trial?

According to 225 Pa. Code Rule 702, expert witnesses must be able to show they have the credentials to provide the testimony they offer. In general, this may include proper education, knowledge and experience in the specific area of medicine about which they are offering testimony and the applicable standard of care for the medical care provided. These credentials need to show that the expert witness has knowledge beyond what a regular layperson would have about a particular medical issue and that this knowledge will help the trier of fact to understand the issue.

When Medical Malpractice Occurs, The Office of Cohen, Placitella & Roth, P.C. Can Help

If you have suffered harm as a result of improper medical care, you need an attorney with knowledge and experience dealing with medical malpractice issues to work hard on your behalf for your rights. The medical malpractice attorneys at Cohen, Placitella & Roth, P.C. are dedicated to the success of your case from start to finish. We have handled a wide variety of medical malpractice cases and work diligently to get you the results you deserve. Contact the medical malpractice attorneys at Cohen, Placitella & Roth, P.C. today either online or by phone at 866.236.4230 to schedule your free consultation so that we may help you recover for your losses.


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