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the negligence action, the medical expenses sought were also covered by the
settlement. Therefore, PPCIGA was entitled to an offset up to the amount
recovered from the parent’s insurer and to the extent the father had a claim for
coverage.
Schmidt v. Workers’ Comp. Appeal Bd., 835 A.2d 877 (Pa. Commw. Ct. 2003). An
employer, who paid workers’ compensation benefits to its injured employee,
was entitled to subrogate against amounts the employee received from the
Pennsylvania Property and Casualty Insurance Guaranty Association (“PPCIGA”)
in a settlement for injuries sustained on the job. The plaintiff brought the suit
against a third party whose insurer had been declared insolvent and PPCIGA had
assumed its obligations. The court reasoned that the non‐duplication provision
of the PPCIGA Act did not specify a workers’ compensation policy as a policy
subject to the exhaustion requirement. The court further noted that the nonduplication
provision did not specify a workers’ compensation policy as being
subject to its exhaustion provision. Additionally, there was no evidence PPCIGA
ever reduced its settlement to the injured worker to account for the workers’
compensations he had received.
Storm v. O’Malley, M.D., 2001 Pa. Super. 184, 770 A.2d 548 (2001). Parties in the
action agreed to a settlement without regard to the Pennsylvania Property and
Casualty Insurance Guaranty Association’s (“PPCIGA”) right to a setoff. PPCIGA
asserted that it was only responsible for the statutory limit of $200,000 less the
medical benefits already paid on the plaintiff’s behalf. The plaintiff asserted that
PPCIGA waived or was estopped from asserting a setoff because it did not raise
the claim at the pretrial conference. The court concluded that the plaintiff did
not reasonably rely on PPCIGA’s omission of its setoff rights during the pretrial
conference. The plaintiff’s counsel researched the setoff issue and admitted
they assumed PPCIGA waived its right. Therefore, PPCIGA could not be
estopped from asserting its right to setoff. Further, estoppel against the
government will not lie where its agents(counsel) had no authority to waive a
governmental right.
Strickler v. Desai, M.D., 571 Pa. 621, 813 A.2d 650 (2002). Dr. Desai was sued in a
medical malpractice action. The Doctor’s insurer was declared insolvent and the
Pennsylvania Property and Casualty Insurance Guaranty Association (“PPCIGA”)
became obligated to cover the claims and defend the Doctor. After the
insolvency, the plaintiffs entered into and the court approved a settlement
between the parties. PPCIGA refused to fund the settlement because it would
allow the plaintiffs to get a double recovery. The plaintiffs demanded medical
expenses in their complaint, but later admitted they received medical expenses
from Aetna, their health insurer. PPCIGA claimed it was entitled to reduce the
amount of its obligation by the amount the plaintiffs received from Aetna, who
already paid medical costs in excess of the amount PPCIGA was obligated to
pay. Since Aetna already reimbursed the plaintiffs for medical expenses, PPCIGA
argued it would result in duplicate payments for the same expense. The court
determined that “[b]ecause [plaintiffs] sought medical expenses in the
complaint and settled all of the claims in the complaint, we deem the
settlement to include amounts attributable to medical expenses.” Id. at 631. The
court affirmed the lower court’s ruling that PPCIGA was entitled to offset the
amount of medical expenses Aetna paid from the amount of its liability.
Taggart v. Graham, 108 Pa. Super. 320, 165 A. 68 (1933), affirmed, Taggart v. De
Fillippo, 315 Pa. 438, 173 A. 423 (1934). A holder of mutual insurance company
certificates could not set off assessments against a claim for insured losses.
Puerto Rico
Phico Ins. Co. v. Pavia Health, Inc., 413 F. Supp 2d 76 (D.P.R. 2006). The Court
determined the choice of law to be used to evaluate a defendant’s counterclaim