The PID’s Administrative Hearings Office (AHO) conducts approximately twenty distinct types of hearings or quasi-hearings, in addition to other miscellaneous cases not susceptible of classification. Almost all are conducted pursuant to the Administrative Agency Law and General Rules of Administrative Practice and Procedure, as modified by the Department’s Special Rules of Administrative Practice and Procedure (31 Pa. Code §§ 56.1-56.3).
Formal hearings or semi-formal reviews may be held on the following:
Insurance policy forms, 40 P.S. § 477(b)
Unfair Insurance Practices Act, 40 P.S. §§ 1171.1 et. seq.
Agency contract terminations 40 P.S. §§ 241-246
Managed care appeals (Act 68) 40 P.S. §§ 991.2101-991.2193
Medical Care Availability And Reduction of Error Fund (Mcare) coverage appeals, 40 P.S. §§ 1303.101-1303.910
Producer and other licensing matters, 40 P.S. §§310.1 et. seq., 40 P.S. §§ 991.1615-.1616, 40 P.S §§ 324.3, 625-3 , 910-37
Rating organizations appeals, 40 P.S. §814
Denial of special statutory fund benefits appeals (various statutes)
Auto insurance policy terminations appeals, 40 P.S. §§ 991.2001-991.2013
Commercial policy matters, 40 P.S. §§ 3401-3409
Homeowner insurance policy terminations appeals, 40 P.S. §§ 1171.1-1171.15
Pennsylvania Assigned Risk Plan appeals 75 Pa.C.S. § 1741
Motor Vehicle Physical Damage Appraisal violations, 63 P.S. §§ 861, 861c, 856
Other matters under the Insurance Commissioner’s jurisdiction
The particulars of the cases vary widely, but generally the AHO receives filings, manages the cases through a pre-hearing process, conducts the hearings in a hearing-room setting and prepares adjudications. The hearings and semi-formal reviews are transcribed by court reporter. The presiding officer explains the process at the outset of each hearing, administers oaths and makes rulings on objections and motions made during the hearing. The parties review the docket exhibits prior to the hearing and may object to the exhibits being admitted for procedural purposes. Except for the more complex cases, hearing exhibits are not pre-exchanged. Telephone testimony is rare but is received in appropriate circumstances.
The hearings are held in Harrisburg, except for policy termination cases and some automobile CAT Fund or managed care cases involving litigants in southeastern and western Pennsylvania which are heard in Philadelphia and Pittsburgh. At the conclusion of the hearing, the parties are afforded the opportunity to submit briefs. The final adjudication, whether issued by the Insurance Commissioner or presiding officer pursuant is sent to the parties by the AHO.
Glossary of Common Phrases, Terms, Vocabulary and Acronyms
In some types of cases the presiding officer and parties use the Act number as shorthand for the involved substantive statute. Acronyms are limited mostly to the shorthand for Department program areas or the insurance entity involved in the case. They are as follows:
CAT Fund - Catastrophic Loss Benefits Continuation Fund
CHIP - Children’s Health Insurance Program
Mcare - Medical Care Availability And Reduction of Error Fund
USTIF - Underground Storage Tank Indemnification Fund
Insurance entity acronym names (e.g. GEICO, USAA) used more commonly than the full name
James A. Johnson, Chief Hearing Officer
901 N. Seventh St. Rm 200
Harrisburg, PA 17102