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PA Supreme Court Limits the Use of Medical Examinations in PIP Claims

January 16, 2020
Stephen Bruderle
Posted in: Automobile & Trucking

The Pennsylvania Supreme Court has held that a provision in an automobile insurance policy requiring an insured who is seeking first party medical benefits to undergo an independent medical examination is void as against public policy. The Pennsylvania Supreme Court ruled on November 20, 2019 that such a requirement in a policy conflicts with 75 Pa. C.S. Section 1796(a) of the Pennsylvania Motor Vehicle Financial Responsibility Law (“MVFRL”). This ruling came as a result of two consolidated cases in which insureds sought PIP benefits but were denied those benefits for failure to appear at the examination which had been demanded by the insurer. In Scott v. Travelers, the insured, William Scott, was involved in an automobile accident and submitted a claim for PIP benefits. When Travelers demanded that he attend an independent medical exam (“IME”) Scott responded by requesting that Travelers submit a list of three doctors whom Scott indicated he would consider allowing to examine him. Travelers did not issue such a list but renewed the request for Scott to undergo an examination. Scott did not attend the examination and was denied the benefits. In Sayles v. Allstate, Samantha Sayles was involved in an automobile accident, received medical treatment and a claim was submitted to Allstate for PIP benefits. Allstate requested that Sayles attend an examination by a physician to be selected by Allstate. Allstate refused to pay the benefits until Ms. Sayles attended the examination. Ms. Sales never underwent the examination and the benefits were denied.

Both claimants argued that policy language requiring an examination when demanded by the insurer directly contradicts Section 1796(a) of the MVFRL which states that “a court of competent jurisdiction… may order the person to submit to a mental or physical examination by a physician. The order may only be made upon motion for good cause shown. The order shall give the person to be examined adequate notice of the time and the date of the examination and shall state the manner, conditions and scope of the examination and of the physician by whom it is to be performed. If a person fails to comply with an order to be examined, the court or the administrator may order that the person be denied benefits until compliance.”

The Pennsylvania Supreme Court was persuaded by the argument that the policy language and the statutory language are in conflict. The statutory framework was established to provide protection for individuals insured under automobile policies and who seek benefits through those policies. Contractual language which attempts to circumvent those protections are void as against public policy.

Significantly the opinion allows the examination to occur upon agreement of the parties. This opinion only applies where the examination is requested, and the claimant refuses the request. This opinion provides no procedural guidance and opens the door to litigation wherein an insurer goes to court for an order compelling an examination.

If you have any questions please feel free to contact Stephen J. Bruderle, Esquire [Link to firm bio here].