Insurance carriers can no longer condition payment of medical benefits on completion of an independent medical examination (IME), unless first obtaining a court order requiring the examination, according to a recent decision from the Pennsylvania Supreme Court. In Sayles v. Allstate Insurance, 2019 Pa. LEXIS 6457 (Pa. Nov. 20, 2019), the court found that policy language requiring an insured to submit to an IME as a prerequisite to receiving first-party medical benefits was void, since it was in direct contradiction to the express language contained in the Pennsylvania Motor Vehicle Financial Responsibility Law (MVFRL), 75 Pa. C.S. Section 1796(a).

Policy and Statutory Language at Issue

 Two cases, both dealing with benefit termination based on refusal to submit to an IME, were initially filed in state court. Each matter was removed to the U.S. District Court for the Middle District of Pennsylvania, and then both were consolidated on appeal to the U.S. Court of Appeals for the Third Circuit. The Third Circuit certified the question to the Pennsylvania Supreme Court, since there was no controlling state appellate holding  on the subject matter. The main issue before the Pennsylvania Supreme Court was the interplay of common policy language requiring an insured to submit to regular IMEs at the carrier’s discretion, read in the context of the MVFRL language as requiring a court order for an IME based on “good cause shown.”

This content has been archived. It is available through our partners, LexisNexis® and Bloomberg Law.

To view this content, please continue to their sites.

Not a Lexis Subscriber?
Subscribe Now

Not a Bloomberg Law Subscriber?
Subscribe Now

Why am I seeing this?

LexisNexis® and Bloomberg Law are third party online distributors of the broad collection of current and archived versions of ALM's legal news publications. LexisNexis® and Bloomberg Law customers are able to access and use ALM's content, including content from the National Law Journal, The American Lawyer, Legaltech News, The New York Law Journal, and Corporate Counsel, as well as other sources of legal information.

For questions call 1-877-256-2472 or contact us at [email protected]