Important New Supreme Court Decision on Independent Medical Examinations (IME's)

The PA Supreme Court on November 20, 2019, held in the combined cases of Sayles v. Allstate Insurance Company and Scott v. Travelers Commercial Insurance Company that auto insurers seeking IME’s in first-party medical claims must comply with the requirements of 1796(a) of the MVFRL.

Section 1796(a) provides:

§ 1796. Mental or physical examination of person

(a) General rule.--Whenever the mental or physical condition of a person is material to any claim for medical, income loss or catastrophic loss benefits, a court of competent jurisdiction or the administrator of the Catastrophic Loss Trust Fund for catastrophic loss claims 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 date of the examination and shall state the manner, conditions and scope of the examination and 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 insurance policies at issue required an insured seeking first-party medical benefits under the policy to submit to IME’s whenever the insurer required and with a doctor selected by the insurer.

The Court noted that Section 1796(a) by its terms applies anytime an insured has made a claim for first-party benefits and an insurer seeks to compel an insured to submit to an IME after the insured has refused a request to voluntarily do so.

Secrtion 1796(a) requires an insurer that wishes to compel a claimant for first-party medical benefits to undergo an IME to file a petition with a court of competent jurisdiction and show good cause for the IME.

Click here for the Court’s opinion.